A systematic review of osteoporosis health beliefs in adult men and women

Health belief model - male osteoporosis: a cross-sectional study

OBJECTIVES

The aim of this study is to examine the knowledge levels, beliefs, and self-efficacies of men regarding osteoporosis according to the health belief model.

METHODS

Men aged 55 years and older were included in the study. After the descriptive characteristics of the participants were recorded, the Male Osteoporosis Knowledge Quiz, Osteoporosis Health Belief Scale, Osteoporosis Self-Efficacy Scale, and Osteoporosis Knowledge Test were administered to the participants face-to-face.

RESULTS

A total of 435 men with an average age of 67.3 ± 0.4 years participated in the study. When the participants were categorized according to age subgroups, it was found that marital status (p = 0.002), economic status (p = 0.016), and education level (p < 0.001) differed with age. The results of the osteoporosis-specific measurement tools used in data collection also differed with age (p < 0.05). It was observed that men's levels of osteoporosis knowledge decreased with increasing age (p < 0.05). The lowest scores for the exercise benefits and health motivation subdimensions of the Osteoporosis Health Belief Scale and the Osteoporosis Self-Efficacy Scale were obtained from the subgroup that included the oldest participants (p < 0.05). The highest scores for the calcium barriers subdimension of the Osteoporosis Health Belief Scale were obtained from younger participants (p = 0.036). The level of osteoporosis knowledge showed a low-to-moderate correlation with each question of the Osteoporosis Health Belief Scale (p < 0.05). Age, education, associating the role of physiotherapy with primary-secondary treatment approaches, and health beliefs were the factors that affected the osteoporosis knowledge levels of the participating men (p < 0.05).

CONCLUSIONS

The knowledge of osteoporosis and preventive beliefs and behaviours of men need to be increased. Knowledge and perceptions of susceptibility to osteoporosis should be developed in men with appropriate education from an early age. We recommend that exercise and physiotherapy approaches should be utilized to a greater extent, especially for individuals in the at-risk age range.

Controlling Nutritional Status score and postmenopausal osteoporosis

OBJECTIVE

This study investigated the association between CONUT score and postmenopausal osteoporosis.

METHODS

Postmenopausal women who were seen at an outpatient clinic in a tertiary hospital for routine gynecologic examination between January 2017 and June 2022 were included in the study. Based on their T-scores, a total of 423 women were divided into two groups. Group 1 included 216 women with osteoporosis (T-score < -2.5 SD), and group 2 included 207 women with normal bone mineral density (T-score > -1 SD). The formula for the CONUT score corresponds to collection of scores from albumin, total cholesterol, and total lymphocyte count. Higher scores indicate poorer nutritional control.

RESULTS

Mean age and mean age at menopause were similar in both groups. The duration of menopause, however, was higher in the women with osteoporosis (11.55 ± 6.82 vs 9.202 ± 6.14 y, P < 0.001). The 25-hydroxy vitamin D level was low in both groups. Body mass index of women with normal bone mineral density was higher than that of women with osteoporosis (31.54 ± 4.19 vs 28.52 ± 4.43 kg/m 2 , P < 0.001). The CONUT scores of the two groups were calculated and found to be higher in women with osteoporosis (3.180 ± 1.804 vs 0.391 ± 0.687, P < 0.001). According to the receiver operating characteristic curve analysis of the CONUT score for predicting osteoporosis, the area under the curve was calculated as 0.932, with a sensitivity of 86.6% and a specificity of 91.1% ( P < 0.001).

CONCLUSIONS

Diet plays an important role in the development of osteoporosis. In this study, it was shown that there is a relationship between CONUT score and osteoporosis.

Perception and awareness of osteoporosis and its related risk factors among women: A cross-sectional study

<b>Objectives:</b> This study was designed to assess the awareness of women of the risk factors and preventive measures of osteoporosis.<br /> <b>Methods:</b> This is a cross-sectional study that was conducted in Jordan. During the study period, a convenience sample of women were invited to participate via a survey link communicated through social media. Linear regression was used to screen independent variables affecting participants’ awareness of osteoporosis, its risk factors, and preventive measures.<br /> <b>Results:</b> 426 women agreed to participate in this study, with a median age of 38.5 years (IQR=16.0). Results showed that women have a median awareness score of 5.0 out of 9.0 (IQR=4.0) about osteoporosis risk factors, whereas women with higher educational levels (diploma or higher) and those with medical-related degrees have a higher awareness about osteoporosis risk factors compared to others (p≤0.05).<br /> Medical websites were the primary source used to obtain information about osteoporosis by the participating women (n=236, 55.4%). Also, results showed that more than 90% of the women believed that osteoporosis is a chronic silent disease that makes your bones less dense and more fragile (n=418, 98.1%), and that bone strength may increase by taking vitamin D and calcium (n=405, 95.0%).<br /> <b>Conclusion:</b> This study showed that women had an intermediate level of awareness of osteoporosis and prevention measures. The importance of medical websites and social media as sources of information was also demonstrated. More public targeted campaigns are needed to promote awareness of osteoporosis, its risk factors, prevention, and treatment.

An interpretive descriptive approach of patients with osteoporosis and integrating osteoporosis management advice into their lifestyle

Introduction

Methods

Results

Conclusion

Cognitive perspective of osteoporosis among adults with type 2 diabetes mellitus: The Malaysian case

Introduction

Osteoporosis and diabetes are highly prevalent diseases. In addition, there is increasing evidence that diabetes is a common risk factor for decreasing bone mineral density and developing osteoporosis and fractures. Data on bone abnormalities in T2DM patients appear to be contradictory and complex, and the exact underlying mechanism is still unclear. Hence, the aims of this study were to assess cognitive perspective of osteoporosis among type 2 diabetes mellitus.

Methods

An observational, cross‐sectional study design was chosen, where data were collected using a self‐report structured questionnaire including osteoporosis self‐efficacy (OSES‐M), knowledge Malay version. Quantitative ultrasound was used as prescreening tool for measuring bone health by applying T‐score.

Results

The results showed that about 231 (51.30%) were males. The average age of the DM patients was 62.67 ± 9.24 years. Moreover, the majority of T2DM patient (343, 76.20%) had poor glycaemic control. The mean ± SD OSES‐M total score, OSES‐M Exercise subscale and OSES‐M Calcium subscale were 731.26 ± 209.83, 357.55 ± 121.23 and 373.71 ± 118.91, respectively. Overall, participants expressed a low self‐efficacy for both exercise and calcium intake experiences. In addition, a significant and positive correlation was found between OSES‐M and OKT‐M total scores (n = 450, r_s = 0.471, p < .05). Also, there were significant correlations between OKT‐M subscales and OSES‐M subscales. Furthermore, significant and positive correlations were found between T‐scores and OSES‐M total score (r = .191), OSES‐M Exercise subscale (r = .209) and OSES‐M Calcium subscale (r = .124). Moreover, significant associations, differences and correlations were found out between OSES‐M with many demographic and clinical data.

