Osteoporosis prevention: pediatricians' knowledge, attitudes, and counseling practices

Pediatric and adult osteoporosis: a contrasting mirror

Pediatric osteoporosis (PO) is a condition that is currently gaining recognition. Due to the lack of official definitions over the past few decades, the exact incidence of PO is unknown. The research does not provide a specific prevalence of PO in different world regions. However, this is expected to change with the latest 2019 guidelines proposed by the International Society of Clinical Densitometry. Although adult osteoporosis (AO) has been postulated a pediatric disease because its manifestation in adulthood is a result of the bone mass acquired during childhood, differences between PO and AO should be acknowledged. AO is defined as low bone density; however, PO is diagnosed based on existing evidence of bone fragility (vertebral fractures, pathological fractures). This is particularly relevant because unlike in adults, evidence is lacking regarding the association between low bone density and fracture risk in children. The enhanced capacity of pediatric bone for reshaping and remodeling after fracture is another difference between the two entities. This contrast has therapeutic implications because medication-free bone reconstitution is possible under certain conditions; thus, background therapy is not always recommended. In this narrative review, differences between PO and AO in definition, assessment, and medical approach were investigated.

Treatment Practices and Confidence in the Management of Pediatric Metabolic Bone Disorders

INTRODUCTION

Pediatric metabolic bone and mineral disorders encompass a wide variety of disorders that can be challenging to diagnose and treat because of inadequate physician training about optimal management.

METHODS

As practice variation and confidence levels may impact clinical outcome, we sought to assess physician confidence in managing pediatric metabolic bone and mineral disorders and the spectrum of treatment practices among members of the Pediatric Endocrine Society (PES) and the Canadian Pediatric Endocrine Group (CPEG). Questionnaires were distributed via e-mail to all members of the PES and CPEG and 244 were completed. Responses were summarized using descriptive statistics, and proportions were compared using χ2 or Fisher's exact tests, as appropriate.

RESULTS

Variations were observed among the respondents' confidence in the management of bone disorders and in the criteria used to initiate/discontinue intravenous bisphosphonates or prescribe burosumab therapy. Respondents felt confident with the management of 4 out of 20 pediatric bone conditions (confidence was defined as >90% of respondents reporting feeling "somewhat confident" or "very confident"). Physicians working in a bone clinic were more confident in prescribing burosumab for the treatment of X-linked hypophosphatemic rickets compared to those not working in a bone clinic (65% vs. 47%, p = 0.03). Most respondents (52%) reported having received inadequate training in pediatric metabolic bone and mineral disorders.

DISCUSSION/CONCLUSION

Dedicated training, knowledge acquisition, and education resources are needed to increase confidence and standardize the use of bone-targeted therapies.

Self-efficacy of osteoporosis preventive behaviors and its predictors in Iranian adolescents

INTRODUCTION

Almost all the bone mass in females is accumulated during adolescence and especially in the years immediately following menstruation. Self-efficacy plays an important role in moderating the relationship between knowledge and behavior. This study aimed to determine the self-efficacy of osteoporosis preventive behaviors and its predictors in female high school students.

METHODOLOGY

This descriptive-analytical cross-sectional study was conducted on 330 female high school students in Saveh, Iran during 2016-2017. A two-stage cluster sampling method was used to select the participants. Data were collected using a socio-demographic questionnaire, the Osteoporosis Knowledge Test (OKT) and the Osteoporosis Self-Efficacy Scale (OSES). A general linear model was used to determine the self-efficacy predictors of osteoporosis preventive behaviors.

RESULTS

The mean [standard deviation (SD)] of the total OKT score was 11.08 (4.08) of attainable range from 0 to 32. The mean (SD) of the total OSES score was 121.97 (37.36) of attainable range from 0 to 200. The mean (SD) of the exercise and calcium subscales of OSES were 58.39 (22.56) and 63.57 (21.02), respectively. There were significant relationships between the total OKT score with the total OSES score (r = 0.16, p = 0.003) and its subscales, including exercise (r = 0.16, p = 0.002) and calcium (r = 0.11, p = 0.03) scores. According to the adjusted general linear model, the variables of economic status, educational level and osteoporosis knowledge were predictors of the self-efficacy in the studied students.

CONCLUSION

Findings suggested that most of the students had moderate levels of knowledge and self-efficacy regarding osteoporosis preventive behaviors; therefore, improving the knowledge and self-efficacy of this group can play a significant role in promoting their health.

