Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 1008
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 8  |  Page : 3089-3093  

Evaluation of knowledge about osteoporosis risk factors among adults above 40 years of age in Hafar Al.Batin Region, Saudi Arabia


General Practitioner, Ministry of Health, Hafar Al-Batin, Saudi Arabia

Date of Submission22-Feb-2021
Date of Decision31-Mar-2021
Date of Acceptance06-May-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Dr. Reem I Alrashidy
General Practitioner, Ministry of Health, Hafar Al-Batin
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_386_21

Rights and Permissions
  Abstract 


Background: Osteoporosis is a growing public health issue that is prevalent among the Saudi Arabian population. Several risk factors for the disease have been identified and could be modified using preventive strategies, including increasing awareness about the disease in susceptible individuals. Methods: A cross-sectional study was conducted using interview-based questionnaires to evaluate knowledge of osteoporosis risk factors in a sample of 513 Saudi participants attending primary health care centers (PHCCs) in the Hafar Al-Batin region, Saudi Arabia. The analysis was conducted using the Statistical Package of Social Sciences (SPSS) Version 21. Findings: A total of 513 participants were surveyed (78.8% female and 21.2% male). The study population had an overall good knowledge about osteoporosis risk factors. The analysis detected significant associations between the level of knowledge and the following parameters: sex, marital status, employment status, and education level (P < 0.05). Conclusions: The majority of the study cohort had good knowledge of osteoporosis risk factors. The male participants had significantly more knowledge compared to females. Married people had better knowledge scores compared to unmarried ones. Employed and educated participants had significantly better knowledge compared to unemployed and those with an education level less than college. The involvement of primary health care utilizers by physicians and health authorities is highly recommended to increase awareness of osteoporosis.

Keywords: Knowledge, osteoporosis, risk factors, Saudi Arabia


How to cite this article:
Alrashidy RI. Evaluation of knowledge about osteoporosis risk factors among adults above 40 years of age in Hafar Al.Batin Region, Saudi Arabia. J Family Med Prim Care 2021;10:3089-93

How to cite this URL:
Alrashidy RI. Evaluation of knowledge about osteoporosis risk factors among adults above 40 years of age in Hafar Al.Batin Region, Saudi Arabia. J Family Med Prim Care [serial online] 2021 [cited 2021 Sep 27];10:3089-93. Available from: https://www.jfmpc.com/text.asp?2021/10/8/3089/324724




  Introduction Top


Osteoporosis is a skeletal disease that is characterized by low bone mass and gradual weakening of bone microarchitecture. It causes bones to become porous and fragile, leading to an increased risk of fractures even with minor trauma.[1] Osteoporosis is a growing health issue that is associated with mortality and reduced quality of life,[2] and it has been recognized as the second most crucial health condition in the developed world following heart diseases.[3] The lifetime risk for osteoporosis-related fractures among women is 30–50%.

As per the International Osteoporosis Foundation, around one in every ten women aged 60 years suffers from osteoporosis, which tends to affect as much as one in every five women at age 70 and two in every five women at age 80 with significant age-related risk in the men population.[4] In Saudi Arabia, 21% of men have osteoporosis,[5] and among women, the prevalence rate has been estimated to be 24% in the age group 50–59 years, 62% in the age group 50–69 years, and 74% in the age group 70–79 years.[6]

It is imperative to screen for potential knowledge gaps in the public understanding of osteoporosis, which may hinder the process of early prevention in susceptible societies. The Saudi Ministry of Health published a national strategy (2018) for osteoporosis prevention and management targeting primary health care providers and family physicians to improve the disease's early detection and treatment.[7] There is growing evidence that knowledge about osteoporosis affects preventive behavior in people with increased risk of the disease.[8],[9] Despite these facts, several authors investigated the knowledge of osteoporosis and its risk in different countries and highlighted a lack of knowledge among the public and even medically-oriented populations.[10],[11],[12],[13],[14]

The diagnosis of osteoporosis is based on the presence of fragility fractures or bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DEXA). A T-score value of ≤ −2.5 is diagnostic of osteoporosis considering the local values of the reference population.[15] Non-pharmacological means, including lifestyle changes, medications, and prevention of falls, are usually the first-line approach for newly diagnosed patients with osteoporosis.[16] Research has highlighted several risk factors for osteoporosis; some of them are modifiable, and hence, are the target of preventive strategies. These risk factors include calcium and vitamin D deficiency, sedentary lifestyle, smoking, and obesity.[17],[18] This study aims to evaluate the knowledge about osteoporosis risk factors among people over 40 years in the eastern province of Saudi Arabia.


