|Year : 2019 | Volume
| Issue : 2 | Page : 70-75
Lifestyle and Preventive Behaviors of Osteoporosis among Women of Reproductive Age in Qazvin-Iran: A Cross Sectional Study
Leili Yekefallah1, Leila Dehghankar1, Mohaddeseh Aliakbari2, Maryam Mafi3
1 Department of Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
2 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
3 Research Deputy, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
|Date of Web Publication||26-Apr-2019|
Dr. Leila Dehghankar
Department of Nursing, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin
Source of Support: None, Conflict of Interest: None
Introduction: Osteoporosis is a silent illness with many negative consequences that can decrease women's quality of life and daily life activities and even cause death. The aim of this study was to examine the lifestyle and preventive behaviors related to osteoporosis among women of reproductive age in Qazvin city, Iran. Methods: In this cross-sectional study, 300 women (mean age = 30.75 ± 7.47 years) were selected using the stratified cluster sampling method. A researcher-made questionnaire consisting of 15 questions on the patterns of nutrition, physical activity, and specific preventive behaviors related to osteoporosis and demographic factors was used for data collection. Data were analyzed using Chi-square with Fisher's exact test and logistic regression model. Results: The study results showed that most women (73.3%) had a positive family history of osteoporosis and 65.3% of them consumed carbonated beverages at least twice a week. Furthermore, 46.7% of them used coffee twice a week. There was a statistically significant relationship between their age (P < 0.0001) and positive family history of osteoporosis (P = 0.05) with knowledge about osteoporosis. According to the logistic regression model, a statistically significant relationship was found between age and awareness of osteoporosis (P = 0.001). Conclusion: Women should be encouraged to change their lifestyle in order to prevent osteoporosis. Educational programs should be held, and educational posters should be installed in gathering areas in the city and health centers with regard to risk factors and preventive behaviors of osteoporosis among women of reproductive age.
Keywords: Osteoporosis, lifestyle, reproductive age, preventive behaviors
|How to cite this article:|
Yekefallah L, Dehghankar L, Aliakbari M, Mafi M. Lifestyle and Preventive Behaviors of Osteoporosis among Women of Reproductive Age in Qazvin-Iran: A Cross Sectional Study. Soc Health Behav 2019;2:70-5
|How to cite this URL:|
Yekefallah L, Dehghankar L, Aliakbari M, Mafi M. Lifestyle and Preventive Behaviors of Osteoporosis among Women of Reproductive Age in Qazvin-Iran: A Cross Sectional Study. Soc Health Behav [serial online] 2019 [cited 2020 Nov 28];2:70-5. Available from: https://www.shbonweb.com/text.asp?2019/2/2/70/257178
| Introduction|| |
Osteoporosis is a silent illness., Nearly 61 million people across the world suffer from bone loss or osteoporosis by 2020. According to a meta-analysis study in Iran, the overall prevalence of osteoporosis in the lumbar spine was 0.17% and the prevalence of osteopenia was 0.35%. In addition, approximately 6 million people in Iran had osteoporosis.
Women are eight times more likely to be at the risk of osteoporosis than men, which indicates that around 200 million women suffer from osteoporosis worldwide. The peak of bone mass density is up to the age of 30 years. With the increase of age, bone density gradually decreases. Women are at a higher risk of osteoporosis because the protective effect of estrogen produced at the reproductive age stops at menopause and bone mass erosion increases.
The risk of osteoporosis increases with irregular menstruation and amenorrhea. Therefore, young women need to be aware of menopause risk factors and should be encouraged to maintain the bone mass density through performing appropriate measures such as exercise and consumption of calcium and Vitamin D tablets.
The negative consequences of this disease can lead to a reduction of women's quality of life, social interaction due to low self-esteem, and pain in daily life activities. This disease can lead to emotional suffering, anxiety about the fear of fractures, and incidence of depression, paralysis, and even death.
