Older men's knowledge about osteoporosis and educational interventions to increase osteoporosis knowledge in older men: A systematic review

Clinical characteristics and risk factors of osteoporosis among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia

This study investigated osteoporosis risk factors among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia in primary care. Advanced age, dementia, depression, and polypharmacy were associated with higher risks for osteoporosis. Screening strategies targeting these factors are crucial for improving bone health as part of comprehensive preventive care.

PURPOSE

Asian patients with type-2 diabetes mellitus (T2DM), hypertension, or hyperlipidaemia (DHL) are predominantly managed in primary care. They are also at risk of osteoporosis, but men are often under-screened and under-treated for this preventable bone disorder. This study aimed to identify the clinical characteristics and risk factors of osteoporosis among older men with DHL in primary care for early intervention.

METHODS

This retrospective study included men aged 65 years and older managed in public primary care clinics for their DHL between 1st July 2017 and 30th June 2018. Demographic, clinical, laboratory, and imaging data were extracted from their electronic medical records based on their International Classification of Diseases-10 (ICD-10) diagnosis codes. Descriptive statistical analyses, with statistical significance set at p < 0.05, were conducted, followed by generalized estimating equation (GEE) modelling.

RESULTS

Medical records of 17,644 men (83.1% Chinese, 16.9% minority ethnic groups, median age 71 years) were analysed. 2.3% of them had diagnosis of osteoporosis, 0.15% had fragility fracture, and 26.0% of those diagnosed with osteoporosis were treated with bisphosphonates. Their mean HbA1c was 6.9%; mean systolic and diastolic blood pressure were 133 and 69 mmHg. The GEE model showed that age (OR = 1.07, 95%CI = 1.05-1.09, p < 0.001), dementia (OR = 2.24, 95%CI = 1.33-3.77, p = 0.002), depression (OR = 2.38, 95%CI = 1.03-5.50, p = 0.043), and polypharmacy (OR = 6.85, 95%CI = 3.07-15.26, p < 0.001) were significantly associated with higher risks for osteoporosis.

CONCLUSION

Age, dementia, depression, and polypharmacy are associated with osteoporosis risks in men with DHL. Strategies to incorporate osteoporosis screening among older men with these risk factors are needed to improve their bone health.

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.

Effects of an 18-month community-based, multifaceted, exercise program on patient-reported outcomes in older adults at risk of fracture: secondary analysis of a randomised controlled trial

This study identified that an 18-month community-based, multifaceted, exercise program consisting of resistance, weight-bearing impact, and balance/mobility training combined with osteoporosis education and behavioural support can improve health-related quality of life (HRQoL) and osteoporosis knowledge in older adults at risk of fracture, but only for those adherent to the exercise regime.

PURPOSE

To evaluate the effects of an 18-month community-based exercise, osteoporosis education and behaviour change program (Osteo-cise: Strong Bones for Life) on HRQoL, osteoporosis knowledge and osteoporosis health beliefs.

METHODS

This was a secondary analysis of an 18-month randomised controlled trial in which 162 older adults aged ≥ 60 years with osteopenia or increased falls/fracture risk were randomized to the Osteo-cise program (n = 81) or control group (n = 81). The program consisted of progressive resistance, weight-bearing impact and balance training (3 days/week); osteoporosis education to facilitate self-management of musculoskeletal health and behavioural support to enhance adherence to exercise. HRQoL, osteoporosis knowledge and osteoporosis health beliefs were assessed using the EuroQoL questionnaire (EQ-5D-3L), Osteoporosis Knowledge Assessment Tool and Osteoporosis Health Belief Scale, respectively.

RESULTS

Overall, 148 participants (91%) completed the trial. Mean exercise adherence was 55% and mean attendance for the three osteoporosis educational sessions ranged from 63-82%. After 12 and 18 months, there were no significant effects of the Osteo-cise program on HRQoL, osteoporosis knowledge or health beliefs relative to controls. Per protocol analyses (≥ 66% exercise adherence; n = 41) revealed a significant net benefit in EQ-5D-3L utility for the Osteo-cise group relative to controls after 12 months (P = 0.024) and 18 months (P = 0.029) and a significant net improvement in osteoporosis knowledge scores at 18 months (P = 0.014).