  Materials and Methods Top


Study design, settings, and population

This observational cross-sectional study was conducted between December 6 and December 24, 2020, and considered all individuals attending primary health care centers (PHCCs) in the Hafar Al-Batin region, the eastern province of Saudi Arabia. The study included Saudi male and female individuals who were 40 years old or above, ambulatory, able to understand the Arabic language, and willing to give consent to participate. We excluded patients with chronic diseases and those coming to the emergency department, patients aged below 15 or above 75 years, individuals with special needs, and those who were not willing to take part in the study. Incomplete questionnaires were also excluded.

The study was reviewed and approved by the National Committee of Bioethics (NCBF) at King Abdulaziz City for Science and Technology (KACST) No. 1005335 on 26/3/2021.

Sample size and sampling procedures

Assuming an awareness rate of 50%, 95% confidence interval, 4% margin of error, and a total approximate population of 5,00,000 individuals, the minimum sample required was calculated to be 600. The sample was stratified to eight PHCCs in the region, with 75 participants from each center.

Data collection and quality control

The directorate of health affairs in Hafar Al-Batin assigned a trained nurse from each center to collect data for this research. The questionnaire was obtained from different studies in the literature about osteoporosis risk factors.[9] All individuals who gave verbal consent to participate in the current investigation were interviewed by the data collectors within 10–20 minutes, assuring complete confidentiality and anonymity of their responses.

The questionnaire included data regarding respondents' sex, age, marital status, education, etc., The main part of the questionnaire covered 10 common risk factors with possible answers of yes or no, stated in affirmative and negative sentences to avoid suggestive questions.

A score of 1 was given to each correct response, and a score of 0 was given to incorrect responses. The total knowledge score ranged from 0 to 10. To avoid arbitrary cut-off points, means and standard deviations were used to determine the knowledge level.

Data management and analysis

The questionnaire papers were verified and entered at home and then merged into one device. Categorical variables were described by frequencies and percentages, while numerical variables were presented as a mean and standard deviation. The analysis of variance (ANOVA) and independent samples t-test were run to determine the differences between the means. The significance level was set at P < 0.05. The analysis was conducted using Statistical Package of Social Sciences (SPSS) Version 20 (SPSS Inc., Chicago, IL).


  Results Top


A total of 603 respondents agreed to participate in the current survey; 513 (85.1%) provided complete responses. The sample consisted of 266 (51.9%) participants aged between 40 and 50 years. There were 404 female respondents comprising 78.8% of the study sample. The majority (72.5%, n = 372) of study population had no job and lacked formal education (53.2%, n = 273). [Table 1] lists the baseline characteristics of the sample.
Table 1: Baseline characteristics of the sample (n=513)

Click here to view


[Table 2] shows responses to questions assessing osteoporosis knowledge among the study group. Participants performed well in all items of osteoporosis risk factors except sex difference, as 155 (69.8%) participants incorrectly thought osteoporosis was more prevalent in the male population compared to the female [Table 2].
Table 2: Knowledge about osteoporosis risk factors (n=513)

Click here to view


Questions regarding risk factors of osteoporosis were summed up to a total of 10 points, and mean scores were compared between different variables. As shown in [Table 3], knowledge about osteoporosis differed between the study subgroups. These differences were statistically significant with respect to sex (P = .009), marital status (P = .000), employment (P = .001), and education (P = 0.014).
Table 3: Osteoporosis knowledge among different sample characteristics

Click here to view



  Discussion Top


The study adds to the literature on osteoporosis in Saudi Arabia, highlighting relevant sociodemographic factors related to the basic public knowledge of osteoporosis. The present investigation's objective was to evaluate knowledge of osteoporosis risk factors in a sample of the general population of the eastern province of Saudi Arabia. The selection of the general population as study subjects is justified by the fact that they are understudied and may have knowledge gaps that, if addressed, would facilitate better prevention policies. Our analysis showed good knowledge about osteoporosis' common risk factors as the respondents scored 8.6 out of 10 on the knowledge questionnaire. Important correlates of the participants' scores and their implications to osteoporosis prevention are discussed.