Osteoporosis involves several controllable and uncontrollable risk factors. Controllable risk factors include a lack of physical activity, positive family history of osteoporosis, low body mass index (BMI), sedentary lifestyle, smoking, alcohol consumption, and unbalanced diet. Specifically, unbalanced diet includes eating disorders; low intake of calcium and Vitamin D; overconsumption of carbonated beverages and caffeinated drinks; drinking more than three cups of coffee a day;,, and long-term use of certain medications such as glucocorticoids, thyroid drugs, hormones, anticoagulants, antacids, and antiepileptics. Uncontrollable factors could be gender, inheritance, ethnicity and race, increase of age, postmenopausal situation, and body size.,,
Prevention of osteoporosis consists of several aspects, including nutrition, exercise, lifestyle, and initial screening. The World Health Organization believes that, for the prevention of osteoporosis, women should follow a balanced diet, take Vitamin D and calcium tablets, and perform regular exercises. Idrees et al. found that 80% of women in reproductive age in Pakistan suffered from calcium deficiency, 44.3% had a daily consumption of milk, 69.5% had performed physical activity such as a daily walk, and 65.5% were exposed to sunlight. However, only 12.1% of them used calcium supplements.
In addition to taking calcium and performing regular exercise, an optimal amount of Vitamin D should be consumed for the prevention of osteoporosis., The study of Al-Muraikhi et al. in Qatar showed that women's overall knowledge score of osteoporosis was 61.4%. Furthermore, 79% of them were exposed to direct sunlight, but only 33.6% of them participated in regular physical exercises. In developing countries, people's general awareness of osteoporosis is still low. Therefore, preventive programs should be started at young ages to prevent the development of related risk factors. Regarding osteoporosis prevention programs, there is sufficient information on preventive measures as well as cultural and socioeconomic features of this disease. However, it is unclear how women of reproductive age in Iran understand the issue of osteoporisis. Therefore, the researcher conducted a study aiming to examine the lifestyle and preventive behaviors of osteoporosis in women of reproductive age in Qazvin city, Iran.
| Methods|| |
Design and setting
This cross-sectional study was carried out on 300 women of reproductive age (18–45 years old) using a random cluster sampling method in 2018 in Qazvin city, Iran. To recruit the samples, the whole city was divided into four geographical areas: North, South, East, and West. From each geographical area, eligible women were reached randomly at different times of the day in public places. Those women who were willing to fill out the questionnaire were recruited. Inclusion criterion was aged between 18 and 45 years.
A researcher-made questionnaire with 15 multiple-choice questions was used for data collection.
Patterns of nutrition and physical activity
The consumption of food groups in eight groups of dairy products included vegetables and fruits, red and white meat, grains and cereals, carbonated beverages, and coffee during the week. A 5-point Likert scale was applied to all the questions: none at all, less than twice a week, 3–4 times a week, more than 4 times per week, and daily.
Physical activity questions during the week included the following four questions: two questions were dichotomous (i.e., yes vs. no), one question was type of activity (i.e., walking, swimming, attending bodybuilding clubs, and other exercise), and one question was the frequency (i.e., every day, less than two times a week, and 3–5 times a week).
Specific preventive behaviors of osteoporosis
Methods used to help with the absorption of calcium, exposure to sunlight, and consumption of foods containing Vitamin D had eight questions.
Validity of the questionnaire was assessed by Pazokian et al. through a content validity method. The questionnaire was submitted to 12 faculty members of Qazvin University of Medical Sciences, which led to some modifications. Reliability of the tool was evaluated using a test–retest method with a correlation coefficient of 0.78.
The demographic questions included family history of osteoporosis, history of hyperthyroidism and hyperparathyroidism, immobilization, use of drugs for more than 6 months, smoking and alcohol consumption, knowledge of osteoporosis, and age at the onset of menstruation.
The women were aware of the voluntary nature of the participation and the right to withdraw at any time without giving any reason. The women were ensured of their confidentiality and were asked to sign the written informed consent form before the study.
Data were analyzed using descriptive analysis (mean, standard deviation, number, and percentages) and inferential statistics (Chi-square with Fisher's exact test and logistic regression) via the SPSS version 23 software (IBM, Chicago, United States of America). The relationship between knowledge of osteoporosis, preventive behaviors of osteoporosis, BMI and positive family history of osteoporosis, history of hyperthyroidism and hyperparathyroidism, immobilization, drug use for more than 6 months, smoking and alcohol consumption, information on osteoporosis, and age of the onset of the menstruation was evaluated using the Chi-square and Fisher's exact tests.