Conclusion

Overall, participants expressed a low self‐efficacy for both exercise and calcium intake experiences. In addition, only 28.70% of the study population was found to have high OSES‐M level. Thus, self‐efficacy is important and effective determinants for gaining positive health behaviours towards osteoporosis.

Osteoporosis knowledge, health beliefs, and self-efficacy in Hong Kong Chinese men

A total of 277 Hong Kong Chinese men participated in this prospective cohort study. Their osteoporosis knowledge was average. Their perceived susceptibility to osteoporosis was low. Barriers to lifestyle modifications were the strongest predictor for self-efficacy in adopting these activities. These results are useful for planning osteoporosis public awareness campaigns for men.

PURPOSE

Male osteoporosis had long been neglected despite one-third of fractures occurring in men. Lifestyle modification through education is the main tactic in osteoporosis prevention, but current programs and strategies are designed for postmenopausal women. Understanding men's knowledge, health belief, and self-efficacy in adopting osteoporosis prevention strategies can help to design a specific program for men.

METHODS

A prospective cohort study was conducted in three men's health clinics in Hong Kong from September to October 2020, recruiting 277 men aged ≥ 20 years. They completed a questionnaire consisting of sociodemographic data, 14 general questions from the Facts on Osteoporosis Quiz (FOOQ), Male Osteoporosis Knowledge Quiz (MOKQ), Osteoporosis Health Belief Scale (OHBS), and Osteoporosis Self-Efficacy Scale (OSES). Scores from these scales and their association with sociodemographic data were reported. Correlations between age, knowledge, health beliefs, and self-efficacy were studied using the Health Belief Model.

RESULTS

The mean age was 36.4 years old, and 52% had university education. Their mean FOOQ + MOKQ score was 10.8 out of 20; mean OHBS score was 129.2 out of 210; and mean OSE-Exercise and OSE-Calcium scores were 66.4 and 68.9 out of 100 respectively. Self-efficacy of exercise was correlated with young age, perceived exercise benefits, and little barriers to exercise (p < 0.01). Self-efficacy of calcium intake was positively correlated with health motivation and self-efficacy of exercise and negatively correlated with barriers to calcium intake (p < 0.01).

CONCLUSION

Male osteoporosis awareness programs should focus on improving knowledge, enhancing awareness on susceptibility, promoting benefits of lifestyle modification, and helping men overcome perceived barriers.

A preliminary study on the effects of an osteoporosis prevention program based on an Information-Motivation-Behavioral skill model in older adult women: A cluster randomized controlled trial

We aimed to evaluate the feasibility and effects of an osteoporosis prevention program using the Information-Motivation-Behavioral skill (IMB) model in older adult women in this preliminary study. Korean women ≥65 years were randomly assigned to control (N=21) and intervention (N=23) groups. The intervention group participated in an IMB model-based, 12-week osteoporosis prevention program. The primary outcome was osteoporosis prevention behavior over time in both groups directly before, immediately after (post-test 1), and 4 weeks after (post-test 2) the intervention. Participants had a higher retention and attendance rate for the intervention, and the osteoporosis prevention behavior of the intervention group at post-test 1 and post-test 2 had significantly improved. The program based on the IMB model may be a feasible and effective intervention for osteoporosis prevention behavior in older adult women.

Lack of calcium rich foods in the diet, low knowledge on calcium level recommendations and severe food insecurity predicts low calcium intake among Vietnamese women

OBJECTIVE

To assess nutrition knowledge related to osteoporosis and calcium, osteoporosis health beliefs, dietary calcium intake and household food insecurity among adult women in Vietnam.

METHODS

Two hundred fifty-one women aged 30-65 years living in a rural district in Hanoi -Vietnam were recruited. A questionnaire was used to collect information on nutrition knowledge related to osteoporosis and calcium intake, health beliefs, household food security, and dietary calcium intake. Data analysis included descriptive statistics and regressions.

RESULTS

Majority of the participants did not know calcium recommendations (95%) and recommended daily servings of calcium-rich foods (60%). In addition, majority of the participants (83.7%) were not aware of osteoporosis risk factors. Slightly less than half of the participants (46.2%) reported that they would have difficulties changing their current diets to consume more calcium rich foods. Half of the participants (50.4%) reported being food insecure, with 22% of them reporting having severe food insecurity. Mean dietary calcium intake was 534.5 mg/day, of which milk and dairy products contributed only 4%. Nutrition knowledge, perceived benefits, and self-efficacy were positively associated with calcium intake (p < 0.05); whereas perceived barriers and severe food insecurity were significantly associated with low dietary calcium intake (p < 0.05).

CONCLUSIONS

The results of this study showed calcium intake among the participating Vietnamese women was lower than the national recommendation, indicating the need for nutrition programs and promotions to increase calcium intake. These programs should aim at increasing awareness on national calcium recommendations and skills to obtain and consume calcium-rich foods while considering development of safety nets for food insecure households, as pertaining to adequate dietary calcium intake.

Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu

BACKGROUND

Assessing people's knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women&apos;s knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya.

METHODS

A cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs.

RESULTS

The mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0-17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate.

CONCLUSIONS

The women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Effect of Education on Preventive Behaviors of Osteoporosis in Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Osteoporosis is one of the diseases that can be prevented by correcting health behaviors during adolescence.

OBJECTIVE

This study was conducted to evaluate the effect of education on preventive behaviors of osteoporosis including physical activity, calcium intake and practice (primary outcomes) and knowledge and attitude related to osteoporosis (secondary outcomes) in adolescents.

METHOD

A search was done in Cochrane Library, PubMed, Embase, Web of Sciences, Scopus, Google Scholar, SID and Magiran regardless of the time limit. To evaluate the quality of selected controlled trials, Cochrane collaboration' instrument was used for assessing the risk of bias. RevMan software was used to analysis and report the data.