Previous research into knowledge and practice of osteoporosis risk factors among the general population revealed conflicting findings depending on the sociodemographic variables of the population under investigation.[19],[20] In one review by Chin et al.,[12] 34 studies from around the world found a noticeable lack of knowledge of osteoporosis among young adults and adolescents. Even in populations that are hypothetically more likely to have good knowledge of osteoporosis, such as medical students, some authors reported under desired levels of osteoporosis-related knowledge.[13],[14],[21] Another study revealed a lack of awareness of osteoporosis among postmenopausal women—a specially important population with an increased risk of osteoporosis.[9] In this study, participants had adequate overall knowledge about specific risk and preventive factors of osteoporosis. This finding is consistent with the studies from the central and southern provinces of Saudi Arabia.[2],[22] Some authors from Saudi Arabia demonstrated lower levels of awareness of the disease among middle-aged and older women.[23] This disparity in osteoporosis awareness could be attributed to the sampling characteristics and study design.

Osteoporosis is well-known to increase susceptibility to fractures and leads to more than 8.9 million fractures worldwide annually.[10] In this analysis, three-quarters of the respondents appreciated the relationship between osteoporosis and fractures. Similar percentages were reported in a study from southern India.[9] Knowledge about the risk of fracture in patients with osteoporosis is critical to disease prevention and may be associated with poor health outcomes in the affected patients.[24] It is noteworthy that one in four of our sample still ignore the fact that osteoporosis is a risk factor for fractures. This could be simply improved by efforts directed to public education.

One exception to the overall good osteoporosis knowledge in this study was the finding of 69.8% of the participants who agreed to the false statement that osteoporosis affects men more than women. In general, women are more prone to osteoporosis compared to men.[11] This is partially attributable to the differences in BMD, bone size, and bone strength between men and women.[25] Although sex is an unpreventable risk factor for osteoporosis, knowledge about sex differences could help as a preventive measure of the disease in the more susceptible sex.

Calcium and vitamin D are important for bone strength as they shape the bone mineral matrix in the form of calcium phosphate. Vitamin D regulates calcium homeostasis. Adequate sunlight exposure is essential for the prevention and management of vitamin D deficiency.[17] These three principles of bone health were evaluated in the current study, and participants showed good awareness about their link to osteoporosis.

Postmenopausal women are especially at an increased risk of osteoporosis given the role of estrogen deficiency in bone loss. It is estimated that postmenopausal osteoporosis affects 200 million women worldwide; of them, 30–50% are predicted to have a clinical fracture.[26] Hormone replacement therapy is a rational and effective approach to osteoporosis among peri- and early postmenopausal women.[27] We found that most participants in this study were aware of the role of hormone replacement therapy (86.5%) and menopause in osteoporosis pathophysiology of osteoporosis (92.2%).

In this study, the male sex was associated with better knowledge about osteoporosis. Other studies reported conflicting findings. In a community-based study, Alamri et al.[28] found that women were more aware of osteoporosis-related knowledge and practice than did men. They explained this association by the fact that the women population may be more exposed to health education by care providers and, being at increased risk, may be the focus of osteoporosis awareness campaigns. However, another study on the general Iranian population found no sex difference in osteoporosis knowledge. The reason for such disparities is mainly methodological and is unlikely to be related to gender type per se.

In agreement with most previous works on osteoporosis awareness, education had a significant role in determining the level of knowledge among the study subjects. Compared with participants with an education level less than college (8.7 ± 1.3), those with college qualifications or more scored higher on the knowledge questionnaire (8.9 ± 0.6). These findings support what has been found by previous works.[28],[29],[30],[31] Education is well-known to affect cognition and health-seeking behaviors, and educated people are more likely to be health-oriented, have informed health-related behaviors, and have access to accurate health information.[28] Moreover, we found employed participants (8.9 ± 0.5) to be more knowledgeable than unemployed participants (8.5 ± 1.5). This is indirectly related to the education status as most educated people in Saudi Arabia are likely to be employed.

