|Year : 2023 | Volume
| Issue : 1 | Page : 22-25
Assessment of osteoporosis knowledge and awareness among Saudi population using the Osteoporosis Knowledge Assessment Tool
Mohammad Abdullah Almalki1, Abdulrahman Hamoud Almalki2, Hanan Helmi Almahdi3, Abdulsalam Hassan Alshehri4, Ruba Salem Alayed5, Mohammad Abdullah Almalki6, Omar S Alsufyani7
1 Spine Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
2 Department of Orthopedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
3 Department of Orthopedics, King Fahad Hospital, Medina, Saudi Arabia
4 Department of Emergency, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
5 Department of Neurology, King Abdullah Specialized Children's Hospital, NGHA, Riyadh, Saudi Arabia
6 Department of Inpatient, Erada Complex for Mental Health, Riyadh, Saudi Arabia
7 General Practitioner, Jazan Military Hospital, Jazan, Saudi Arabia
|Date of Submission||18-Mar-2023|
|Date of Decision||06-May-2023|
|Date of Acceptance||09-May-2023|
|Date of Web Publication||07-Aug-2023|
Abdulrahman Hamoud Almalki
Department of Orthopedics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: Osteoporosis is a skeletal disorder that is characterized by low bone mass, micro-architectural disruption, and skeletal fragility, resulting in an increased risk of fracture. Osteoporosis imposes a great threat to public health as it is a major cause for fractures that are associated with high morbidity and mortality, such as hip and vertebral fractures. It is considered a preventable disease, thus in this study, we are aiming to assess the knowledge of the individuals to be able to address the insufficient awareness among the society.
Materials and Methods: This is a quantitative, descriptive cross-sectional study that was conducted in the capital city of Riyadh, Saudi Arabia. Arabic self-reported questionnaire was used consisted of sociodemographic questions and the Osteoporosis Knowledge Assessment Tool.
Results: With a sample of 451, only 15.2% of the participants were aware about osteoporosis. A total of 42.8% believed that it is easy to judge if you were at risk of developing osteoporosis from signs and symptoms and only 9.3% of participants know that osteoporosis does not usually cause symptoms such as pain before fractures.
Discussion: Major lack and inadequacy were found among our sample regarding the knowledge of osteoporosis which correlates with previous studies. Significant increase in the awareness level of Chinese society was noticed between 2011 and 2018 from 30.7% to 67.8%, respectively.
Conclusion: Knowledge of osteoporosis among Saudi society is way behind the required level. Raising the awareness of the individual will help to decrease the prevalence of osteoporosis and osteoporotic fractures leading to decrease in morbidity and mortality, burden, and cost.
Keywords: Awareness, knowledge, osteoporosis
|How to cite this article:|
Almalki MA, Almalki AH, Almahdi HH, Alshehri AH, Alayed RS, Almalki MA, Alsufyani OS. Assessment of osteoporosis knowledge and awareness among Saudi population using the Osteoporosis Knowledge Assessment Tool. Saudi J Sports Med 2023;23:22-5
|How to cite this URL:|
Almalki MA, Almalki AH, Almahdi HH, Alshehri AH, Alayed RS, Almalki MA, Alsufyani OS. Assessment of osteoporosis knowledge and awareness among Saudi population using the Osteoporosis Knowledge Assessment Tool. Saudi J Sports Med [serial online] 2023 [cited 2023 Sep 22];23:22-5. Available from: https://www.sjosm.org/text.asp?2023/23/1/22/383097
| Introduction|| |
Osteoporosis is defined as a skeletal disorder that is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in an increased risk of fractures. The clinical diagnosis of osteoporosis can be made if a fragility fracture was present, particularly at the spine, hip, wrist, humerus, rib, or pelvis. Fragility fractures are fractures that occur from a fall from a standing height or less, without any major trauma. In cases where fragility fractures did not occur, bone mineral density assessment by a dual-energy X-ray absorptiometry is the gold standard for the diagnosis of osteoporosis. According to the World Health Association, a T-score ≥−1 standard deviation is considered normal, a T-score between − 1 and − 2.5 standard deviation is considered low bone mass or osteopenia, while a T-score ≤−2.5 standard deviation is considered osteoporosis.
