Awareness of Osteoporosis among Postmenopausal Women in Najran Region, Saudi Arabia: A Cross-Sectional Study
Rashed Salem Alqudhaya1, Saleh Yousef Alyami2*, Salem Mohammed AlHashel2, Hidar Salem Alqudhaya2, Eibraheim Ahmad AlMardef2, Nemer Nasser AlMardef2, Mohammed Nasser AlMutlaq2, Ali Salem AlShaiban2, Ashjan Saeed AlMansour2, Yunus Salem Alyami3
1King Khalid Hospital, Najran city, Saudi Arabia
2College of Medicine, Najran University, Najran City, Saudi Arabia
3Medical Laboratory, Najran University, Najran city, Saudi Arabia
Abstract
Introduction: Osteoporosis is characterized by a decrease in bone mass. Fractures due to osteoporosis are associated with chronic pain, limited mobility, increased mortality, and financial burdens. While osteoporosis is common in both genders, postmenopausal women are at increased risk. This study aims to evaluate the awareness of osteoporosis among postmenopausal women in the Najran region, Saudi Arabia, and to identify its associated factors.
Methods: This cross-sectional study was conducted from April to June 2024. It evaluated osteoporosis awareness among 313 postmenopausal women in Najran, Saudi Arabia, excluding postmenopausal women who work as healthcare providers on hormone replacement therapy and with mental limitations. An online questionnaire assessed demographic and osteoporosis-related characteristics using the Osteoporosis Knowledge Assessment Tool (OKAT), an Arabic valid and reliable tool, had 20 questions rated on a three-point Likert scale (true, false, and I don’t know).
Results: Out of 701 women, only 313 postmenopausal women were included. The median age was 53 years. Seventy-five percent (236) were married,145 (46%) had a university education or higher and 162 (52%) were housewives. Thirty-six percent (114) and 98 (31%) had a personal and family history of osteoporosis, respectively. The median age at puberty was 13 years, and 226 (72%) reported a history of regular menses previously. The mean knowledge score was 8.965±3.406. Among the participants, 43.5% had good knowledge of osteoporosis. Higher education levels were significantly associated with better knowledge (p=0.030), with those with a university education scoring higher than those with lower education levels.
Conclusion: Although 43.5% of participants demonstrated good knowledge of osteoporosis, the majority had poor knowledge, highlighting a significant gap in awareness that needs to be addressed through targeted educational interventions
Introduction
Osteoporosis is a chronic skeletal condition characterized by reduced bone mass and deterioration of bone tissue, leading to increased bone fragility and fracture risk1. The disease represents a significant global health issue, with a prevalence similar to other common chronic diseases such as hypertension and diabetes2. Furthermore, the complications of osteoporosis can be considerable, with bone fractures representing the most common manifestation of the disease and affecting commonly vertebral bodies, distal radius, proximal humerus, pelvis, and proximal femur3,4. Osteoporosis is a widespread disease, with more than one-third of women and one in five men sustaining fractures in their lifetime due to low bone mass5. Osteoporosis is defined by the World Health Organization (WHO) as having bone mineral density (BMD) of 2.5 standard deviations or more below the average value for young, healthy women6. Fractures due to osteoporosis are associated with significant health issues, including chronic pain, limited mobility, increased mortality, and financial burdens for individuals and society7,8. Risk factors for osteoporosis can be categorized into modifiable and non-modifiable factors. Non-modifiable risk factors include age, gender, ethnic origin, family history of osteoporosis or fractures in a first-degree relative, and age at menarche and menopause. These factors cannot be changed, but they help identify individuals at higher risk. Modifiable risk factors, however, are lifestyle-related and can be altered to reduce the risk of developing osteoporosis. They include smoking, alcohol consumption, low physical activity levels, and a poor diet of calcium and vitamin D9. While osteoporosis is common in both genders, postmenopausal women are at increased risk, leading to the well-defined entity known as postmenopausal osteoporosis9,10. At menopause, the normal bone turnover cycle is impaired by estrogen deficiency. This may be due to estrogen receptors in osteoclast progenitor cells and multinucleated osteoclasts. The osteoclastic resorption activity increases while the osteoblastic activity decreases, resulting in a net loss of bone11.
