Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality [
Although osteoporosis is an incurable disease, there are several steps that can be taken in order to control bone loss, including adequate calcium and vitamin D intake, regular physical exercise, and pharmacological treatment [
Despite the fact that osteoporosis is a major health concern among men, little research attention has been paid to evaluating the associations between knowledge and health behaviors in this population. The limited number of studies among men shows that they demonstrate a low level of knowledge about the disease [
A convenience sample of 100 osteoporotic men attending the bone and mineral clinic at a major medical center in Israel was recruited in 2004. The sociodemographic and health characteristics of the sample are presented in Table
Sociodemographic and health characteristics (
Sociodemographic characteristics | |
---|---|
Mean age (S.D.) | 62.9 (11.3) |
Mean years of education (S.D.) | 13.6 (11.3) |
Marital status (%) | |
Married | 85 |
Income (%) | |
400–5999 NIS | 31 |
6000+ NIS | 69 |
Health characteristics | |
Had an osteoporotic fracture (%) | 33 |
Mean (S.D.) | −2.4 (1.5) |
Mean (S.D.) | −2.7 (0.8) |
The following measures were used to collect data for the present study.
Two types of health behaviors were assessed, namely, calcium intake and participation in physical activities.
Similar to other studies [
Participation in physical activity was assessed by asking whether participants regularly engaged in physical activities, which type of activities they engaged in (e.g., walking, swimming, weight-bearing exercises, and home exercises), the number of times a week, and for how many minutes each time. A total score of the number of minutes engaged in all physical activities was calculated.
Participants’ knowledge about osteoporosis was assessed by an adapted version of the Facts on Osteoporosis Quiz (FOOQ) [
This information included gender, age, education level, income, and marital status. In addition, data were collected from the participants’ medical records regarding the number of previous fractures, time since the last fracture, and bone density scan scores.
A computerized search of medical records was performed by the physician in order to locate men who had been treated for osteoporosis during the year preceding the study. A total of 115 patients were approached by the physician and presented with the aims of the study. A response rate of 87% was obtained, resulting in a final sample size of 100 participants. Once the participants signed informed consent forms, they were contacted by the researcher and were interviewed on the phone using a structured questionnaire.
The research protocol was approved by the Helsinki committee of the medical center. All participants signed informed consent forms. In order to protect the participants’ privacy, the data obtained from their medical records and interviews were coded anonymously to a password-protected file.
The statistical analysis included descriptive statistics (means, standard deviations, percentages) to describe the sample and the main study variables (knowledge level, health behaviors, and background data). Pearson’s correlations were calculated to assess the correlations between health behaviors, level of knowledge, and background data.
Table
Percentage of participants responding correctly to knowledge items (
Item | % of participants correctly responded |
---|---|
(1) One in four women over the age of 60 will develop osteoporosis* | 65 |
(2) One of every 3-4 fractures in the femoral neck occurs in men†* | 41 |
(3) Heredity does not play a role in osteoporosis | 65 |
(4) Early menopause, such as hysterectomy, is not a risk factor for osteoporosis | 48 |
(5) High caffeine intake (more than two cups per day) increases the risk of osteoporosis* | 35 |
(6) A lifetime low intake of calcium will increase the risk of osteoporosis* | 93 |
(7) Hypogonadism is not a risk factor for osteoporosis† | 43 |
(8) Smoking is not a risk factor for osteoporosis | 47 |
(9) 20–25% of all osteoporotic fractures occur in men†* | 40 |
(10) Weight-bearing exercise such as walking can help prevent osteoporosis* | 98 |
(11) After age 40, it is too late for people to increase their calcium intake to prevent osteoporosis | 65 |
(12) There is no treatment for osteoporosis once you develop it | 89 |
(13) After menopause, osteoporosis may be slowed down by taking estrogen* | 36 |
(14) All individuals lose bone mass after 40 years of age* | 62 |
(15) Men can be totally cured from osteoporosis once they develop it† | 71 |
(16) Normally, bone loss slows down after menopause | 64 |
(17) A diet high in calcium throughout life can help prevent osteoporosis* | 92 |
(18) Women over 40 need about 1500 mg of calcium* | 67 |
(19) There is no way to prevent osteoporosis | 72 |
(20) Dairy products are a major source of calcium* | 95 |
(21) It is normal for bone loss to continue throughout life* | 85 |
(22) Active individuals are at higher risk for osteoporosis than inactive individuals | 90 |
(23) Alcohol abuse is not linked to the incidence of osteoporosis | 60 |
(24) A risk factor for osteoporosis is having a mother with it* | 78 |
(25) Young women need the equivalent in calcium of a glass of milk a day to prevent osteoporosis | 71 |
(26) Inactivity increases the risk of osteoporosis* | 97 |
(27) Thin women are more often affected by osteoporosis than heavy ones* | 45 |
Mean (S.D.) | 18.1 (4.3) |
Median | 18 |
Range | 6–27 |
*item is a true statement; †denotes new items, not included in the original FOOQ.
Table
Mean and standard deviations of calcium intake and participation in physical activities (
Health behavior | Mean | S.D. | Range |
---|---|---|---|
Calcium intake (mg/day) | 842.5 | 387.4 | 0–1771 |
Physical activities (min/week) | 120.5 | 111.3 | 0–600 |
Thirty percent of the participants reported that they do not engage in any kind of physical activity. Of the 70% who did report on regular participation in physical activities, 52% reported on walking, 9% reported on swimming, 6% reported on weight-bearing exercises, and 3% reported on daily performance of home exercises.
Several statistically significant correlations were found between the participants’ sociodemographic/clinical characteristics, their level of knowledge, and their health behaviors. The participants’ level of knowledge about osteoporosis was positively correlated with education level and age (
The current study had two main objectives: to evaluate the level of knowledge about osteoporosis in osteoporotic men and to assess its correlations with health behaviors. Overall, participants demonstrated a moderate level of knowledge about the disease. However, in comparison to other studies among men [
Participants showed a high level of knowledge regarding the role of physical activities and calcium intake in preventing osteoporosis. This finding is encouraging, as these activities are major countermeasures against bone loss [
Regarding the second aim of the study, that is, to assess the correlations between the level of knowledge about osteoporosis and the health behaviors of osteoporotic men, the findings support those of studies among women [
Several interesting correlations were found in the present study. For instance, a positive correlation was found between the level of knowledge about osteoporosis and the level of education. As suggested in other studies [
Higher age was found to be positively correlated with level of knowledge and participation in regular physical activities. The tendency towards later onset of osteoporosis in men [
Finally, the participants’ reported mean of 120 minutes of weekly engagement in physical activities is encouraging since it meets the recommended level of physical activity for maintaining bone health [
Two main limitations regarding the present study should be noted. First, due to the use of a convenience sample, the results of the present study apply to this specific clinical setting and do not allow generalization to all osteoporotic patients in Israel. Second, the cross-sectional nature of the present study calls for caution when interpreting the findings. Despite its limitations, this study makes an important contribution to expanding our knowledge about osteoporosis and the correlations between level of knowledge, performance of regular physical activities, and calcium intake among osteoporotic men. The findings stress the need for health professionals to consider using intervention programs to evaluate and improve the level of knowledge about osteoporosis, especially among less educated patients.