CONCLUSION

This study supports the importance of adherence to exercise regimes, as adherence to the Osteo-cise: Strong Bones for Life program was associated with improvements in HRQoL and osteoporosis knowledge in older adults at increased risk for falls and fractures.

TRIAL REGISTRATION NUMBER

ACTRN12609000100291.

Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians

Background: Osteoporosis is an emerging geriatric condition with high morbidity and healthcare cost in developing nations experiencing rapid population ageing. Thus, identifying strategies to prevent osteoporosis is critical in safeguarding skeletal health. This study aimed to evaluate the effects of a bone health screening and education programme on knowledge, beliefs, and practice regarding osteoporosis among Malaysians aged 40 years and above. Methods: A longitudinal study was conducted from April 2018 to August 2019. During the first phase of the study, 400 Malaysians (190 men, 210 women) aged ≥ 40 years were recruited in Klang Valley, Malaysia. Information on subjects’ demography, medical history, knowledge, and beliefs regarding osteoporosis, physical activity status, and dietary and lifestyle practices were obtained. Subjects also underwent body anthropometry measurement and bone mineral density scan (hip and lumbar spine) using a dual-energy X-ray absorptiometry device. Six months after the first screening, similar investigations were carried out on the subjects. Results: During the follow-up session, 72 subjects were lost to follow up. Most of them were younger subjects with a lower awareness of healthy practices. A significant increase in knowledge, beliefs (p < 0.05), calcium supplement intake (p < 0.001), and dietary calcium intake (p = 0.036) and a reduction in coffee intake (p < 0.001) were found among subjects who attended the follow-up. In this study, the percentage of successful referrals was 41.86%. Subjects with osteoporosis were mostly prescribed alendronate plus vitamin D3 by medical doctors, and they followed the prescribed treatment accordingly. Conclusions: The bone health screening and education programmes in this study are effective in changing knowledge, beliefs, and practice regarding osteoporosis. The information is pertinent to policymakers in planning strategies to prevent osteoporosis and its associated problems among the middle-aged and elderly population in Malaysia. Nevertheless, a more comprehensive bone health education program that includes long-term monitoring and consultation is needed to halt the progression of bone loss.

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.

How much do patients know about osteoporosis? A survey among patients referred to the dual-energy X-ray absorptiometry exam

BACKGROUND

Inadequate osteoporosis education can make patients ill-informed concerning preventive and therapeutic interventions and creates misconceptions and unnecessary concerns about the disease.

AIM

Our study aimed to assess whether patients referred to the DXA exam by their general practitioner are informed about risk factors for osteoporosis, comparing patients who received a diagnosis of osteoporosis before the exam with those without this diagnosis.

METHODS

An observational single-center study was performed among patients who were referred to the DXA exam at the Osteoporosis Service of Marche Nord Hospital (Fano, Italy) between April and July 2019. Socio-demographic and clinical characteristics, awareness of suffering from osteoporosis, femoral and lumbar spine T-score and bone mineral density, risk of fracture and the I-FOOQ score were assessed.

RESULTS

A pilot study was carried out to validate the questionnaire in the Italian language (alpha-Cronbach 0.75). After that, a sample of 128 patients was enrolled (response rate 93.3%). Mean age was 66 ± 10.6 years, 95.6% were women. Overall, I-FOOQ mean score was 12 ± 3.5. Age, educational level, menopausal age, body mass index, femoral T-score were not associated with a better knowledge (p > 0.05). A comparison between who know to suffer from osteoporosis and others found no differences (12.2 ± 3.4 and 12 ± 3.5, respectively, p = 0.772). Effect of walking, recommended calcium intake, and familiar predisposition are the less known topics.