Postmenopausal women with limited awareness of osteoporosis had less use of osteogenic medications to treat fractures12. The limited awareness was evident in a study of Jordanian premenopausal and postmenopausal women that found a significant lack of awareness of osteoporosis, resulting in average knowledge scores of 51.3 and 50.9 out of 100, respectively13. In Egypt, premenopausal and postmenopausal women showed a profound lack of awareness about osteoporosis and fractures, with a low level of understanding of diets rich in calcium and vitamin D; however, non-osteoporotic women showed a higher level of awareness14. Similarly, studies conducted among Malaysians aged 40 years and above reported moderate knowledge and beliefs about osteoporosis, with poor osteo-protective behavior, suggesting that knowledge and beliefs play important roles in promoting osteo-protective practices15. A study of postmenopausal women in Kenya found that they had a limited knowledge of osteoporosis, a moderate level of health motivation, and a low perceived susceptibility to the condition16. These persistent gaps in knowledge among postmenopausal women and the general population on the prevention and treatment of osteoporosis stress the need to increase awareness of osteoporosis, which is essential for developing policies and making future healthcare decisions17,18. Accordingly, this study aims to evaluate the awareness of osteoporosis among postmenopausal women in the Najran region, Saudi Arabia, and to identify its associated factors.
Material and Methods
Study Design, Setting and Population
A descriptive cross-sectional study was conducted between April and June 2024 among postmenopausal women who resided in the Najran region of Saudi Arabia. The Najran region is located southwest of the Kingdom of Saudi Arabia and is bordered by Yemen. Its area is 360,000 km2, and its capital is the city of Najran. Menopause was defined as the absence of menstruation in the last 12 months, either natural menopause or surgery- or drug-induced menopause. We excluded healthcare providers such as doctors, nurses, or other allied health professionals, women on hormone replacement therapy, and those with diagnosed cognitive impairments. Healthcare providers were excluded to avoid potential bias from their professional knowledge, which may affect the general population’s awareness levels. Women on hormone replacement therapy were excluded because the therapy may affect bone density, influencing their risk perception and awareness. Participants with cognitive impairments were excluded to ensure the reliability and accuracy of their responses.
Sample Size Calculation
The sample size was calculated using Epi info. Considering a margin of error of 5%, an expected proportion of 50%, a 95% confidence interval, and a postmenopausal women population of 608467, the sample size was 384.
Data Collection Tool
The questionnaire was developed in Arabic and revised by two rheumatologists and a family medicine specialist to ensure face validity, focusing on clarity, relevance, and content appropriateness. A pilot study was then conducted with 20 participants to assess the clarity, comprehensibility, and ease of use of the questionnaire. Feedback from the pilot was used to make necessary adjustments to improve the questionnaire’s structure and language. Responses from the pilot study were not included in the final analysis. The questionnaire was divided into three sections: the first assessed the demographic characteristics of the participants, such as age, gender, marital status, occupation, education, nationality, and residence. The second evaluates the family history of osteoporosis, personal history of osteoporosis, age at puberty, history of menstrual regularity and smoking habit. The third section evaluates osteoporosis awareness using the Osteoporosis Knowledge Assessment Tool (OKAT). OKAT is a valid and reliable tool for assessing osteoporosis knowledge19. The validated Arabic version was used20. It consists of 20 questions rated on a three-point Likert scale (true, false, and I don’t know). OKAT focuses on four basic themes: (1) understanding the symptoms and risk of fracture of osteoporosis, (2) the knowledge of risk factors for osteoporosis, (3) knowledge of preventive factors such as physical activity and diet relating to osteoporosis and (4) treatment availability.
Statistical Analysis
The data was cleaned and organized in Excel and then imported into SPSS version 27 (Statistical Product and Service Solutions, SPSS Inc., Chicago, IL, USA) for analysis. Data cleaning included removing any duplicate responses, identifying and excluding responses that did not meet the inclusion criteria and ensuring that all participants answered all required questions and that there were no outliers or implausible values. To calculate the knowledge score, responses were coded as follows: correct answers were coded as 1, while incorrect and unsure answers were coded as 0. The normality of continuous variables was assessed using both a histogram and the Kolmogorov-Smirnov test. Since the knowledge scores did not follow a normal distribution, non-parametric tests were chosen for the analysis. Descriptive statistics were used to calculate the median and interquartile range for the continuous variables and frequencies with percentages for categorical variables. To compare differences in osteoporosis knowledge based on demographic characteristics, we applied the Kruskal-Wallis rank sum test and Wilcoxon rank sum test due to the non-parametric nature of the data. Multiple logistic regression analysis was performed to identify the predictors of good osteoporosis knowledge. A p-value of < 0.05 was considered significant for this study.