A nonlinear logistic regression model with ENTER method was used to assess the predictive factors of preventive behaviors of osteoporosis. To apply logistic regression, assumptions were checked; normal distribution of dependent variable was confirmed. Furthermore, data were checked for eliminating the concerns of outliers. The dependent variable was knowledge of osteoporosis, with the answers of yes and no. Independent variables of age and a positive family history of the osteoporosis were entered into the model. Independent variables with significant association were chosen to be entered in the regression model.
| Results|| |
The majority of the women were at the age range of 26–35 years, with a mean age of 30.75 ± 7.47 years and BMI of 24.64 ± 4.38. In addition, 73.3% of them had a positive family history of osteoporosis, 91.7% had a family history of other related disease, 57.7% consumed Vitamin D tablets, and 72% were not exposed to sunlight. Moreover, most of the women used the Internet, radio, and television to learn about osteoporosis, and 47.7% were aware of the disease [Table 1]. Regarding the pattern and frequency of regular physical activity, 27.3% of them had a regular physical activity for 3–5 times a week and 8% had no physical activity.
|Table 1: Frequency distribution of demographic variables in women of reproductive age in Qazvin|
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Regarding drug use in the last 6 months as a risk factor for osteoporosis, 85% of the women did not take any drug in the last 6 months. Only 5.3% of them consumed antidepressants and 1% used prednisolone. It was found that 59.3% of the women experienced menstruation at the age of 13–14 years.
Regarding diet, 65.3% of the women consumed carbonated beverages at least twice a week and 46.7% consumed coffee twice a week. Only 19.3% of the women received daily milk, 33% of them consumed milk less than twice a week, 45% used red meat three to four times a week, and 23.7% used white meat like chicken and fish three to four times a week [Table 2].
|Table 2: The distribution and frequency of nutritional habits between women of reproductive age|
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The Chi-square test showed a statistically significant relationship between age (P < 0.0001) and positive family history of osteoporosis (P = 0.05) with knowledge about osteoporosis. That is, with the increase of women's age, their awareness of the disease increases [Table 3].
|Table 3: Relationship between demographic variables and awareness of osteoporosis in women of reproductive age|
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In the logistic regression model, only age had a statistically significant relationship with awareness of osteoporosis in women of reproductive age. One-year increase in the women's age increased 1.05 time women's awareness of osteoporosis [Table 4].
|Table 4: Assessing the predictors of osteoporosis behaviors using nonlinear logistic regression model (single variable)|
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| Discussion|| |
Awareness of osteoporosis is associated with osteoporosis preventive behaviors. In the present study, only 47.7% of women of reproductive age were aware of osteoporosis. Appropriate policies should be developed to improve women's awareness because only the knowledge of osteoporosis cannot improve the lifestyle. There is a need to reschedule the lifestyle among women for performing regular physical activity and having appropriate diet; thus, they may be prevented from developing osteoporosis. Performing a regular physical activity and receiving proper nutrition can be a simple and effective method to prevent diseases and maintain and promote health.,
In previous studies, 61.6% of Egyptian women, 61.4% of women of reproductive age in Qatar, and 86.8% of women of reproductive age in Pakistan were aware of osteoporosis preventive behaviors.
It was shown that 57.7% of women consumed Vitamin D tablets and 72% had no exposure to sunlight. A probable reason for low Vitamin D intake and low exposure to sunlight was an inadequate training of health-care staff.
According to previous studies, 90.2% of Egyptian women and 79% of women of reproductive age in Qatar were exposed to direct sunlight. In the study of Kamran et al., 24.9% of Pakistani women had exposure to sunlight. The difference could be considered in terms of geographical and cultural conditions. In societies where women wear less clothing due to weather conditions and cultural beliefs, they are more exposed to direct sunlight to get Vitamin D.
The majority of women used the Internet, radio, and television to obtain information about osteoporosis. In the study of Idrees et al., the best source of information was stated to be television (44.8%) and the Internet, which was in line with the results of the present study. Regarding drugs used during the last 6 months as a risk factor for osteoporosis including corticosteroids, thyroid and parathyroid drugs, antacids, and narcotics, 85% of women did not take any drug during the last 6 months. Only 5.3% of the women consumed antidepressants and 1% used prednisolone. Pazokian et al. in their study showed that 96% of girls did not take any drug.