CONCLUSION

Patients who undergo the DXA exam are poorly informed about risk factors for osteoporosis, independently of age, education, bone mineral density and risk of fracture. Knowing to suffer from osteoporosis does not increase the likelihood to be informed. It is mandatory to improve the education that is provided to the patients, as there are effective non-pharmacological interventions to prevent and treat osteoporosis.

Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis

OBJECTIVE:

The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients.

METHODS:

The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators.

RESULTS:

In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group (P < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up (P < .05). After PKP operation, ZOL injections reduced the rate of RVF (P < .05). In the comparison of ODI scores, the experimental group improved compared with the control group (P < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group (P < .05).

CONCLUSION:

Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.

Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies

Background

Patients with low bone density or osteoporosis need information for effective prevention or disease management, respectively. However, patients may not be getting enough information from their primary care providers or other sources. Inadequate disease information leaves patients ill-informed and creates misconceptions and unnecessary concerns about the disease.

Objective

We systematically reviewed and synthesized the available literature to determine patient knowledge, beliefs, and concerns about osteoporosis and identify potential gaps in knowledge.

Methods

A systematic search was conducted for full-text qualitative studies addressing understanding, literacy, and/or perceptions about osteoporosis and its management, using Medline, EMBASE, Web of Science, Cochrane Library, CINAHL, ERIC, PsychINFO, Psyc Behav Sci Collec, and PubMed, from inception through September 2016. Studies were selected by two reviewers, assessed for quality, and themes extracted using the Joanna Briggs Institute data extraction tool. Thematic analysis was used to identify themes and subthemes.

Results

Twenty-five studies with a total of 757 participants (including 105 men) were selected for analysis out of 1031 unique citations. Selected studies were from Australia, Canada, Denmark, Norway, the United Kingdom, and the United States. Four main themes emerged: inadequate knowledge, beliefs and misconceptions, concerns about osteoporosis, and lack of information from health care providers. Participants had inadequate knowledge about osteoporosis and were particularly uninformed about risk factors, causes, treatment, and prevention. Areas of concern for participants included diagnosis, medication side effects, and inadequate information from primary care providers.

Conclusion

Although there was general awareness of osteoporosis, many misconceptions and concerns were evident. Education on bone health needs to reinforce areas of knowledge and address deficits, misconceptions, and concerns.

Men's experiences of having osteoporosis vertebral fractures: a qualitative study using interpretative phenomenological analyses

Men and women with vertebral fractures due to osteoporosis are treated differently by society and health care professionals. This can lead to inequalities in health care and affects how men with fractures view themselves as people. We need to raise awareness that men get these fractures as well as women.

INTRODUCTION

There is a lack of research exploring the experience of osteoporosis from the male perspective. This study was undertaken to explore and describe the experiences of men with vertebral fractures due to osteoporosis, including their perceptions of diagnosis, treatment and changes in their sense of self.

METHODS

The study consists of in-depth semi-structured interviews with nine male participants of the PROVE (Physiotherapy Rehabilitation for Osteoporotic Vertebral Fracture) study. Interviews were digitally audio recorded and fully transcribed. Data were coded in accordance with an interpretative phenomenological analysis approach to analyses.

RESULTS

Three main themes are presented. (i) Osteoporosis is considered an old women's disease. (ii) Men are diagnosed and treated differently than women in the NHS. Health care inequalities exist. (iii) Changes in self can occur in men after vertebral fracture/s due to osteoporosis.

CONCLUSIONS

Greater awareness that men get this condition is needed in both society in general and also by health care professionals who often do not expect osteoporosis to affect men. Approaches to diagnosis and treatment need to be considered and improved to ensure that they become appropriate and effective for men as well as women.

Low knowledge of osteoporosis and its risk factors in urban Indian adults from Pune city, India

OBJECTIVE

To assess knowledge of osteoporosis and its risk factors and to explore associations between knowledge and various sociodemographic factors in Indian adults.