RESULTS

Of 2159 articles retrieved, 20 of them were reviewed and 18 of them entered the mete-analysis. The meta-analysis showed significant differences between the education and control groups in terms of calcium intake (SMD = 0.78, 95%CI = 0.55 to 1.02, P < 0.00001), practice (SMD = 0.54, 95%CI = 0.41 to 0.68, P < 0.0001), knowledge (SMD = 1.76, 95%CI = 1.10 to 2.42, P < 0.00001) and attitude (SMD = 0.96, 95%CI = 0.53 to 1.40, P < 0.0001) mean score in adolescents but education is not effective on average minute/week of physical activity per week (MD = 31.94, 95%CI = -6.53 to 70.40, P = 0.10), mean score of physical activity (MD = 2.66, 95%CI = -0.55 to 5.88, P = 0.10) and percent of students participated in the physical activity (OR = 1.45, 95%CI = 0.30 to 6.91, P = 0.64).

CONCLUSION

Education is effective in improving their knowledge and attitudes toward osteoporosis. It can also improve some health-related behaviors for bone health such as sufficient dairy calcium intake but it has not been effective in establishing a regular exercise program.

Osteoporosis Knowledge and Health Beliefs Among Female Community Leaders in Peru

Background: Osteoporosis presents an increasing problem globally, primarily affecting older adults and postmenopausal women. Among important modifiable risk factors for osteoporosis, physical activity and calcium intake help reduce bone mineral loss and decrease the prevalence of osteoporosis. Although osteoporosis knowledge and health beliefs are associated with adopting preventive behavior and screening rates, few studies have evaluated them in Latin American populations. Materials and Methods: We conducted a cross-sectional study among female community leaders in a Peruvian periurban setting. A total of 60 women participated in the study, with a mean age of 43.7 ± 8.3 years, mean body mass index of 30.4 ± 5.3 kg/m², 88% being overweight or obese, and 58.3% having completed high school education or beyond. Participants completed translated and culturally adapted Osteoporosis Knowledge Test and Osteoporosis Health Belief Scale via semistructured interviews. Results: Most participants reported high knowledge regarding osteoporosis, perceived benefits to exercise and calcium intake, and health motivation. The level of osteoporosis knowledge was highly associated with the level of education, and we found a trend for the association between level of knowledge and perceived benefits of exercise and barriers to calcium intake among participants. Conclusions: Female community leaders with high health motivation and community engagement can contribute enormously to osteoporosis prevention programs in local communities in the future.

Sex differences in osteoporosis self-efficacy among community-residing older adults presenting for DXA

The Osteoporosis Self Efficacy Scale was determined to equivalently measure calcium and exercise beliefs in both sexes. Despite data illustrating men's and women's similar self-efficacy, gender differences in clinical predictors of self-efficacy imply that efforts to improve care must account for more than self-efficacy.

INTRODUCTION

To understand the extent to which the Osteoporosis Self Efficacy (OSE) Scale is reliable for both men and women. A secondary objective was to evaluate sex differences in OSE.

METHODS

For this cross-sectional study, we analyzed data collected as part of the Patient Activation after DXA Result Notification (PAADRN) pragmatic trial which enrolled 7749 community-residing adults aged 50 and older reporting for bone densitometry. We used univariable methods, item analysis, exploratory and confirmatory factor analyses, and linear regression to evaluate sex differences in OSE responses and measurement.

RESULTS

In this sample, the confirmatory factor analysis model for OSE both overall and within groups indicated a poor fit. The sex differences in the measurement model, however, were minor and reflected configural invariance (i.e., constructs were measuring the same things in both men and women), confirming that the OSE was measuring the same constructs in men and women. Men overall had higher exercise self-efficacy and women higher calcium self-efficacy. Overall, education, hip fracture, and self-reported health status predicted exercise self-efficacy whereas prior DXA, self-reported osteoporosis, and history of pharmacotherapy use did not. Predictors of calcium self-efficacy differed by gender.

CONCLUSION

The OSE can be used to measure calcium and exercise self-efficacy in all older adults. However, gender differences in clinical predictors of self-efficacy and the lack of an association of prior DXA with self-efficacy imply that interventions to improve self-efficacy may be insufficient to drive significant improvement in rates of osteoporosis evaluation and treatment.

TRIAL REGISTRATION

Patient Activation after DXA Result Notification (PAADRN), NCT01507662, https://clinicaltrials.gov/ct2/show/NCT01507662.

Gendered perceptions of osteoporosis: implications for youth prevention programs

The presentation of osteoporosis as a woman's disease in prevention information influences how osteoporosis is perceived and how prevention information is internalized and applied. Using the Health Belief Model as a framework, gendered perceptions of osteoporosis were investigated in Canadian young adults to inform the design of prevention programs. A combination of the Osteoporosis Health Belief Scale (OHBS) and semi-structured interviews were used to explore participants' perceptions of osteoporosis severity, susceptibility, and motivation to engage in prevention activities. Sixty multiethnic men and women aged 17-30 years living in Hamilton, Ontario, Canada participated in the study. While the findings from the OHBS indicated that both genders scored high for self-efficacy, the results from the qualitative interviews showed ambivalent attitudes toward prevention behaviors, indicating a disconnect between quantitative and qualitative findings. Perceptions related to severity and susceptibility revealed that while osteoporosis was generally viewed as a woman's disease, perceived individual risk of disease was a negotiation between larger gender constructs of osteoporosis and a variety of risk factors. This study indicates that osteoporosis prevention programs should consider actively acknowledging gendered and youth-based conceptions of osteoporosis in order to increase prevention behaviors in the whole population to reduce future disease.

Cross-Cultural Adaptation and Psychometric Properties of Osteoporosis Knowledge Tool-Arabic Version Among Iraqi Population

Background:

Osteoporosis is a major public health problem as the majority of people are not aware of the disease until the complications occur.

Objective:

The aims of this study were to validate Osteoporosis Knowledge Tool (OKT-A) Arabic version and to assess the osteoporosis knowledge among Iraqi general population.

Methods:

A descriptive, cross-sectional study was carried out in the city of Baghdad with a random cluster sampling method from the community. Forward–backward-forward translation method was used to translate the OKT questionnaire from English into Arabic language. The psychometric assessment process includes: face validity, reliability (Cronbach’s alpha and test-retest), item difficulty index, point biserial correlation and discriminatory power.

Results:

The results showed good face validity. The Cronbach’s alpha and Pearson correlation coefficient of the test re-test reliability were 0.775 and 0.412, respectively. Item difficulty index, point biserial correlation ranges and discriminatory power were 0.105 to 0.852, 0.105 to 0.445 and 0.933, respectively. These results demonstrated that OKT-A was a reliable and stable tool. The results showed low OKT-A scores 11.50±3.958. Furthermore, the OKT-A scores and its subscales were less than 50%. In addition, there were significant differences between the following independent variables in relation to total OKT-A scores: educational level, do you have osteoporosis or ever heard about osteoporosis. Moreover, there was a significant association between ever heard about osteoporosis groups and the OKT-A knowledge levels.