Ethical Considerations
This study has been approved by the scientific research ethics committee at Najran Health Cluster (IRB registration number with KACST, KSA: H-l1-N-140). Every participant was provided with a comprehensive explanation regarding the study's objectives. Subsequently, online informed written consent was obtained from all participants, affirming their voluntary participation in the study. The ethical preference of participant withdrawal at any point was emphasized. Anonymity and confidentiality were maintained by using an online platform that did not collect any personally identifiable information. The survey was completed anonymously, and participants were informed that their responses would remain confidential. Data was stored securely and accessible only to the research team, with all identifiers removed before analysis.
Results
Out of 701 women, 210 were premenopausal women, 145 were on hormonal therapy and 33 had mental illness. Only 313 postmenopausal women were included. The median age was 53 (interquartile range of 47 to 60). Around 236 (75.4%) postmenopausal women were married, and 137 (43.8%) reported an average monthly income of more than 10,000 SAR. Seventeen percent (53) were illiterate, 115 (36.7%) had education before university, and 145 (46.3%) had a university education or higher. One hundred and six postmenopausal women (33.8%) were employed, 162 (51.8%) were housewives, and 45 (14.4%) were retired. Most postmenopausal women lived in urban areas (n=218, 69.6%). [Table 1]
Table 1: Demographic characteristics of study participants
Characteristic |
N = 3131 |
Age |
53 (47, 60) |
Marital status |
|
Married |
236 (75.4%) |
Single |
77 (24.6%) |
Family income |
|
Less than 3000 SAR |
48 (15.3%) |
3000-10,000 SAR |
128 (40.9%) |
More than 10,000 SAR |
137 (43.8%) |
Educational level |
|
Illiterate |
53 (16.9%) |
Before university education |
115 (36.7%) |
University education and above |
145 (46.3%) |
Employment status |
|
Employed |
106 (33.8%) |
Housewife |
162 (51.8%) |
Retired |
45 (14.4%) |
Residence |
|
Rural |
95 (30.4%) |
Urban |
218 (69.6%) |
1Median (IQR); n (%)
SAR: Saudi riyal
One hundred and fourteen postmenopausal women (36.4%) had a personal history of osteoporosis, and 98 (31.3%) had a family history of the condition. The median age at puberty was 13 years, and 226 (72.2%) reported positive history of menstrual regularity. Most women (83%) were non-smokers, and 54 (17.3%) were smokers. [Table 2]
Table 2: Risk factors related to osteoporosis among study participants
Characteristic |
N = 3131 |
Personal history of osteoporosis |
|
No |
199 (63.6%) |
Yes |
114 (36.4%) |
Family history of osteoporosis |
|
No |
215 (68.6%) |
Yes |
98 (31.3%) |
History of menstrual regularity |
|
No |
87 (27.8%) |
Yes |
226 (72.2%) |
Age at puberty |
13.00 (12.00, 15.00) |
Smoking |
|
No |
259 (82.7%) |
Yes |
54 (17.3%) |
1n (%); Median (IQR)
The mean knowledge score was 8.965±3.406. One hundred and seventy-seven (56.5%) postmenopausal women were categorized as having poor knowledge, and 136 (43.5%) had good knowledge. Two hundred and eighty participants (89.5%) correctly identified that osteoporosis leads to an increased risk of bone fractures, while only 5 (1.6%) disagreed, and 28 (8.9%) did not know. Conversely, 206 participants (65.8%) noted that osteoporosis typically causes symptoms before fractures occur, whereas 43 (13.7%) didn't believe it does, and 64 (20.4%) did not know. Regarding peak bone mass, 114 respondents (36.4%) stated that having a higher peak bone mass does not protect against osteoporosis later in life, while 55 (17.6%) disagreed, and 144 (46.0%) did not know. Additionally, 70 (22.4%) thought osteoporosis was more common in men, compared to 149 (47.6%) who correctly identified it as more common in women, while 94 (30.0%) did not know. The belief that cigarette smoking contributes to osteoporosis was affirmed by 168 participants (53.7%), while 43 (13.7%) disagreed and 102 (32.6%) did not know.