DESIGN

Cross-sectional study. The Revised Osteoporosis Knowledge Test (OKT) was used to assess knowledge of osteoporosis. Four scores (OKT-total, range 0-32; OKT-exercise, range 0-20; OKT-nutrition, range 0-26; OKT-risk factors, range 0-14) were generated by giving 1 point to every correct answer and 0 points for incorrect or 'not known' answers.

SETTING

Tertiary-care hospital in Pune city, India.ParticipantsAdults aged 40-75 years (n 477; 234 males) enrolled through voluntary routine health checks and health camps.

RESULTS

Mean age of the study population was 54·6 (sd 9·5) years. Half the participants were aware of osteoporosis and could correctly define it. Women showed significantly higher median OKT-total and OKT-nutrition scores than men (P0·1).

CONCLUSIONS

Understanding about osteoporosis and its risk factors is low in the present cohort of Indian men and women. There is need to create awareness programmes aimed at both men and women especially targeting those with lower education, lower socio-economic status and no previous exposure to osteoporosis.

Osteoporosis prevention: where are the barriers to improvement in a French general population? A qualitative study

We conducted a qualitative study with French men and women in order to provide insight into individuals' experiences, behaviors, and perceptions about osteoporosis (OP) and OP care. The data showed that both sexes, but especially men, were unfamiliar with OP, did not always feel concerned, and mistrusted pharmacological treatments.

INTRODUCTION

To engage actively in osteoporosis (OP) prevention, people need to have basic knowledge about the disease. The aim of this qualitative study was to explore knowledge and representations of OP care and prevention among both men and women.

METHODS

Focus groups were conducted in the Rhône-Alpes Region, France, with women aged 50-85 years and men aged 60-85 years, with or without a history of fragility fracture and/or an OP diagnosis (respectively referred to as "aware" or "unaware"). A total of 45 women (23 "aware" and 22 "unaware" in 5 and 4 focus groups, respectively) and 53 men (19 "aware" and 34 "unaware" in 3 and 4 focus groups, respectively) were included. A thematic analysis of transcripts was performed to explore knowledge and representations about OP, risk factors, prevention, and treatment.

RESULTS

The data showed that both sexes, but especially men, had limited knowledge of OP and considered it as a natural aging process not related to fragility fractures. They generally did not feel concerned by OP and no important difference was observed between "aware" and "unaware" patients. Women expressed their fear of the disease, associated with aging and the end of life, while men considered it to be a women's disease only. Both sexes were aware of OP risk factors, but were suspicious towards treatments because of the associated side effects.

CONCLUSION

Understanding people's representation of OP might help to provide patients with relevant information in order to optimize their preventive behavior and decrease the burden of the disease.

Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly

BACKGROUND

Several educational intervention programs have been designed and developed to improve osteoporosis diagnosis and treatment. However, most of the prior studies focused on how educational intervention programs affected diagnosis and treatment of condition of osteoporosis. The purpose of this prospective and educational intervention study was to evaluate the changes in osteoporosis knowledge, osteoporosis self-efficacy, fall self-efficacy, physical exercise and changes in dietary pattern of calcium and vitamin D intake after osteoporosis education.

METHODS

From November 1, 2015 to August 31, 2016, 271 eligible candidates (who were over 50 years old and from 23 different community centers) were recruited through an announcement made by the public office, by two health care providers. The intervention involved an individualized education program to allow for differences in antecedent educational levels regarding several aspects of osteoporosis, including osteoporosis knowledge, osteoporosis self-efficacy, awareness of self-efficacy risk factors relating to an accidental fall and nutritional education (including the importance of sufficient calcium and vitamin D intake). The researchers revisited the community centers three months after the initial visit.

RESULTS

Of the 271 potential participants, 199 (73.4%; 43 men and 156 women) completed the education program and the second questionnaire. After education intervention, parameters including osteoporosis knowledge, osteoporosis self-efficacy and fall self-efficacy were improved (P < 0.0001). After education regarding percentage of calcium and vitamin D intake below recommended cut-offs, inadequate dietary calcium and vitamin D intake were decreased (P < 0.0001) from 89.4% (178/199) and 84.4% (168/199) to 79.9% (159/199) and 65.8% (131/199), respectively, at the three-month follow-up. (p = 0.038, p = 0.017).