Conclusion:

This study showed good validity and reliability of OKT-A tool among Arabic general population. In addition, the results showed an urgent need for implementing an educational programme and should be a public health practice to increase the knowledge toward osteoporosis and its related risk factor.

Systematic scoping review of patients' perceived needs of health services for osteoporosis

Health service planners, administrators and providers need to understand the patients' perspective of health services related to osteoporosis to optimise health outcomes. The aims of this study were to systematically identify and review the literature regarding patients' perceived health service needs relating to osteoporosis and osteopenia. A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990-2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients' perceived needs of osteoporosis health services were categorised. Thirty-three studies (19 quantitative and 14 qualitative) from 1027 were relevant. The following areas of perceived need emerged: (1) patients sought healthcare from doctors to obtain information and initiate management. They were dissatisfied with poor communication, lack of time and poor continuity of care. (2) Patients perceived a role for osteoporosis pharmacotherapy but were concerned about medication administration and adverse effects. (3) Patients believed that exercise and vitamin supplementation were important, but there is a lack of data examining the needs for other non-pharmacological measures such as smoking cessation and alcohol. (4) Patients wanted diagnostic evaluation and ongoing surveillance of their bone health. This review identified patients' needs for better communication with their healthcare providers. It also showed that a number of important cornerstones of therapy for osteoporosis, such as pharmacotherapy and exercise, are identified as important by patients, as well as ongoing surveillance of bone health. Understanding patients' perceived needs and aligning them with responsive and evidence-informed service models are likely to optimise patient outcomes.

Transgender Individuals and Osteoporosis Prevention

BACKGROUND

Risk behaviors and hormone use place transgender individuals (TIs) in jeopardy for osteoporosis.

PURPOSE

The purpose of this study was to expand the science about the knowledge, health beliefs, and osteoporosis (OP) preventing behaviors of TIs.

METHODS

This was a mixed-methods pilot study of a convenience sample of 31 TIs 30 years and older. Participants completed an online Osteoporosis Bone Health Survey. Fifteen participants were randomly selected for an interview to describe their perceptions of bone health.

RESULTS

Transgender individuals performed poorly on the knowledge measure. There were no significant findings for osteoporosis health beliefs. Participants' daily dietary dairy calcium intake was 800 mg and daily walking activity was 17 minutes. Perceptions of bone health revealed two essential elements, knowing and doing.

CONCLUSION

Determining TIs' bone health perception is important because of their unique healthcare issues. Healthcare providers need to be aware of TIs' bone health needs to help enhance TIs' OP knowledge, health beliefs, and preventing behaviors.

Women's lived experiences of learning to live with osteoporosis: a longitudinal qualitative study

Background

A vast amount of literature exists concerning pharmaceutical adherence in osteoporosis. However, the process of learning to live with osteoporosis over time remains largely unknown. The purpose of this study was to gain a deeper understanding of the continued process of how women learn to live with osteoporosis. Our objective was to explore what characterizes women’s experiences of living with osteoporosis during the first year after diagnosis, when patients are prescribed anti-osteoporotic treatment, without having experienced an osteoporotic fracture.

Methods

Forty-two narrative qualitative interviews were conducted with fifteen recently diagnosed Danish women. A longitudinal design was chosen since this allows an investigation of the perspective over time. The interviews were conducted in the period of March 2011 to August 2012. Data were analyzed using a phenomenological-hermeneutic interpretation of text. No medical records were available for the researchers. All information with the exception of T-score was self-reported.

Results

The participants’ experiences could be described in two key themes developed through the analysis: 1) “To become influenced by the medical treatment” which consisted of two sub-themes “taking the medication”, and “discontinuing the medication”. 2) “Daily life with osteoporosis”, which was characterized by three sub-themes: “interpretation of symptoms”, “interpretation of the scan results” and “lifestyle reflections”. The results highlighted that learning to live with osteoporosis is a multifaceted process that is highly influenced by the medical treatment. In some cases, this is a prolonged process that can take around one year.

Conclusions

The results suggest a need for improved support for individual women during the complex process of learning to live with osteoporosis. The study adds new knowledge that can be useful for healthcare professionals taking a health-oriented stance when supporting women in self-management of their illness. Further investigations of lived experiences over time in the field of osteoporosis research are therefore needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-017-0377-z) contains supplementary material, which is available to authorized users.

Assessing health beliefs about osteoporosis among women attending primary health care centres in Qatar

Objective

Osteoporosis is a global health problem, and its prevalence is rapidly increasing worldwide. Misconceptions about osteoporosis and the lack of preventive measures among women are still common, emphasizing the need for primary prevention at an early age. The process of planning an effective osteoporosis prevention programme requires sufficient information about women's osteoporosis health beliefs. The objective of this study is to assess the health beliefs of 20–44 year-old Arab women about osteoporosis at primary health care centres in the State of Qatar.

Methods

The researchers utilized a cross-sectional study design, where cluster sampling with proportionate allocation was employed to enrol 766 eligible women who were interviewed using a structured Arabic questionnaire.

Results

The majority of the participating women showed lower perceived susceptibility to osteoporosis (71.7%) but higher perceived benefits of preventive practices (91.7%).

Conclusion

Despite lower perception of susceptibility to osteoporosis, women were highly motivated to take care of their health and believed in the benefits of a calcium-rich diet and regular exercise. The integration of osteoporosis prevention into women's health programmes at the primary health care level, as well as physical activity and nutritional programs, are recommended.

Factors associated with the accuracy of self-reported osteoporosis in the community

We examined the agreement between self-reported osteoporosis and bone mineral density (BMD) results through dual-energy x-ray absorptiometry (DXA) using data from a national representative sample taken from the US communities. Six-year data from the continuous National Health and Nutrition Examination Survey 2005-2006, 2007-2008, and 2009-2010 were merged. Participants included adults 50 years of age or older whose data appeared in both questionnaire and medical examination data files. Self-reported osteoporosis was defined by an affirmative response to a question in the osteoporosis questionnaire then compared with BMD-defined osteoporosis, defined by BMD values taken from the examination data. Agreement between self-reported osteoporosis and DXA results were low. Kappa was only 0.24 (95 % confidence interval = 0.21-0.27), and sensitivity and positive predictive value were 28.0 and 40.8 %, respectively. When stratified by gender or age group, agreement remained poor. Self-report of osteoporosis would not be suitable for accurate prevalence estimates for osteoporosis regardless of gender or age group.