Osteoporosis: prevention and implications for social work practice and policy

Osteoporosis is one of the major disorders of our time and is increasing at an alarming rate. It affects over 10 million women in the United States and is expected to affect 14 million by the year 2020. There are a number of risk factors for osteoporosis that are of a modifiable nature; however, many women do not take the necessary precautions to prevent the disease. The reasons that women do not actively engage in preventative and remedial strategies to deal with the potential for osteoporosis are complex. It is clear that women must have adequate knowledge to make informed decisions regarding osteoprotective behaviors. Social workers are in a unique position to provide interventions not only on a micro level (educating individual clients) but also on a macro level in terms of large-scale education campaigns focusing on nutrition and exercise both in children and in adults. This article examines the reasons for the failure of women to engage in osteoprotective behaviors by exploring barriers to prevention and their impact on social work policy, practice, and research.

Opinions and attitudes concerning osteoporosis among Austrian general practitioners

General practitioners play a crucial role in the management of osteoporosis. Thus, it is essential to determine the opinions and attitudes of family doctors concerning this disease. A structured pencil-paper questionnaire was distributed to all general physicians in a practice in Austria and 3.2% responded. Results were compared with a similar survey carried out in 1993. 84.4% of the responding doctors regarded the public health impact of osteoporosis as rather or very important, compared with 49.2% in 1993. 83.3% regarded prevention of osteoporosis as effective or very effective. This proportion rose from 66.2% in 1993. Regular physical exercise was rated as most effective in the prevention of osteoporosis, followed by calcium-rich diet and vitamin D- and calcium supplementation. 33.6% reported carrying out a standardised risk assessment prior to referral/non-referral for bone mineral densitometry. The most frequently cited aspects of the patient's medical history leading to this examination were permanent corticosteroid therapy, a history of fractures, and pain, as reported by 93.6, 84.6 and 71.2%, respectively. The most frequently reported interventions recommended by doctors to their osteoporosis patients in the prevention of falls were reduction of trip hazards (87.2%), reduction of psychotropic drugs (50.0%), balance, strength and endurance training (57.7, 48.1, and 42.3%, respectively). These results reveal strengths in the approach to prevention and early recognition of osteoporosis and prevention of falls, but potential room for improvement in the management of osteoporosis by general practitioners is also shown.

Using the internet to educate adolescents about osteoporosis: application of a tailored web-education system

Osteoporosis is a "pediatric disease with geriatric consequences." This article describes the development and pilot testing of an online system to educate high school students grades 9-12 about osteoporosis; an age where positive health changes could have long lasting effects. The intervention goal was to improve knowledge about osteoporosis and intent to adopt healthy bone practices. Online pre- and postintervention surveys evaluated participants' pre- and postintervention osteoporosis knowledge, attitudes, preventive practices, and postintervention intent to change healthy bone practices. Participants completed the Web-based program that provided detailed information about osteoporosis, and healthy bone practices, immediately after completing the pretest and just prior to completing the posttest. Eighty-nine students completed both the pre/posttests and were included in data analysis. Participants ranged in age from 13 to 17 and 75% were Caucasian (n = 65). Based on pre/posttest scores of 9 factual questions, students significantly improved their knowledge (p < .0001) and overall knowledge rating about osteoporosis at posttest (p < .001). Participants changed their perception regarding the disease's seriousness (p < .001), and considered adopting osteoporosis prevention practices. The study shows that an interactive educational Web site is an effective method for increasing awareness and understanding of osteoporosis in high school students.

Osteoporosis practice patterns in 2006 among primary care physicians participating in the NORA study

This study investigated osteoporosis management trends from 1998 to 2006 among 808 primary care physicians involved in the US-based NORA (National Osteoporosis Risk Assessment) study. These results suggest some significant improvements in osteoporosis management over the past eight years.

INTRODUCTION

The purpose of this study was to investigate osteoporosis management trends among a large cohort of primary care physicians (PCPs) involved in the US-based NORA (National Osteoporosis Risk Assessment) study.

METHODS

In 2006, we undertook a resurvey of the 2,836 NORA PCPs who completed a baseline survey in 1998. Of the 2,199 PCPs for whom we had current contact information and who were still practicing, we collected usable surveys from 808 (37% response rate).

RESULTS

From 1998 to 2006, more than double the percentage of NORA PCPs reported using BMDs "often" (35% vs. 87%). There was a doubling of the percentage of NORA PCPs who reported that a T-score of < or = -2.5 was the threshold indicating the presence of osteoporosis (34% vs. 67%). The percentage of NORA PCPs who reported using bone turnover markers to screen, diagnosis, or monitor osteoporosis almost tripled (19% vs. 55%). The percentage of patients prescribed or recommended hormone therapy dropped sixfold (67% to 11%), and the percentage of patients prescribed bisphosphonates increased fourfold from 15% to 59%.

CONCLUSION

These results suggest some significant improvements in osteoporosis management over the past eight years.

Nurses' knowledge and perceptions about osteoporosis: a questionnaire survey

BACKGROUND

Knowledge about a disease provides professionals involved in its prevention and treatment with the information to make informed decisions about health practices. Gaps of knowledge regarding osteoporosis prevention and treatment have been found among different health professionals over the world, including nurses.