Regarding the nutritional patterns of women of reproductive age, 65.3% of the women consumed carbonated beverages at least twice a week and 46.7% consumed coffee twice a week. EL-Sayed Hossein reported that only 5.4% of Egyptian women used coffee, tea, and caffeine during the week. Furthermore, Al-Muraikhi acknowledged that 56% of women consumed coffee and beverages. Given that a low consumption of caffeine, coffee, tea, and carbonated beverages is one of the most important factors in the prevention of osteoporosis, education can reduce the prevalence of osteoporosis.
Only 19.3% of women had a daily milk intake that was aligned with the studies by EL-Sayed Hossein and Pazokian et al. However, the study by Kamran et al. in Pakistan showed that only 25.6% of women consumed milk. Given the role of milk in the prevention of osteoporosis, all women of reproductive age are encouraged by the health-care team to consume three glasses of milk per day.
Furthermore, 45% of women used red meat 3–4 times a week and 23.7% used white meat like chicken and fish 3–4 times a week. Pazokian et al. in 2013 reported that 24% of women consumed fish and white meat twice a week. Also, EL-Sayed Hossein in 2014 reported that 28.6% of women consumed meat and fish in their weekly meals. Given the fact that high protein consumption and low calcium consumption have a close relationship with the development of osteoporosis, an increase in the consumption of white meat during the week and reduction of consumption of red meat are needed.
Regarding the pattern and frequency of regular physical activity, 27.3% of women had a regular physical activity of 3–5 times a week. As regular physical activity for at least 3–4 times a week, and at least 20–30 min each time, increases the absorption of calcium and improves bone density in women of reproductive age, women should be encouraged to exercise during the week. Kamran et al. reported that only 20.7% of women had regular exercise, and Al-Muraikhi also stated that 33.6% of them performed regular physical activity three times per week. The results were similar with those of the current study, but the study by EL-Sayed Hossein in 2014 acknowledged that 94.6% of women performed a regular physical activity.
The Chi-square test showed a statistically significant relationship between age and positive family history of osteoporosis and having knowledge of osteoporosis so that, with the increase of age, women's awareness of the disease increases. Also, in the regression model, the age variable showed a significant relationship with awareness of osteoporosis in women of reproductive age. An increase in one unit in the women's age increases their awareness 1.07 times. Riaz in Pakistan showed that awareness of osteoporosis in young women was much lower compared to middle-aged women, but Alexandrakis reported that middle-aged women had a weaker awareness of osteoporosis. Increasing women's age especially in those with a positive history of osteoporosis in the family make them to seek knowledge and information about osteoporosis to identify and observe preventive behaviors in them.
With the use of a cross-sectional design, the causal effects cannot be concluded in our findings. Additionally, subjective measure of osteoporosis preventive behaviors (using self-reported questionnaires) may provide bias estimation due to recall bias or social desirability. Given that this study focused on a sample of women of reproductive age in public places of Qazvin city, Iran, future studies need to consider measures for samples of women in various places including their homes and workplaces.
| Conclusion|| |
The majority of women had a positive family history of osteoporosis, and a higher percentage of them did not take Vitamin D tablets and had a high consumption level of coffee, tea, carbonated beverages, and red meat throughout the week. They should be encouraged to change their lifestyle to prevent osteoporosis. Taking proper food and having a healthy diet is one of the key factors for maintaining the bone density and bone mass and increasing bone strength in women to get pregnant. Most women spend majority of their time at home or at workplace; thus, they are less exposed to sunlight and they have low mobility level than men. As a result, women have increased prevalence of osteoporosis. Educational programs should be held and educational posters should be installed in gathering areas in the city and health centers with regard to risk factors and preventive behaviors of osteoporosis among women in the age group of 18–45 years.
Conducting early screening programs for the diagnosis of osteoporosis among women at the age group of 18–45 years is needed to prevent the complications and adverse outcomes of the disease. Also, public media, especially TV and radio, are important sources of information regarding how to have a healthy lifestyle.
The authors would like to thank all women who participated and spent time to answer the questions.
Financial support and sponsorship
This work was supported by Deputy for Research and Technology of Qazvin University and Medical Sciences (grant numbers 28/6/5034).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]