Osteoporosis-Related Health Behaviors in Men With Prostate Cancer and Survivors: Exploring Osteoporosis Knowledge, Health Beliefs, and Self-Efficacy

This descriptive study aimed to (a) determine the extent of osteoporosis knowledge, perceived health beliefs, and self-efficacy with bone healthy behaviors in men with prostate cancer and survivors and (b) identify how dietary bone healthy behaviors are associated with these psychobehavioral and psychosocial factors. Three different questionnaires were used to measure osteoporosis knowledge, health beliefs, and self-efficacy in a group of men with prostate cancer and survivors. Bone health was assessed via dual-energy X-ray absorptiometry and calcium intake using a diet history. The prevalence of osteoporosis and low bone mass was high at over 70%. Participants had inadequate osteoporosis knowledge with a mean score of 43.3% ( SD = 18%) on the Facts on Osteoporosis Quiz. Participants scored low on the subscale measuring barriers to exercise (median = 11; interquartile range [IQR] = 6.5), indicating minimal barriers to exercise participation, and the subscale measuring the benefits of exercise scored the highest (median = 24; IQR = 3.5) compared with the other subscales. Men with prostate cancer and survivors were highly confident in their exercise and calcium self-efficacy (83.0%, IQR = 24.0% and 85.7%, IQR = 27.0%, respectively). Participants did not meet their calcium requirements or consume enough dairy products for optimum bone health. Men with prostate cancer and survivors have poor osteoporosis knowledge, but are confident in their self-efficacy of undertaking bone healthy behaviors. This confidence did not translate to specific dietary behaviors as they did not meet their calcium or dairy intake requirements. Implications for cancer survivors is that there is a need for bone health education programs among prostate cancer survivors. These programs should go beyond education and empowerment to provide practical guidance to maximize uptake of bone healthy behaviors.

Application of the health belief model and social cognitive theory for osteoporosis preventive nutritional behaviors in a sample of Iranian women

BACKGROUND

Osteoporosis is the most common metabolic bone disease. The purpose of this study is to investigate the health belief model (HBM) and social cognitive theory (SCT) for osteoporosis preventive nutritional behaviors in women.

MATERIALS AND METHODS

In this quasi-experimental study, 120 patients who were women and registered under the health centers in Fasa City, Fars Province, Iran were selected. A questionnaire consisting of HBM constructs and the constructs of self-regulation and social support from SCT was used to measure nutrition performance. Bone mineral density was recorded at the lumbar spine and femur. The intervention for the experimental group included 10 educational sessions of 55-60 min of speech, group discussion, questions and answers, as well as posters and educational pamphlets, film screenings, and PowerPoint displays. Data were analyzed using SPSS 19 via Chi-square test, independent t-test, and repeated measures analysis of variance (ANOVA) at a significance level of 0.05.

RESULTS

After intervention, the experimental group showed a significant increase in the HBM constructs, self-regulation, social support, and nutrition performance, compared to the control group. Six months after the intervention, the value of lumbar spine bone mineral density (BMD) T-score increased to 0.127 in the experimental group, while it reduced to -0.043 in the control group. The value of the hip BMD T-score increased to 0.125 in the intervention group, but it decreased to -0.028 in the control group.

CONCLUSIONS

This study showed the effectiveness of HBM and constructs of self-regulation and social support on adoption of nutrition behaviors and increase in the bone density to prevent osteoporosis.

Nutrition and bone health in women after the menopause

Osteoporosis affects one out of three postmenopausal women. Their remaining lifetime risk of fragility fractures exceeds that of breast cancer. The risk of osteoporosis and/or fragility fractures can be reduced through healthy lifestyle changes. These include adequate dietary intakes of calcium, vitamin D and protein, regular weight-bearing exercise, reduction in alcohol intake and smoking cessation. European guidance for the diagnosis and management of osteoporosis in postmenopausal women recommends a daily intake of at least 1000 mg/day for calcium, 800 IU/day for vitamin D and 1 g/kg body weight of protein for all women aged over 50 years. The development of programs that encourage lifestyle changes (in particular balanced nutrient intakes) are therefore essential for the reduction of osteoporosis risk.

[Bone mineral density, biochemical bone turnover markers and factors associated with bone health in young Korean women]

PURPOSE

This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women.

METHODS

Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report.

RESULTS

The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score≤-2) and 14.3% women had higher BMD (Z-score≥0) than women of same age. BTMs were not significantly different between high-BMD (Z-score≥0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors.

CONCLUSION

Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

Depression is associated with increased incidence of osteoporotic thoracolumbar fracture in postmenopausal women: a prospective study

PROPOSE

To determine whether depression in postmenopausal women with osteoporosis is associated with an increased risk of thoracolumbar fragility fracture.

METHODS

Postmenopausal women with osteoporosis and without prior vertebral fracture history who were seen at our institution from January 2006 to January 2010 (n = 1397) were divided into depression group (n = 494) and depression-free group (n = 903). After at least 4 years the incidence of thoracolumbar osteoporotic vertebral fracture was compared between the groups. For those who developed vertebral fracture, quality of life over the subsequent 2 months and fracture pain in the subsequent 2 weeks were compared. Depression was assessed with the 21-item Beck Depression Inventory, pain intensity with the visual analogue scale and quality of life with the Medical Outcomes Study 36-item Short-Form Survey.

RESULTS

The incidence of thoracolumbar fractures among women with continuous depression was higher than the group without depression (35.43 vs. 25.14 %, respectively; (P < 0.05). Osteoporotic thoracolumbar fractures were associated with significantly lower quality of life scores in women with depression than in those without depression (P < 0.05). Fracture pain was experienced by a higher percentage of patients with continuous depression than by those without depression (44.00 vs. 27.31 %; P < 0.05).

CONCLUSION

Depression is associated with a higher risk of thoracolumbar fracture, with more fracture pain and with lower quality of life in the 2 months following fracture.

Osteoporosis knowledge, self-efficacy, and health beliefs among Chinese individuals with HIV

Individuals with HIV are at increased risk for osteoporosis and fracture. Using the Health Beliefs Model, we identified key relationships between knowledge, self-efficacy and health beliefs pertaining to physical activity and dietary calcium intake, two key modifiable preventive measures for osteoporosis.

PURPOSE

Individuals with HIV are at increased risk for osteoporosis and fracture. Few studies have systematically explored concerns related to osteoporosis prevention among this group. Applying the Health Beliefs Model (HBM), we examined associations between osteoporosis-related preventive health behaviors (i.e., physical exercise and dietary intake) and knowledge, self-efficacy and health beliefs in a large cohort of Chinese individuals with HIV.