Individuals with osteoporosis have the highest risk of fracture, but there are more fractures in osteopenic patients as the patients in this category are comparatively more. Risk factors for fractures include advanced age, previous fracture, long-term glucocorticoid therapy, low body weight, family history of hip fracture, cigarette smoking, and excess alcohol intake. The two most important factors in the development of osteoporosis in both men and women are advanced age and estrogen deficiency. Most bone loss occurs after the age of 65. Men, however, are less likely to develop osteoporosis than women as they gain more bone density during puberty and their bone loss during aging is less owing to the fact that they do not experience the abrupt decline in estrogen that happens to women.
Osteoporosis imposes a great threat to public health as it is a major cause for fractures that are associated with high morbidity and mortality, such as hip and vertebral fractures. Osteoporotic hip fractures are associated with a mortality rate that ranges from 10% to 45% in the 1st year and from 1.9% to 42% for osteoporotic vertebral fractures. In North America, Europe, Japan, and Australia, osteoporosis in the hip and spine affects 49 million adults with 9%–38% in women and 1%–8% in men. In 2012, a study in Saudi Arabia found that of 5160 women between 50 and 79 years of age, 36.6% were osteopenic and 34% were osteoporotic, while in men, the prevalence was 46.3% for osteopenia and 30.7% for osteoporosis. Another study conducted on Saudi men found that the prevalence of osteoporosis in the lumbar spine and the femoral neck to be 21.4% and 11.4%, respectively, more commonly in men above the age of 50. In postmenopausal Saudi women, a study estimated that 33.4% of women aged between 50 and 59 were osteoporotic while 24.3% were osteopenic. In women aged between 60 and 69 years, osteopenia accounted for 27% and while osteoporosis prevalence increased to 62%, in women aged between 70 and 79 years, osteopenia affected 21.5%, while 73.8% of them had osteoporosis. Another study explored the prevalence of osteopenia and osteoporosis among premenopausal women and found it to be 24.8% and 4.3%, respectively, with a significant increase with age.
For the economic impact of osteoporotic fractures, treatment in the US had an estimated cost of $17 billion in 2005, while it was estimated to cost €37 billion in Europe in 2010. In Saudi Arabia, the direct cost of osteoporotic hip fracture management was estimated to be SR 2.09 million, which is not inclusive of indirect costs or other types of osteoporotic fractures.
To a certain extent, studies found that osteoporosis can be considered a preventable disease which emphasizes the importance of raising awareness in our society, so in our study, we are aiming to assess the knowledge of the individuals to be able to address the insufficient awareness among the society.
| Materials and Methods|| |
This is a quantitative, descriptive, cross-sectional study that was conducted in the capital city of Riyadh, Saudi Arabia, over a period from November 2021 to March 2022. The convenience sampling technique was used and the sample size was calculated using Raosoft, Inc®, at a 5% margin of error and 95% level of confidence, a minimum of 385 subjects to reach statistically significant results. The data were collected through an online self-reported Arabic questionnaire, consisted of two sections. The first section dealt with the sociodemographic characteristics of the participants as age, education, and marital status. The second one was comprised twenty questions that aim to assess the participants knowledge about osteoporosis, the participants answers by true or false to those questions, if the participants gets 60% of the questions correct, they are considered aware. The Osteoporosis Knowledge Assessment Tool (OKAT) was used and it has been proved to be both a valid and reliable tool in both Arabic and English versions according to the literature., Ethical approval was obtained from the Research Ethics Committee.
After obtaining the IRB approval, a pilot study was conducted to rule out any ambiguity of the data form, test the logistics of data collection, suitability/clarity of the data collection tool, and estimation of time needed for data collection. Collected data were coded in Excel sheet and then transferred to SPSS, version 24,0 IBM company, New York, USA, which was used for data analysis, t-test for independent samples and Chi-square were used to test statistical significance; descriptive statistics (mean, standard deviation, frequencies, and percentages) were used to describe the quantitative and categorical variables.
| Results|| |
In our study, a sample of 451, 69.5% (310) of which were females, 51.9% of the participants were between 20 and 29 years of age, 14.6% where aged 10–19 years, 13.1% aged 40–49 years, and the minority was 1.1% for participants above 60 years. Majority of the sample, 93.8% (423) were Saudis while 6% were non-Saudis.
The bachelor degree holders were a majority of the participants with a percentage of 61.6%.