Even though our participants scored well on most questionnaire items, there still are some knowledge gaps to be improved, especially knowledge about sex differences in osteoporosis incidence. Better knowledge of the disease could be achieved through education programs directed to the public. Using the Health Belief Model, if individuals appreciated the likelihood of being affected by certain diseases, they will be more likely to adhere to preventive measures of these diseases. This applies well to osteoporosis as a prevalent condition among middle-aged and elderly Saudis. Reaching the public is now feasible at the lowest possible costs through the Internet and social media. We, therefore, suggest increasing the public awareness of osteoporosis risk factors using free online courses and other learning materials that are designed to be evidence-based and easily delivered to the general population.

Limitations

The findings should be interpreted with caution, considering some limitations to the present study, namely the cross-sectional nature of study design and the use of a self-reported questionnaire. Using an interview-based study is advised in future studies aiming at a more detailed and objective overview of the subject.


  Conclusion Top


Overall, the findings of the current study demonstrated that the majority of the study subjects had good knowledge of osteoporosis. Some participants' characteristics, including male sex, marital status, education, and being employed, were found to be associated with better osteoporosis-related information. We encourage involving the public in health promotion programs and patient education, focusing on osteoporosis risk factors and prevention methods.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kadam NS, Chiplonkar SA, Khadilkar A V, Khadilkar VV. Prevalence of osteoporosis in apparently healthy adults above 40 years of age in Pune City, India. Indian J Endocrinol Metab 2018;22:67-73.  Back to cited text no. 1
    
2.
Barzanji AT, Alamri FA, Mohamed AG. Osteoporosis: A study of knowledge, attitude and practice among adults in Riyadh, Saudi Arabia. J Community Health 2013;38:1098-105.  Back to cited text no. 2
    
3.
Kanis JA. Assessment of osteoporosis at the primary health care level. World Health 2007;339. Available from: http://www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf.  Back to cited text no. 3
    
4.
International osteoporosis foundation (IOF). Osteoporosis facts and statistics Switzerland: International Osteoporosis Foundation; 2015 [Internet]. 2015. Available from: http://www.iofbonehealth.org/facts-statistics#category-14.  Back to cited text no. 4
    
5.
El-Desouki MI, Sulimani RA. High prevalence of osteoporosis in Saudi men. Saudi Med J 2007;28:774-7.  Back to cited text no. 5
    
6.
El-Desouki MI. Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry. Saudi Med J 2003;24:953-6.  Back to cited text no. 6
    
7.
Ministry of Health. National Plan for Osteoporosis Prevention and Management in the Kingdom of Saudi Arabia. [Internet]. 2018. Available from: https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/Publications-2019-04-23-001.aspx.  Back to cited text no. 7
    
8.
Gopinathan NR, Sen RK, Behera P, Aggarwal S, Khandelwal N, Sen M. Awareness of osteoporosis in postmenopausal Indian women: An evaluation of Osteoporosis Health Belief Scale. J Midlife Health 7:180-4.  Back to cited text no. 8
    
9.
Senthilraja M, Cherian K, Jebasingh F, Kapoor N, Paul T, Asha H. Osteoporosis knowledge and beliefs among postmenopausal women: A cross-sectional study from a teaching hospital in southern India. J Fam Med Prim Care 2019;8:1374.  Back to cited text no. 9
    
10.
Hammoudeh S, Abdelrahman MH, Chandra P, Hammoudeh M. An assessment of patients' knowledge of osteoporosis in Qatar: A pilot study. Qatar Med J 2015;2015:13.  Back to cited text no. 10
    
11.
Janiszewska M, Żołnierczuk-Kieliszek D, Kulik T, Dziedzic MA, Barańska A, Kryk A. Men's knowledge about osteoporosis and its risk factors. Menopausal Rev 2016;3:148-55.  Back to cited text no. 11
    
12.
Chan C, Mohamed N, Ima-Nirwana S, Chin K-Y. A review of knowledge, belief and practice regarding osteoporosis among adolescents and young adults. Int J Environ Res Public Health 2018;15:1727.  Back to cited text no. 12
    
13.
Ghaffari M, Nasirzadeh M, Rakhshanderou S, Hafezi Bakhtiari M, Harooni J. Osteoporosis-related knowledge among students of a medical sciences university in Iran: Calcium intake and physical activity. J Med Life 2015;8:203-8.  Back to cited text no. 13
    
