Osteoporosis is a major and growing public health problem particularly in women. It is a systemic skeletal disorder, characterized by reduction of bone mass, deterioration of bone structure, increasing bone fragility, and increasing fracture risk. It is a major cause of fractures, resulting in pain, disability, costly rehabilitation, poor quality of life, and premature death [1-3]. 

Approximately, osteoporosis is affecting 200 million women worldwide, and the risk of the disease is increasing with advanced age .Developing countries continue to be ill-equipped to handle burden of the disease. This coupled with poor literacy rates and lack of awareness on the risk factors and symptoms results in poor outcomes [4-5].

Several risk factors for osteoporosis have been identified. These include female sex, Asian or Caucasian race, advancing age, family history of osteoporosis or fragility fractures, a low body mass index, menopause before age 45 years, prolonged amenorrhea unrelated to menopause, nulliparity, prolonged lactation, diet low in calcium and vitamin D, poor intestinal absorption of calcium, lactose intolerance, excessive caffeine or alcohol consumption; smoking, sedentary life style, and prolonged treatment with thyroid hormones, glucocorticoids, anticonvulsants, aluminum antacids, and use of anticoagulants [2,6].

There is evidence suggesting that knowledge on osteoporosis is a major contributor to osteoporosis preventive behaviour. Knowledge of modifiable risk factors (smoking, lack of physical exercise, dietary habits, multiparity) and treatment for osteoporosis should be targeted by prevention programmes. Estimating the level of knowledge can help to guide public health programmes [3,7]. 

Osteoporosis knowledge was tested in different international studies. Most of these studies found a lack of knowledge and awareness regarding osteoporosis among females with different age groups, accompanied by deprived application and less self-efficacy or confidence toward exercise and calcium intake, which determined as preventative behaviors [4,7].

Osteoporosis knowledge and health beliefs are associated with adopting preventive behavior, but few studies have evaluated them in Himachal Pradesh. Therefore, the purpose of this study is to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among females of Himachal Pradesh

Objectives of the Study

To evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among females of Himachal Pradesh

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: Himachal Pradesh

• Study Duration: between January 2022- March 2022 

• Study population:   Female population aged between 18-60 years

• Sample Size: 400 females assuming 50% adults have adequate knowledge, beliefs and practices of osteoporosis preventive measures, 5% absolute error, 95% confidence level, and 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and the knowledge, beliefs and practices of osteoporosis preventive measures was created

• Inclusive Criteria: who were willing to participate in the study

• Exclusion Criteria: who were not willing to participate in the study

• Validity of Tool:  by the experts in this field

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin. Responses were then recorded in a Google Excel spreadsheet, the information from which was used to generate graphical display

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The goal of the current study was to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among women in Himachal Pradesh. In the present study 58.75% (235) of the females fall were below 40 years of age while 41.25% (165) were above 40 years.

Table 1 described the knowledge of participants regarding osteoporosis risk factors and preventive factors. It revealed that Participants had a relatively low level of knowledge regarding risk factors and preventive factor for osteoporosis.

Table 2 illustrates beliefs of participants regarding osteoporosis. It was revealed regarding their chance of getting osteoporosis, perception towards barriers to calcium intake, Perceptions towards benefits of calcium intake, Perceived seriousness of osteoporosis and Health motivation towards osteoporosis

Table 3 showed that female of Himachal Pradesh had moderate self-efficacy in practicing osteoporosis recommended practices. 

Table 3 showed that female of Himachal Pradesh had moderate self-efficacy in practicing osteoporosis recommended practices.

Table 1: Knowledge about Risk and Preventive Factors of Osteoporosis among Participants

Table 2: Beliefs of Participants Regarding Osteoporosis

Table-3: Preventive Practices of Participants Regarding Osteoporosis

It is critical that women become better educated about the risk factors that lead to osteoporosis, because this illness has long term effects on women. In order for women to make choices about prevention, they need to know what osteoporosis is, how to prevent it, and how to perform the preventive behaviours. Therefore, this study was conducted to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among females of Himachal Pradesh 

Concerning study participants’ characteristics, the findings of the current study revealed that, Participants had a relatively low level of knowledge regarding various risk factors and preventive measures for osteoporosis. In general, they also had modest positive beliefs towered osteoporosis with a moderate self-efficacy in practicing osteoporosis recommended practices.

Researches in around the world, shows that getting enough calcium and vitamin D can help keep the bones strong and prevent osteoporosis. Osteoporosis makes the bones weaker and more likely to fracture. Vitamin D and calcium promote bone density. Vitamin D is important because it helps the body absorb the calcium in your diet. We obtain most of our vitamin D from the sun. Vitamin D can also be found in small quantities in foods such as: fatty fish (salmon, herring, and mackerel), liver, eggs, fortified foods such as low-fat milks and margarine. For most people, it is unlikely that adequate quantities of vitamin D will be obtained through diet alone. vitamin D supplements is necessary, if anyone concerned that he or she is not getting enough vitamin D [8-10].