One question was about whether the participants exercise more than 30 min/week or not, the responses varied, where 243 of them (53.9%) reported that they do not exercise and 208 (46.1%) exercised more than 30 min/week.
The participants were asked about their history of fractures, 100 participants had a positive history which accounts for 22.2%. Seven percent of the participants were diagnosed with osteoporosis, whereas 58.1% had a positive family history of bone fractures or osteoporosis.
OKAT was used in our study which is a series of questions that had true, false, or I do not know answers and the participants were given points for each right answer they got. The participants who got 60% or more of the questions right we were considered aware. Only 15.2% of the participants were aware about osteoporosis. The average percentage of right answers was 40%.
The majority of the participants were aware that osteoporosis leads to an increased risk of fractures with a percentage of 95.6.
A total of 42.8% believed that it is easy to judge if you were at risk of developing osteoporosis from signs and symptoms.
Only 9.3% of participants know that osteoporosis does not usually cause symptoms such as pain before fractures.
Sixty-six percentage of the participants believed that the incidence of osteoporosis among women is more common than men.
Cigarette smoking can contribute to developing osteoporosis was believed to be true by 54.1%.
For race and osteoporosis, 60.3% of the sample did not know whether Caucasian females have higher risk of fractures than other races or not.
Around two-thirds of the participants believed that by the age of 80, most women will suffer from osteoporosis.
Only 25.3% of the participants thought that women at the age of 50 and over are expected to get bone fractures.
Half of the participants, 55.9% believed that the presence of a family history of osteoporosis increases the risk of being osteoporotic.
On the other hand, 42.4% of the participant believe that any type of physical activity is useful for osteoporosis patients.
The fact that it is true that you can get your daily dose of calcium by drinking 2 cups of milk a day was believed by 62.3% of the participants.
"For people who cannot consume dairy products, sardines, and broccoli are good alternatives as a source of calcium” was believed to be true by 65% of the participants.
On the other hand, 59.6% of the participants believed that supplementary calcium pills alone cannot prevent bone loss and osteoporosis. A quarter of the participants think it is true that alcoholic beverages have little effect on osteoporosis when consumed in moderation and consuming a salt-rich diet is a risk factor for developing osteoporosis was believed by 30.2%.
Forty-six participants did not know if there is an effective treatment for osteoporosis available in Saudi Arabia.
| Discussion|| |
Osteoporosis yields tremendous patients health-care costs for not only the treatment but also high social costs because of potential dependency. In this study, we aim to further address the areas of inadequacy in the knowledge and awareness of osteoporosis among the Saudi community.
A strong public knowledge of osteoporosis among society is a goal of any modern community, information about the Saudi population perception of osteoporosis through OKAT could guide primary prevention programs to target certain populations and specific knowledge deficits in the community. The purpose of this study was to evaluate and assess the Saudi population level of knowledge about osteoporosis. Major lack and inadequacy were found among our sample regarding the knowledge of osteoporosis with only 15.2% of the participants being aware about osteoporosis which does correlate with previous studies that stated that Saudi population is not aware of osteoporosis., Alshareef et al. found that 79.4% of the sample have insufficient information regarding osteoporosis. Among young Pakistani females, 67% think that osteoporosis has signs and symptoms which is a higher percent comparing to 42.8% in our study who believed that it is easy to judge if you were at risk of developing osteoporosis from signs and symptoms. For the knowledge regarding diet and osteoporosis, our results were similar to what Alshareef et al. found in their study. China can give us a great example of how awareness levels can be improved, in 2011 a Chinese study found that only 30.7% had heard of osteoporosis, and only 18.5% had heard of osteoporotic fracture. A newer study done in 2018 showed a significant improvement in osteoporosis awareness among Chinese society as osteoporosis awareness score for disease definition was 77.7%, diagnosis 49.6%, risk factors 49.2%, treatment 60.5%, and prevention 69.9%. The overall awareness score was 67.8%.,
The health belief model suggests that people will adhere to and follow preventive measures when they feel that they are susceptible to disease and also perceive that this disease will affect their lives. Thus, it is important that health-care practitioners orient their patients about the potentially debilitating complications of osteoporosis such as hip fractures.