CONCLUSIONS

This prospective intervention study demonstrated that education on osteoporosis knowledge and regular exercise programs could improve osteoporosis self- efficacy, fall self-efficacy and increase dietary calcium and vitamin D intake.

Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study

Low bone mineral density (BMD) and osteoporosis have become a public health problem. We found that non-Hispanic white, black, and Asian adults with extremely low education and personal income are more likely to have lower BMD. This relationship is gender-specific. These findings are valuable to guide bone health interventions.

INTRODUCTION

The evidence is limited regarding the relationship between socioeconomic status (SES) and bone mineral density (BMD) for minority populations in the USA, as well as the relationship between SES and BMD for men. This study explored and examined the relationship between SES and BMD by race/ethnicity and gender.

METHODS

Data (n = 6568) from the Louisiana Osteoporosis Study (LOS) was examined, including data for non-Hispanic whites (n = 4153), non-Hispanic blacks (n = 1907), and non-Hispanic Asians (n = 508). General linear models were used to estimate the relationship of SES and BMD (total hip and lumbar spine) stratified by race/ethnicity and gender. Adjustments were made for physiological and behavioral factors.

RESULTS

After adjusting for covariates, men with education levels below high school graduate experienced relatively low hip BMD than their counterparts with college or graduate education (p < 0.05). In addition, women reporting a personal annual income under $20,000 had relatively low hip and spine BMD than their counterparts with higher income level(s) (p < 0.05).

CONCLUSIONS

Establishing a conclusive positive or negative association between BMD and SES proved to be difficult. However, individuals who are at an extreme SES disadvantage are the most vulnerable to have relatively low BMD in the study population. Efforts to promote bone health may benefit from focusing on men with low education levels and women with low individual income.

Men's health-seeking behaviours regarding bone health after a fragility fracture: a secondary analysis of qualitative data

In our qualitative study, men with fragility fractures described their spouses as playing an integral role in their health behaviours. Men also described taking risks, preferring not to dwell on the meaning of the fracture and/or their bone health. Communication strategies specific to men about bone health should be developed.

INTRODUCTION

We examined men's experiences and behaviours regarding bone health after a fragility fracture.

METHODS

We conducted a secondary analysis of five qualitative studies. In each primary study, male and female participants were interviewed for 1-2 h and asked to describe recommendations they had received for bone health and what they were doing about those recommendations. Maintaining the phenomenological approach of the primary studies, the transcripts of all male participants were re-analyzed to highlight experiences and behaviours particular to men.

RESULTS

Twenty-two men (50-88 years old) were identified. Sixteen lived with a wife, male partner, or family member and the remaining participants lived alone. Participants had sustained hip fractures (n = 7), wrist fractures (n = 5), vertebral fractures (n = 2) and fractures at other locations (n = 8). Fourteen were taking antiresorptive medication at the time of the interview. In general, men with a wife/female partner described these women as playing an integral role in their health behaviours, such as removing tripping hazards and organizing their medication regimen. While participants described giving up activities due to their bone health, they also described taking risks such as drinking too much alcohol and climbing ladders or deliberately refusing to adhere to bone health recommendations. Finally, men did not dwell on the meaning of the fracture and/or their bone health.

CONCLUSIONS

Behaviours consistent with those shown in other studies on men were described by our sample. We recommend that future research address these findings in more detail so that communication strategies specific to men about bone health be developed.

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.

The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

OBJECTIVES

To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.

METHODS

The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥ 50 years of age and pharmacists were included in the study.

RESULTS

A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean ± SD accuracy rate was 0.60 ± 0.22 (range: 0.26-0.94). The Cronbach's α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman's rho: 0.761-0.990, p < 0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9 ± 8.7 vs 63.6 ± 17.4, p < 0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.

CONCLUSION

The OPAAT was found to be a valid and reliable instrument for assessing patient's knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.

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.