Ninety-two (29.4%) believed white women are at the highest risk of fractures compared to other races, while 86 (27.5%) disagreed, and 135 (43.1%) were unsure. One hundred and eighty-four participants (58.8%) recognized that falls are as important as low bone strength in causing fractures, while 41 (13.1%) disagreed, and 88 (28.1%) were unsure. On the expectation of fractures from age 50, 159 participants (50.8%) correctly anticipated at least one fracture before death, 57 (18.2%) disagreed, and 97 (30.9%) were unsure. For the prevalence of osteoporosis by age 80, 188 (60.1%) correctly noted that the majority of women have osteoporosis, while 45 (14.4%) disagreed, and 80 (25.6%) were unsure.
Ninety-four participants (30.0%) correctly identified that hormone therapy does not prevent further bone loss after menopause, 55 (17.6%) disagreed, and 164 (52.4%) were unsure. In contrast, 167 (53.4%) recognized physical activity benefits for osteoporosis, 57 (18.2%) disagreed, and 89 (28.4%) were unsure. One hundred sixty-five participants (52.7%) felt clinical risk factors are sufficient to assess osteoporosis risk, whereas 50 (15.9%) disagreed, and 98 (31.3%) were unsure. A family history of osteoporosis was thought to strongly predispose individuals by 177 participants (56.5%), with 48 (15.3%) disagreeing and 88 (28.1%) unsure.
179 (57.2%) believed two glasses of milk a day provide adequate calcium, 59 (18.8%) disagreed, and 75 (23.9%) were unsure. 185 (59.1%) correctly identified sardines and broccoli as non-dairy sources of calcium, 37 (11.8%) disagreed, and 91 (29.1%) were unsure. On, 101 (32.3%) believed that calcium supplements alone could prevent bone loss, 135 (43.1%) disagreed, and 77 (24.6%) were unsure. One hundred forty-eight participants (47.3%) thought that the impact of moderate alcohol consumption on osteoporosis is minimal, 43 (13.7%) disagreed, and 122 (38.9%) were unsure. The high salt intake was recognized as a risk factor for osteoporosis by 133 (42.5%), with 62 (19.8%) disagreeing and 118 (37.9%) uncertain. 111 (35.5%) thought that there is minimal bone loss in the 10 years post-menopause, while 90 (28.5%) disagreed, and 112 (35.8%) were unsure. Lastly, 81 participants (25.9%) believed there were no effective osteoporosis treatments available in Saudi Arabia, whereas 125 (39.9%) disagreed, and 107 (34.2%) were unsure. [Table 3]
Table 3: Knowledge of osteoporosis among postmenopausal women
Characteristic |
True |
False |
I do not know |
Osteoporosis leads to an increased risk of bone fractures |
280 (89.5%)* |
5 (1.6%) |
28 (8.9%) |
Osteoporosis usually causes symptoms (e.g., pain) before fractures occur |
206 (65.8%) |
43 (13.7%)* |
64 (20.4%) |
Having a higher peak bone mass at the end of childhood gives no protection against the development of osteoporosis in later life |
114 (36.4%) |
55 (17.6%)* |
144 (46.0%) |
Osteoporosis is more common in men |
70 (22.4%) |
149 (47.6%)* |
94 (30.0%) |
Cigarette smoking can contribute to osteoporosis |
168 (53.7%)* |
43 (13.7%) |
102 (32.6%) |
White women are at highest risk of fracture as compared to other races |
92 (29.4%)* |
86 (27.5%) |
135 (43.1%) |
A fall is just as important as low bone strength in causing fractures |
184 (58.8%)* |
41 (13.1%) |
88 (28.1%) |
From age 50, most women can expect at least one fracture before they die |
159 (50.8%)* |
57 (18.2%) |
97 (30.9%) |
By age 80, the majority of women have osteoporosis |
188 (60.1%)* |
45 (14.4%) |
80 (25.6%) |
Hormone therapy prevents further bone loss at any age after menopause |
94 (30.0%)* |
55 (17.6%) |
164 (52.4%) |
Any type of physical activity is beneficial for osteoporosis |
167 (53.4%) |
57 (18.2%)* |
89 (28.4%) |
It is easy to tell whether I am at risk of osteoporosis by my clinical risk factors |
165 (52.7%)* |
50 (15.9%) |
98 (31.3%) |
A family history of osteoporosis strongly predisposes a person to osteoporosis |