14.
Bilal M, Haseeb A, Merchant AZ, Rehman A, Arshad MH, Malik M, et al. Knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Pakistan. Asia Pac Fam Med 2017;16:6.  Back to cited text no. 14
    
15.
Khaltaev N, Pfleger BA. On behalf of WHO, WHO Scientific Group on the Assessment of Osteoporosis at the Primary Health Care Level meeting. Summary Meeting Report, Brussels, Belgium, 5-7 May, 2004. Available from: http://www.who.int/chp/topics/Osteoporosis.pdf.  Back to cited text no. 15
    
16.
Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137-41.  Back to cited text no. 16
    
17.
Muñoz-Garach A, García-Fontana B, Muñoz-Torres M. Nutrients and dietary patterns related to osteoporosis. Nutrients 2020;12. doi: 10.3390/nu12071986.  Back to cited text no. 17
    
18.
Ross PD. Osteoporosis. Frequency, consequences, and risk factors. Arch Intern Med 1996;156:1399-411.  Back to cited text no. 18
    
19.
Bouvard B, Annweiler C, Legrand E. Osteoporosis in older adults. Jt Bone Spine 2021;88:105135. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1297319X21000075.  Back to cited text no. 19
    
20.
Al Hamam N, Al-Moaibed G, Alfayez E, Alfayez E, Al-Mubaddil M, Alramadhan N. Prevalence and risk factors for osteoporotic fracture among adults with comorbidities in Al-Ahsaa, Saudi Arabia. J Fam Med Prim Care 2020;9:877-82.  Back to cited text no. 20
    
21.
Khired ZA, El-Akabawy G, Alsebail RA, Alotaibi AE, Alblowi NS, Alaradi HK, et al. Osteoporosis knowledge, attitudes, and practices among female Princess Nourah University students in Riyadh, Saudi Arabia. Arch Osteoporos 2021;16:1.  Back to cited text no. 21
    
22.
Darout IA, Alamir A, Sultana S. Osteoporosis knowledge and related health behavior among women in Jazan Region, Kingdom of Saudi Arabia. J Contemp Dent Pract 2017;18:378-82.  Back to cited text no. 22
    
23.
Al-Shahrani FM, Al-Zahrani AM, Al-Haqawi AI. Knowledge of osteoporosis in middle-aged and elderly women. Saudi Med J 2010;31:684-7.  Back to cited text no. 23
    
24.
Sujic R, Gignac MA, Cockerill R, Beaton DE. Factors predictive of the perceived osteoporosis-fracture link in fragility fracture patients. Maturitas 2013;76:179-84.  Back to cited text no. 24
    
25.
Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res 2011;469:1900-5.  Back to cited text no. 25
    
26.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17:1726-33.  Back to cited text no. 26
    
27.
Gambacciani M, Levancini M. Featured Editorial Hormone replacement therapy and the prevention of postmenopausal osteoporosis. Menopausal Rev 2014;4:213-20.  Back to cited text no. 27
    
28.
Alamri FA, Saeedi MY, Mohamed A, Barzanii A, Aldayel M, Ibrahim AK. Knowledge, attitude, and practice of osteoporosis among Saudis. J Egypt Public Health Assoc 2015;90:171-7.  Back to cited text no. 28
    
29.
Al Attia HM, Abu Merhi AA, Al Farhan MM. How much do the Arab females know about osteoporosis? The scope and the sources of knowledge. Clin Rheumatol 2008;27:1167-70.  Back to cited text no. 29
    
30.
Yu S, Huang Y-C. Knowledge of, attitudes toward, and activity to prevent osteoporosis among middle-aged and elderly women. J Nurs Res 2003;11:65-72.  Back to cited text no. 30
    
31.
Bubshait D, Sadat-Ali M. Economic Implications of osteoporosis-related femoral fractures in Saudi Arabian society. Calcif Tissue Int 2007;81:455-8.  Back to cited text no. 31
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
   
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
   Materials and Me...
  Results
  Discussion
  Conclusion
   References
   Article Tables

 Article Access Statistics
    Viewed116    
    Printed0    
    Emailed0    
    PDF Downloaded17    
    Comments [Add]    

Recommend this journal