METHODS

We conducted a cross-sectional study with participants from an ongoing multi-center trial. Volunteers completed a questionnaire consisting of the International Physical Activity Questionnaire (IPAQ), a calcium and vitamin D intake assessment, the Osteoporosis Knowledge Test, Osteoporosis Self-Efficacy Scale, Osteoporosis Health Beliefs Scale, and relevant sociodemographic and clinical risk factors.

RESULTS

A total of 263 of 297 eligible participants enrolled in this study. Mean age of participants was 38.4 ± 9.8 years, average BMI was 21.6 ± 2.6 kg/m(2), and 76 % were men. About 30 % of the sample reported low physical activity. Consumption of foods from each calcium and vitamin D-rich category averaged between multiple times per month to weekly. Knowledge regarding osteoporosis was universally low and self-efficacy correlated directly with engagement in preventive behaviors. Women and individuals with lower education perceived greater barriers to adopting preventive behaviors. Multivariate logistic regression adjusted for age, sex and BMI showed that calcium and vitamin D intake was directly correlated with knowledge and self-efficacy, whereas physical activity correlated with manual labor occupation, perceived barriers to exercise and health motivation.

CONCLUSIONS

Behavioral frameworks such as the HBM may provide important insight into promoting adoption and maintenance of osteoporosis-related preventive behaviors among individuals with HIV.

Fears and beliefs in rheumatoid arthritis and spondyloarthritis: a qualitative study

Objectives

To explore beliefs and apprehensions about disease and its treatment in patients with rheumatoid arthritis and spondyloarthritis.

Methods

25 patients with rheumatoid arthritis and 25 with spondyloarthritis participated in semi-structured interviews about their disease and its treatment. The interviews were performed by trained interviewers in participants' homes. The interviews were recorded and the main themes identified by content analysis.

Results

Patients differentiated between the underlying cause of the disease, which was most frequently identified as a hereditary or individual predisposition. In patients with rheumatoid arthritis, the most frequently cited triggering factor for disease onset was a psychological factor or life-event, whereas patients with spondyloarthritis tended to focus more on an intrinsic vulnerability to disease. Stress and overexertion were considered important triggering factors for exacerbations, and relaxation techniques were frequently cited strategies to manage exacerbations. The unpredictability of the disease course was a common source of anxiety. Beliefs about the disease and apprehensions about the future tended to evolve over the course of the disease, as did treatment expectations.

Conclusions

Patients with rheumatoid arthritis and spondyloarthritis hold a core set of beliefs and apprehensions that reflect their level of information about their disease and are not necessarily appropriate. The physician can initiate discussion of these beliefs in order to dispel misconceptions, align treatment expectations, provide reassurance to the patient and readjust disease management. Such a dialogue would help improve standards of care in these chronic and incapacitating diseases.

Osteoporosis treatment disparities: a 6-year aggregate analysis from national survey data

We studied factors to determine the receipt of osteoporosis treatment in individuals with osteoporosis. Treatment was associated with age, gender, race, body mass index (BMI), family history, arthritis and thyroid problems, daily glucocorticoid use, number of prescriptions and healthcare visits, and insurance type.

INTRODUCTION

Osteoporosis is underrecognized and undertreated. Few studies have examined factors associated with osteoporosis treatment in a large, national sample of men and women.

METHODS

We aggregated National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2010 and created a subsample which included individuals 50 years or older who were identified to have osteoporosis either by self-report data or by bone density measurements. The primary outcome was the receipt of osteoporosis treatment either from self-report or from prescription records. Covariates included sociodemographics, clinical characteristics, and access to healthcare variables. Logistic regression analyses were performed to determine factors that associate with osteoporosis treatment.

RESULTS

From a sample of 31,0134 participants, 1,133 subjects (3.65 %) met the study criteria. Treatment was associated with age (odds ratio (OR) = 1.14), gender (OR = 13.25), race (OR = 2.23, White vs. Black; OR = 1.76, other vs. Black), BMI (OR = 1.67, normal vs. obese; OR = 2.68, overweight vs. obese), family history of osteoporosis (OR = 1.94), arthritis (OR = 1.43), daily glucocorticoid use (OR = 1.43), number of prescriptions (OR = 1.01), and number of healthcare visits in the past year (OR = 1.44, 4-9 vs. 0-3 visits). All odds ratios were statistically significant.

CONCLUSION

A large number of individuals diagnosed with osteoporosis above the age of 50 remain untreated. It is important for healthcare providers to better assess older adults with osteoporosis, including individuals who frequently receive medical care.

Bone health care for patients with prostate cancer receiving androgen deprivation therapy

Patients with prostate cancer often receive androgen deprivation therapy (ADT) as part of their treatment regimen. However, treatment with ADT causes multiple side effects, including reduced bone mineral density (BMD), lower lean body mass, and a higher risk for fractures. Several organizations provide clinical practice guidelines for osteoporosis screening, prevention, and treatment in this population, but adherence to these guidelines remains low. Areas for improvement in provider adherence include baseline and follow-up BMD testing, as well as counseling regarding healthy bone behaviors such as calcium/vitamin D intake, lifestyle changes, and physical exercise. Comparison of osteoporosis care in breast cancer and non-oncology populations shows that suboptimal bone health care is not isolated to prostate cancer. A summary of the literature examining improvements in patient adherence and provider delivery of bone health care is included in this review, but high-quality studies are lacking. Patients may be the most receptive to written educational information delivered at or near the time of ADT initiation. Involvement of a primary care practitioner and oncologist in care delivery is associated with higher BMD test use. Institution-level programs that automatically initiate osteoporosis screening and management may be effective at reducing the incidence of hip fracture. Lastly, suggestions are provided for future approaches to knowledge translation and quality of care studies to improve bone health.

The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study

PURPOSE

Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated.

METHODS

A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes.

RESULTS

A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density.

CONCLUSIONS

Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.