177 (56.5%)* |
48 (15.3%) |
88 (28.1%) |
An adequate calcium intake can be achieved from two glasses of milk a day |
179 (57.2%)* |
59 (18.8%) |
75 (23.9%) |
Sardines and broccoli are good sources of calcium for people who cannot take dairy products |
185 (59.1%)* |
37 (11.8%) |
91 (29.1%) |
Calcium supplements alone can prevent bone loss |
101 (32.3%) |
135 (43.1%)* |
77 (24.6%) |
Alcohol in moderation has little effect on osteoporosis |
148 (47.3%)* |
43 (13.7%) |
122 (38.9%) |
A high salt intake is a risk factor for osteoporosis |
133 (42.5%)* |
62 (19.8%) |
118 (37.7%) |
There is a small amount of bone loss in the ten years following the onset of menopause |
111 (35.5%) |
90 (28.8%)* |
112 (35.8%) |
There are no effective treatments for osteoporosis available in Saudi Arabia |
81 (25.9%) |
125 (39.9%)* |
107 (34.2%) |
Knowledge of osteoporosis |
|
|
|
Poor |
177 (56.5%) |
|
|
Good |
136 (43.5%) |
|
|
1n (%)
*Correct answers
The educational level was significantly associated with the knowledge scores (p=0.030), with those with university education scoring higher (9.5±3.4) than those with lower education levels. Other factors such as age, marital status, family income, employment status, residence, personal and family history of osteoporosis, regularity of menses, smoking status, and age at puberty did not show a statistically significant association with the knowledge scores. [Table 4]
Table 4: Determinants of knowledge of osteoporosis among postmenopausal women
Characteristic |
N = 3131 |
p-value2 |
Age |
|
0.3 |
40-55 years |
9.0±3.6 |
|
56 and above |
8.8±3.0 |
|
Marital status |
|
0.2 |
Married |
9.1±3.4 |
|
Single |
8.5±3.4 |
|
Family income |
|
0.7 |
Less than 3000 SAR |
8.6±4.2 |
|
3000-10,000 SAR |
9.2±3.3 |
|
More than 10,000 SAR |
8.9±3.3 |
|
Educational level |
|
0.030 |
Illiterate |
8.2±3.0 |
|
Before university education |
8.7±3.5 |
|
University education and above |
9.5±3.4 |
|
Employment status |
|
0.2 |
Employed |
9.5±3.1 |
|
Housewife |
8.7±3.6 |
|
Retired |
8.6±3.2 |
|
Residence |
|
0.2 |
Rural |
9.4±3.2 |
|
Urban |
8.8±3.5 |
|
Personal history of osteoporosis |
|
0.3 |
No |
9.1±3.9 |
|
Yes |
8.8±2.4 |
|
Family history of osteoporosis |
|
0.9 |
No |
9.0±3.4 |
|
Yes |
8.9±3.4 |
|
Regularity of menses |
|
>0.9 |
No |
9.0±2.7 |
|
Yes |
8.9±3.6 |
|
Smoking |
|
0.6 |
No |
9.0±3.6 |
|
Yes |
8.9±2.0 |
|
Age at puberty |
|
0.2 |
13 years or above |
9.1±3.5 |
|
9-12 years |
8.7±3.3 |
|
1knowledge score: Mean±SD
2Kruskal-Wallis rank sum test; Wilcoxon rank sum test
Education was the only predictor of osteoporosis knowledge. Postmenopausal women with university education had higher knowledge than illiterates (OR: 2.46, 95% CI: 1.18, 5.32, P-value = 0.019). [Table 5]
Table 5: Predictors of osteoporosis knowledge among postmenopausal women
Characteristic |
OR1 |
95% CI1 |
p-value |
Age |
0.99 |
0.96, 1.02 |
0.5 |
Marital status |
|
|
|
Married |
— |
— |
|
Single |
0.60 |
0.34, 1.06 |
0.082 |
Family income |
|
|
|
Less than 3000 SAR |
— |
— |
|
3000-10,000 SAR |
0.92 |
0.45, 1.88 |
0.8 |
More than 10,000 SAR |
0.49 |
0.23, 1.04 |
0.065 |
Educational level |
|
|
|
Illiterate |
— |
— |
|
Before university education |
1.66 |
0.81, 3.49 |
0.2 |
University education and above |
2.46 |
1.18, 5.32 |
0.019 |
History of osteoporosis |
|
|
|
No |
— |
— |
|
Yes |
0.66 |
0.39, 1.11 |
0.12 |
Family history of osteoporosis |
|
|
|
No |
— |
— |
|
Yes |
1.06 |
0.64, 1.76 |
0.8 |
1OR = Odds Ratio, CI = Confidence Interval
Discussion
This study found that more than a third of women (36%) had a personal history, and 31% had a family history of osteoporosis. The mean knowledge score was 8.9±3.4, with 56.5% of postmenopausal women falling under the “poor knowledge.”. The knowledge scores were significantly associated with educational level (p=0.030), with individuals with a university education scoring higher (9.5±3.4) than those with lower education levels.