It is important to emphasize on physical activity for the prevention of osteoporosis, of our sample, only (46.1%) exercised more than 30 min/week, this puts the majority at risk not only for osteoporosis but also cardiovascular disease at later stages of life.
Because our survey was an online questionnaire, participants may not feel motivated to provide honest answers due to a lack of interest and boredom.
Another limitation is recall bias as some participants might not remember a history of fractures or osteoporosis in their families.
Our sample lacked educational diversities as around 61.6% of our sample are bachelor degree holders, which might not reflect the actual population.
| Conclusion/Recommendations|| |
We can see clearly that the knowledge of osteoporosis among Saudi society is the way behind the required level. As it is a preventable disease, raising the awareness of the individual will help to decrease the prevalence of osteoporosis and osteoporotic fractures leading to a decrease in morbidity and mortality, burden, and cost. Each health-care personnel should play a role in raising awareness in the community as well as utilizing social media and TV for this purpose.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al
., National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int 2014;25:2359-81. Published online 2014 Aug 15.
US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al
. Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA 2018;319:2521-31.
Castelo-Branco C. Management of osteoporosis. An overview. Drugs Aging 1998;12 Suppl 1:25-32.
Kaufman JM, Reginster JY, Boonen S, Brandi ML, Cooper C, Dere W, et al
. Treatment of osteoporosis in men. Bone 2013;53:134-44.
Teng GG, Curtis JR, Saag KG. Mortality and osteoporotic fractures: Is the link causal, and is it modifiable? Clin Exp Rheumatol 2008;26:S125-37.
Al-Saleh Y, Sulimani R, Sabico S, Raef H, Fouda M, Alshahrani F, et al.
2015 guidelines for osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society. Ann Saudi Med 2015;35:1-12.
Sadat-Ali M, Al-Habdan IM, Al-Turki HA, Azam MQ. An epidemiological analysis of the incidence of osteoporosis and osteoporosis-related fractures among the Saudi Arabian population. Ann Saudi Med 2012;32:637-41.
El-Desouki MI, Sulimani RA. High prevalence of osteoporosis in Saudi men. Saudi Med J 2007;28:774-7.
El-Desouki MI. Osteoporosis in postmenopausal Saudi women using dual x-ray bone densitometry. Saudi Med J 2003;24:953-6.
Mahboub SM, Al-Muammar MN, Elareefy AA. Evaluation of the prevalence and correlated factors for decreased bone mass density among pre and post-menopausal educated working women in Saudi Arabia. J Health Popul Nutr 2014;32:513-9.
Gendler PE, Coviak CP, Martin JT, Kim KK, Dankers JK, Barclay JM, et al.
Revision of the osteoporosis knowledge test: Reliability and validity. West J Nurs Res 2015;37:1623-43.
Sayed-Hassan RM, Bashour HN. The reliability of the Arabic version of osteoporosis knowledge assessment tool (OKAT) and the osteoporosis health belief scale (OHBS). BMC Res Notes 2013;6:138.
Si L, Winzenberg TM, Jiang Q, Chen M, Palmer AJ. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int 2015;26:1929-37.
Alamri FA, Saeedi MY, Mohamed A, Barzanii A, Aldayel M, Ibrahim AK. Knowledge, attitude, and practice of osteoporosis among Saudis: A community-based study. J Egypt Public Health Assoc 2015;90:171-7.
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.
Alshareef SH, Alwehaibi A, Alzahrani A, Fagihi A, Alkenani A, Alfentoukh M, et al
. Knowledge and awareness about risk factors of osteoporosis among young college women at a university in Riyadh, KSA. J Bone Res 2018;6:194.
Noman H, Qaiser I. Exploration of osteoporosis knowledge and perception among young women in Quetta, Pakistan. J Osteopor Phys Act 2015;3.
Xu J, Sun M, Wang Z, Fu Q, Cao M, Zhu Z, et al.
Awareness of osteoporosis and its relationship with calcaneus quantitative ultrasound in a large Chinese community population. Clin Interv Aging 2013;8:789-96.
Oumer KS, Liu Y, Yu Q, Wu F, Yang S. Awareness of osteoporosis among 368 residents in China: A cross-sectional study. BMC Musculoskelet Disord 2020;21:197.
Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr 1974;2:328-35.
Morris HA. Osteoporosis prevention – A worthy and achievable strategy. Nutrients 2010;2:1073-4.