Women's experiences of their osteoporosis diagnosis at the time of diagnosis and 6 months later: a phenomenological hermeneutic study

This paper describes a phenomenological hermeneutic study of experiences of women who were recently diagnosed with osteoporosis. The research objective was to investigate women's experiences of living with osteoporosis during the first 6 months after diagnosis when treatment was first prescribed. Fifteen women were included in the study. The inclusion criteria were a DXA scan at one of the two hospitals showing a T-score below −2.5 (lower back or hip), age 65 years or older; no previous known osteoporotic fracture; at least one of the known risk factors for osteoporosis; and prescription of anti-osteoporotic treatment. Exclusion criteria were previous diagnosis of osteoporosis or previous treatment with anti-osteoporotic medication. Data were collected through in-depth interviews shortly after diagnosis and 6 months later. The performed analyses were inspired by Paul Ricoeur's theory of interpretation of texts comprising three levels: naïve reading, structural analysis, and critical interpretation and discussion. Three key themes emerged: 1) being diagnosed, 2) being prescribed medical treatment, and 3) being on the path of learning to live with osteoporosis. The findings suggest a need for improved support for the patients to gain understanding of their diagnosis and the risk of osteoporotic fracture as well as to learn to live with osteoporosis. The study highlights new health promotion areas for targeting interventions at newly diagnosed patients, helping them accept and interpret the diagnosis, and the medical treatment.

Nutrition and bone health: turning knowledge and beliefs into healthy behaviour

Primary osteoporosis prevention requires healthy behaviours, such as regular physical exercise and adequate dietary intakes of calcium, vitamin D and protein. Calcium and vitamin D can decrease postmenopausal bone loss and prevent fracture risk. However, there is still a high prevalence of calcium and vitamin D insufficiency in women aged 50+ years. Dietary sources of these nutrients are the preferred choice, and dairy products represent a valuable dietary source of calcium due to the high content, high absorptive rate and relatively low cost. Furthermore, dairy products also contain other key nutrients including vitamin D, phosphorus and protein that contribute to bone health. Studies of women's beliefs and behaviours with respect to osteoporosis highlight poor knowledge of the importance of dietary nutrient intakes and low concern regarding bone health. Osteoporosis educational programmes exist to help women change behaviours relevant to bone health. Such programmes can have positive influences on women's knowledge, attitudes, perceived norms, motivation and behaviours. Increased awareness of the consequences of low calcium and vitamin D intakes may promote women's attitudes towards dietary sources, in particular dairy products, and lead to better adherence to health recommendations. Increasing dietary nutrient intakes through educational initiatives should be further developed to aid the prevention of osteoporosis and the efficacy of osteoporosis management.

Osteoporosis knowledge and attitudes: a cross-sectional study among female nursing school students in Damascus

SUMMARY

This study was conducted to determine the level of osteoporosis knowledge and beliefs among nursing college students in Damascus. A worrying deficit of knowledge was found. They believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about it. Innovative educational interventions should be considered.

PURPOSE

Increasing awareness, knowledge, and promoting healthy behaviors about osteoporosis and related risk factors are effective prevention measures for building and maintaining strong bone throughout the life-span. We hypothesized a lack of knowledge and unhealthy beliefs about osteoporosis among young women in our setting. The level of osteoporosis knowledge, beliefs, and behavior among nursing college students in Damascus was evaluated in this study.

METHODS

A cross-sectional study was conducted on a convenience sample of female young students seen at the nursing school. All students registered for the year 2011-2012 were included in the study. A self-administered questionnaire was implemented. The questionnaire included background information and both osteoporosis-related tools (Arabic version), namely the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale.

RESULTS

A total of 353 female students answered the questionnaire with a response rate of 98.3%. A worrying deficit of knowledge was found among surveyed Syrian young adult females with a total mean score of 7.9 (2.7) out of possible 20 points, being 39.6% of possible maximum score on the OKAT. Those young women believed osteoporosis to be a serious disease but did not feel susceptible to or concerned about the illness. Perceived moderate to high barriers to exercises and calcium intake indicated negative health beliefs.

CONCLUSIONS

The findings generally reveal poor knowledge about osteoporosis among nursing school female students at Damascus. Integration of osteoporosis in school curricula and public education efforts is urgently needed.

Proline/arginine-rich end leucine-rich repeat protein N-terminus is a novel osteoclast antagonist that counteracts bone loss

(hbd) PRELP is a peptide corresponding to the N-terminal heparin binding domain of the matrix protein proline/arginine-rich end leucine-rich repeat protein (PRELP). (hbd) PRELP inhibits osteoclastogenesis entering pre-fusion osteoclasts through a chondroitin sulfate- and annexin 2-dependent mechanism and reducing the nuclear factor-κB transcription factor activity. In this work, we hypothesized that (hbd) PRELP could have a pharmacological relevance, counteracting bone loss in a variety of in vivo models of bone diseases induced by exacerbated osteoclast activity. In healthy mice, we demonstrated that the peptide targeted the bone and increased trabecular bone mass over basal level. In mice treated with retinoic acid to induce an acute increase of osteoclast formation, the peptide consistently antagonized osteoclastogenesis and prevented the increase of the serum levels of the osteoclast-specific marker tartrate-resistant acid phosphatase. In ovariectomized mice, in which osteoclast activity was chronically enhanced by estrogen deficiency, (hbd) PRELP counteracted exacerbated osteoclast activity and bone loss. In mice carrying osteolytic bone metastases, in which osteoclastogenesis and bone resorption were enhanced by tumor cell-derived factors, (hbd) PRELP reduced the incidence of osteolytic lesions, both preventively and curatively, with mechanisms involving impaired tumor cell homing to bone and tumor growth in the bone microenvironment. Interestingly, in tumor-bearing mice, (hbd) PRELP also inhibited breast tumor growth in orthotopic sites and development of metastatic disease in visceral organs, reducing cachexia and improving survival especially when administered preventively. (hbd) PRELP was retained in the tumor tissue and appeared to affect tumor growth by interacting with the microenvironment rather than by directly affecting the tumor cells. Because safety studies and high-dose treatments revealed no adverse effects, (hbd) PRELP could be employed as a novel biological agent to combat experimentally induced bone loss and breast cancer metastases, with a potential translational impact.

Causes, consequences, and treatment of osteoporosis in men

Men undergo gradual bone loss with aging, resulting in fragile bones. It is estimated that one in five men will suffer an osteoporotic fracture during their lifetime. The prognosis for men after a hip fracture is very grim. A major cause is reduction of free testosterone. Many other factors result in secondary osteoporosis, including treatment for other diseases such as cancer and diabetes. Patients should be screened not only for bone density but also assessed for their nutritional status, physical activity, and drug intake. Therapy should be chosen based on the type of osteoporosis. Available therapies include testosterone replacement, bisphosphonates, and nutritional supplementation with calcium, vitamin D, fatty acids, and isoflavones, as well as certain specific antibodies, like denosumab and odanacatib, and inhibitors of certain proteins.