Chinese men's knowledge and risk factors of osteoporosis: compared with women's

Male osteoporosis is underappreciated. Little is known about men's knowledge of osteoporosis and how much men are at risk. This study surveyed men's knowledge of osteoporosis and their risk factors with reference to women in the primary care setting in Macau, China. A convenience sample of 302 men and 635 women aged 18 to 90 years completed questionnaires comprising the Osteoporosis Knowledge Assessment Tool and the One-Minute Osteoporosis Risk Test. Their risks of osteoporosis were assessed with the Osteoporosis Self-Assessment Screening Test. Men and women, who were aged 55 years or below, had similarly limited knowledge of osteoporosis. People aged above 55 years had significantly less knowledge; men had less knowledge than women only in this age-group. If questions specific to women or menopause were excluded, men had similar knowledge as women. A higher proportion of men than women had risk factors as more men consumed alcohol or smoked tobacco. Similar proportions of men and women reported a loss of 1 inch in body height after age 40. After age 55, 29.2% men were at medium to high risk of osteoporosis. This study concludes that health education and primary prevention of osteoporosis should be promoted to men starting in middle-age.

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.

Knowledge of osteoporosis among men in the primary care setting

OBJECTIVES

Osteoporosis has been often viewed as a disease affecting women; however, men are at risk for osteoporosis, and the mortality after hip fracture in men older than 75 years of age is significantly higher than in women. We aimed to assess knowledge of osteoporosis and its risk factors in men.

METHODS

A questionnaire assessing knowledge of osteoporosis was presented to 136 male patients randomly in Internal Medicine and Family Practice clinics at Saint Joseph Hospital.

RESULTS

A total of 136 men agreed to fill in the questionnaire. Only 130 patients who completed the entire questionnaire were included in the data analysis. Twenty-three percent of men surveyed had never heard about osteoporosis. Thirty-nine percent were unaware that osteoporosis is directly responsible for disabling hip fractures. Sixty-seven percent did not know that a potential outcome of hip fracture is death. Only 38% recognized that smoking is a risk factor, 20% knew that excessive caffeine intake can put them at risk, and 35% realized that excessive alcohol intake is a risk factor. Only 21% could correctly identify the calcium-rich foods among the choices. There was a positive relationship (P < 0.05) between receiving an official discussion with a physician regarding osteoporosis and the actual score on the "knowledge of osteoporosis" questionnaire.

CONCLUSION

A significant percentage of men are unaware of the complications and risk factors for osteoporosis. Receiving educational information about osteoporosis from a physician should be considered at an early stage, especially for those patients with modifiable risk factors.

Increased osteoblast and osteoclast activity in female senescence-accelerated, osteoporotic SAMP6 mice during fracture healing

BACKGROUND

Previous studies have shown that fracture healing depends on gender and that in females, ovariectomy-induced osteoporosis impairs the healing process. There is no information, however, whether the alteration of fracture healing in osteoporosis also depends on gender.

MATERIALS AND METHODS

Therefore, we herein studied fracture healing in female and male senescence-accelerated osteoporotic mice, strain P6 (SAMP6), including biomechanical, histomorphometric, and protein biochemical analysis.

RESULTS

Bending stiffness was reduced in male and female SAMP6 mice compared with senescence-resistant strain 1 (SAMR1) controls. This was associated with elevated serum concentrations of tartrate-resistent acid phosphatase form 5b (TRAP) in both female and male SAMP6 mice. Callus size, however, was significantly larger in female SAMP6 mice compared with male SAMP6 mice and female SAMR1 controls. This indicates a delayed remodeling process in female SAMP6 mice. The delay of callus remodeling in female SAMP6 mice was associated with a significantly higher osteoprotegerin (OPG) callus tissue expression and increased serum concentrations of osteocalcin (OC) and deoxypyridinoline (DPD), indicating elevated osteoblast and osteoclast activities.

CONCLUSION

The present study shows that remodeling during fracture healing in female, but not in male, SAMP6 mice is delayed, most probably due to an increased osteoblast and osteoclast activity.