OBJECTIVES

The aim of this study was to assess a wider variety of aspects related to nurses' knowledge and attitudes regarding osteoporosis.

DESIGN

A cross-sectional research design was used.

SETTINGS

Two academic centers in the northern part of Israel.

PARTICIPANTS

A convenience sample of 158 registered nurses (mean age=39+/-10.3), attending classes at two academic centers.

METHODS

Data were collected using a self-administered survey.

RESULTS

Nurses were positive about their role and their skills for osteoporosis management, yet subjective and objective knowledge in different aspects of the disease was moderate. The average score of knowledge regarding risk factors for osteoporosis, as assessed by the Facts on Osteoporosis Quiz (FOOQ), was 17 (SD=3) out of 24, with female nurses, nurses working in Health Maintenance Organizations-HMOs, and nurses who underwent a bone density measurement scoring higher (p< 0.05).

CONCLUSIONS

Nurses believed they have an important role in educating the public on osteoporosis prevention and management. Yet, their knowledge on different issues (e.g. signs of the disease, medication, and lifestyle issues) was only moderate. The only osteoporosis-related aspect they reported being confident about was advising on fall prevention. Measures should be taken in order to expand nurses' knowledge, such as education programs and postgraduate courses.

Management of osteoporosis: a national survey of Israeli dietitians' knowledge and perceptions

The aim of this study was to assess Israeli dietitians' knowledge and attitudes regarding osteoporosis. Participants were 320 dietitians responding to a mail survey. Israeli dietitians scored highly on the Facts on Osteoporosis Quiz-FOOQ. Israeli dietitians' dietary knowledge regarding calcium (recommended dietary allowance, content in food and in supplements) was fairly high; unlike knowledge regarding vitamin D. Israeli dietitians had a firm positive opinion of their role in the prevention and treatment of osteoporosis.

Osteoporosis in children and adolescents: etiology and management

Bone mass increases progressively during childhood, but mainly during adolescence when approximately 40% of total bone mass is accumulated. Peak bone mass is reached in late adolescence, and is a well recognised risk factor for osteoporosis later in life. Thus, increasing peak bone mass can prevent osteoporosis. The critical interpretation of bone mass measurements is a crucial factor for the diagnosis of osteopenia/osteoporosis in children and adolescents. To date, there are insufficient data to formally define osteopenia/osteoporosis in this patient group, and the guidelines used for adult patients are not applicable. In males and females aged <20 years the terminology 'low bone density for chronologic age' may be used if the Z-score is less than -2. For children and adolescents, this terminology is more appropriate than osteopenia/osteoporosis. Moreover, the T-score should not be used in children and adolescents. Many disorders, by various mechanisms, may affect the acquisition of bone mass during childhood and adolescence. Indeed, the number of disorders that have been identified as affecting bone mass in this age group is increasing as a consequence of the wide use of bone mass measurements. The increased survival of children and adolescents with chronic diseases or malignancies, as well as the use of some treatment regimens has resulted in an increase in the incidence of reduced bone mass in this age group. Experience in treating the various disorders associated with osteoporosis in childhood is limited at present. The first approach to osteoporosis management in children and adolescents should be aimed at treating the underlying disease. The use of bisphosphonates in children and adolescents with osteoporosis is increasing and their positive effect in improving bone mineral density is encouraging. Osteoporosis prevention is a key factor and it should begin in childhood. Pediatricians should have a fundamental role in the prevention of osteoporosis, suggesting strategies to achieve an optimal peak bone mass.

Knowledge about osteoporosis and its related factors among public health nurses in Taiwan

Although osteoporosis prevention has been identified as a critical issue for women and the elderly population, some health professionals still misunderstand osteoporosis. Public health nurses (PHNs) are responsible for health promotion and disease prevention in community populations. The objective of this study was to investigate PHNs' knowledge of osteoporosis and its related factors. A cross-sectional research design was used: 678 subjects from 3,300 PHNs who worked at health centers in Taiwan during 2000 were selected by cluster random sampling to participate in this study; 539 of them returned the questionnaire. On average, the PHNs' knowledge was found to be 0.68 (ranging from 0 to 1). The highest and lowest scores were found in the areas of disease prevention and the detection of the symptoms/signs of osteoporosis. By using one-way ANOVA, our study found that participants who had studied osteoporosis at school, had graduated from university, were RNs or LPNs and had studied osteoporosis as part of continuing education (CE) had higher knowledge scores. This study recommends that CE and nursing education about osteoporosis need to be highly valued. Nursing educators should reassess and reconstruct nursing curricula. Health administrators should evaluate learning needs and provide CE via multiple channels. Symptoms/signs, diagnosis/treatment and prevention issues are suggested as the core components of designing nursing curricula and CE.

Knowledge about osteoporosis: assessment, correlates and outcomes

During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.