Enjoying a healthy, balanced diet with a variety of foods and an adequate intake of calcium is a vital step to building and maintaining strong, healthy bones. If there is not enough calcium in the blood, body will take calcium from your bones. Enough calcium in the diet is an important way to preserve bone density. Dairy foods have the highest levels of calcium, but there are many other sources of calcium, including spinach and almonds. If anyone unable to get enough calcium from the diet alone, then calcium supplements is necessary [11].

Weight-bearing exercise encourages bone density and improves balance so falls are reduced. It does not treat established osteoporosis. General recommendations include: Choose weight-bearing activities such as brisk walking, jogging, tennis, netball or dance. While non-weight-bearing exercises, such as swimming and cycling, are excellent for other health benefits, they do not promote bone growth. Including some high-impact exercise into routine, such as jumping and rope skipping also helps. Strength training (or resistance training) is also an important exercise for bone health. It involves resistance being applied to a muscle to develop and maintain muscular strength, muscular endurance and muscle mass. Importantly for osteoporosis prevention and management, strength training can maintain, or even improve, bone mineral density [8,12].

General recommendations for lifestyle changes to protect against osteoporosis also include stop smoking as smokers have lower bone density than non-smokers, get some sun – exposure of some skin to the sun needs to occur on most days of the week to allow enough vitamin D production, drink alcohol in moderation as excessive alcohol consumption increases the risk of osteoporosis and limit caffeinated drinks – excessive caffeine can affect the amount of calcium that our body absorbs. Drink no more than two to three cups per day of cola, tea or coffee is advisable [8].

Most people don’t realize they have osteoporosis until a fracture happens, as there are usually no signs or symptoms. This is why osteoporosis is often called the ‘silent disease’. Although osteoporosis can strike at any age, it is most common among older people, especially older women .Osteoporosis particularly affects women in their middle and later years, although some men are also affected. Osteoporosis causes no specific pain or symptoms. However, it does increase the risk of serious or debilitating fractures. If you have osteoporosis, lifestyle changes and medical treatment can prevent further bone loss and reduce your risk of bone fractures [2,12-13].

Present study concluded that females of Himachal Pradesh possessed an insufficient knowledge regarding osteoporosis and were not adequately applied in preventative practices. This was primarily due to little appreciation of the seriousness of osteoporosis. Therefore, public health strategies should be developed to increase women's knowledge of osteoporosis prevention and change lifestyle habits. Furthermore, it could be of paramount importance to future studies conducted on practices and beliefs related to osteoporosis.

1. National Institutes of Health – Bones. Available at: https://www.bones.nih.gov/health-info/bone/osteoporosis/overview (Accessed on 10 May 2022)

2. Mayo Clinic. Available at: https://www.mayoclinic.o rg/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968 (Accessed on 10 May 2022)

3. Wikipedia. Available at: https://en.wikipedia.org/ wik i/Osteoporosis (Accessed on 10 May 2022)

4. Cleveland Clinic. Available at: https://my.clevelan dclinic.org/health/diseases/4443-osteoporosis (Accessed on 10 May 2022)

5. Healthline. Available at: https://www.healthline.com /health/osteoporosis (Accessed on 10 May 2022)

6. eMedicine – Medscape. Available at: https://emedicine .medscape.com/article/330598-overview (Accessed on 10 May 2022)

7. Better Health Channel. Available at: https://www.betterh ealth.vic.gov.au/health/conditionsandtreatments/osteoporosis (Accessed on 10 May 2022)

8. National Institutes of Health – Bones. Available at: https://www.bones.nih.gov/health-info/bone/bone-health/nutrition/calcium-and-vitamin-d-important-every-age (Accessed on 08 May 2022)

9. EndocrineWeb. Available at: https://www.endocrinewe b.com/conditions/osteoporosis/role-calcium-vitamin-d-bone-health (Accessed on 09 May 2022)

10. National Osteoporosis Foundation (NOF). Available at: https://www.nof.org/patients/treatment/calciumvitamin-d/ (Accessed on 07 May 2022)

11. HelpGuide. Available at: https://www.helpguide.org/articles/healthy-eating/calcium-and-bone-health.htm (Accessed on 10 May 2022)

12. National Institute on Aging (NIA). Available at: https://www.nia.nih.gov/health/osteoporosis (Accessed on 02 May 2022)

13. National Institute on Aging (NIA). Available at: https://www.nia.ni h.gov/health/osteoporosis (Accessed on 02 May 2022)