Anti-osteoporotic therapy in Denmark--predictors and demographics of poor refill compliance and poor persistence

In this study of 100,949 new users of oral bisphosphonates age ≥ 35 years, "early quitters" were found to differ from others with poor refill compliance in terms of socioeconomic, demographic, and treatment-related characteristics. New risk factors for poor compliance and persistence were identified.

INTRODUCTION

Poor compliance with anti-osteoporotic therapy is an on-going worldwide challenge. In this study, we hypothesized that "early quitters" differ in socioeconomics, demographics, co-medications, and comorbid conditions from other patients with low compliance.

METHODS

The study was a register-based nationwide cohort study of anti-osteoporotic therapy comprising 100,949 men and women. Statistical analysis including backward stepwise logistic regression analysis was used to explain causes of treatment failure and Kaplan-Meier survival analysis to estimate persistence of treatment.

RESULTS

It was noted that 56.6 % of the patients were persistent and compliant, 4.7 % of the patients were persistent but "low compliant" while 38.7 % of the patients were "early quitters". "Early quitters" were found to differ in socioeconomics from "low compliant" patients. Differences concerning increased risk of "early quitters" were associated with high household income, subjects' age 71.9-79 years, living in the countryside or village, prior treatment with analgesics and anti-parkinson drugs, and dementia. Differences concerning decreased risk of "early quitters" were associated with male, living in an apartment, children living at home, living close to a university hospital, anti-osteoporotic therapy other than alendronate, number of drugs especially above three, pulmonary disease, collagen disease.

CONCLUSION

The results suggest a need for improved support for patients to facilitate the interpretation of the disease and the perception of the benefits and risks of treatment-to reduce the risk of "early quitters". We were able to identify new risk groups that may be candidates for targeted actions.

Evaluation of the osteoporosis health belief scale in korean women

Background

The Osteoporosis Health Belief Scale (OHBS) is a 42-item questionnaire designed to assess susceptibility, seriousness, calcium benefits, calcium barriers, exercise benefits, exercise barriers, and health motivation related to osteoporosis. We aimed to evaluate its psychometric properties to enable the provision of educational tips regarding osteoporosis.

Methods

All women who had visited the department of obstetrics and gynecology (OBGYN) and whose bone mineral density was measured from January 2010 to December 2011 were enrolled by interview using the OHBS. We also evaluated the women's general clinical characteristics.

Results

One hundred seventy-seven women were enrolled in the present study. In the present study, the barriers to calcium intake subscale had the lowest mean score (15.03±3.02), and the Benefit of Exercise subscale had the highest (23.02±3.03). The scores for participants in their 20s were significantly higher than scores for those in their 70s on the Benefits of Exercise subscale and Barriers to Exercise subscale (P=0.014 and P=0.022, respectively).

Conclusions

Education for health motivation to prevent osteoporosis is important for young women. Additional systematic education programs are needed for the general population.

The reliability of the Arabic version of osteoporosis knowledge assessment tool (OKAT) and the osteoporosis health belief scale (OHBS)

Background

Knowledge and awareness about osteoporosis and its related risk factors are important contributors to osteoporosis preventive behavior. There is a need to assess the reliability of international osteoporosis-related knowledge and belief measurement tools in Arabic community. This study aimed to assess the reliability of the Arabic version of Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) among Syrian women.

Methods

The study included two phases. The first phase included a forward and backward translation of the osteoporosis-related tools (OKAT and OHBS) followed by a pilot testing. The second phase was an assessment of the test-retest reliability of the tools among a convenience sample of one hundred working women at Damascus Faculty of Medicine and its teaching hospitals. For this purpose each instrument was administered twice to all women at an interval of two weeks. Data collection took place in the fall of 2011, and was facilitated by a trained interviewer whose task was to administer the tools and collect some background data from the women who consented to participate in the study.

Results

A total of one hundred women were recruited in this study for the reliability test-retest of the Arabic version of the tools. The mean age of studied women was 37.1 (SD = 8.4) years. Most of the women were married and nearly one-half of them had a university education. The internal consistency values for OHBS (Cronbach’s alpha = 0.806) as well as the OKAT (Cronbach’s alpha = 0.824) met the 0.7 Cronbach’s alpha value requirement. Item analysis did not necessitate any omissions in either tool. McNemar’s test identified only three items on the OKAT questionnaire that significantly differed from the test to the retest. The OKAT mean score (SD) for the test was 9.4 (2.6) and that for the re-test was 10.1 (2.9). Paired t test did not show significant difference (P = 0.068).

Conclusion

The Arabic version of both the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) was found to be reliable as well as acceptable. Further research is needed as to complete the validation of those tools and to use them at larger scale whether in knowledge assessment or in assessing interventions.

Osteoporosis knowledge, health beliefs, and healthy bone behaviours in patients on androgen-deprivation therapy (ADT) for prostate cancer

OBJECTIVES

To describe in patients with prostate cancer, receiving androgen-deprivation therapy (ADT): (i) knowledge, self-efficacy (SE), and health beliefs about osteoporosis (OP); (ii) current engagement in healthy bone behaviours (HBBs). To explore the relationships between knowledge, SE, and health beliefs, and engagement in HBBs.

PATIENTS AND METHODS

175 patients receiving ADT by injection completed questionnaires assessing current HBBs, OP knowledge, SE, and health beliefs (motivation, perceived susceptibility, and seriousness). Descriptive statistics and independent samples t-tests were used to assess relationships between knowledge, SE, health beliefs, and engagement in HBBs.

RESULTS

Only 38% of patients had undergone a dual X-ray absorptiometry scan in the past 2 years. OP knowledge was low (mean [sd, range] 9.6 [4.4, 0-19]) and perceived SE moderate (84.7 [24.5, 0-120]). Health motivation was fairly high (23.6 [3.1, 6-30]), but perceived susceptibility (16.8 [4.3]) and seriousness (16.8 [4.2]) of OP were low. Few patients met the recommendations for vitamin D intake (42%) and exercise (31%), and 15% were at risk of over-supplementation of calcium. Patients taking calcium supplements (P = 0.04), and meeting guidelines for vitamin D (P = 0.008) and for exercise (P = 0.002) had significantly greater knowledge than those who did not. Patients who were engaging in less than four of five HBBs had lower knowledge (P < 0.001) and health motivation (P = 0.01) than those who were engaging in four or all five HBBs.

CONCLUSIONS

Most patients who are receiving ADT are not receiving appropriate screening, lack basic information about bone health, and are not engaging in the appropriate HBBs. These findings support the application of the Health Belief Model in this population: interventions that teach patients about the implications of bone loss, encourage proper uptake of HBBs, and promote feelings of SE could increase engagement in HBBs to prevent and manage bone loss.