This study aimed to assess the awareness of osteoporosis among Saudi women in the Northern Province. The study included 313 postmenopausal women. Our findings align with a study in the Aseer Region - Saudi Arabia, where 80.4% of the general population demonstrated a strong understanding of the consequences of osteoporosis. Meanwhile, 44.7% exhibited good general knowledge about osteoporosis, and 33.8% were well-informed about its risk and protective factors. Overall, 36.9% of Aseer`s general population had good knowledge scores about osteoporosis21. Another study in Saudi Arabia by Tlt et al. highlighted that males (91.7%) and females (94.8%) were aware that not eating enough calcium-rich foods could be a major risk factor for osteoporosis. Nevertheless, the overall knowledge about the disease was low22. At Ha'il City – Saudi Arabia, the overall awareness of the general population was noticeably lacking, with an average knowledge score of 11.56±3.66 out of a possible 22 points. There was no significant correlation between the total awareness score and educational levels23. At the Northern Border – Saudi Arabia, the overall knowledge about osteoporosis among the general population was generally poor (15.4%), yet 53.9% demonstrated moderate knowledge scores24. Considering the same setting with different populations, a study among university-level students in Saudi Arabia revealed that 92% of students were aware of osteoporosis, primarily learning about it from friends. Overall, 53.4 of the students had a good or high level of knowledge. The knowledge score was correlated with education (p < 0.0001) and gender; females were more knowledgeable than males (p < 0.0001)25.
In Turkey, rural women's knowledge of osteoporosis was investigated. The overall knowledge about osteoporosis was low, with an average score of 5.52 out of 20. Among the women surveyed, 60.8% had heard of osteoporosis, and 44.9% could correctly define it. Younger and more educated women had higher awareness and accurate understanding of osteoporosis (p < 0.001). Television was the primary source of information, cited by 55% of respondents, followed by healthcare workers. The most commonly mentioned risk factors for osteoporosis chosen by the participants were menopause and a low-calcium diet26. In a Canadian study comparing the knowledge about osteoporosis among genders. 89% were aware of osteoporosis, and 61% provided the correct definition. Men had lower awareness and accuracy in defining osteoporosis compared to women, and only 54% of men are aware that they can also be affected by the disease. The main sources of information were television, newspapers, and friends, with physicians ranking fifth. Overall, 84% stressed diet's importance in preventing osteoporosis27. Although 81.6% of women had heard about the disease in Vietnam, only 49% answered correctly on knowledge-related questions28. In China, the overall knowledge score about the disease among the general population was 67.8%; their main source of information was health programs on radio and television. Among Chinese women, awareness about osteoporosis was better among those with higher educational levels, younger and more active with physical exercises29,30.
The limitation includes the self-report nature of the study. This online nature hinders the participation of women with no internet access and the lack of control groups, which can be used to compare the knowledge level among post- and pre-menopausal women. Or comparing men and women regarding their general knowledge about the disease. Yet, these can be used to conduct future studies in this field.
Conclusion
The study highlights a significant gap in osteoporosis awareness among postmenopausal women in the Najran region of Saudi Arabia, with a considerable proportion (43.5%) having good knowledge. The findings underscore the importance of educational initiatives to enhance osteoporosis awareness, especially targeting women with lower educational levels. These efforts are essential to improve osteoporosis management and prevention strategies. The implications of this study in the field of public awareness could be by improving osteoporosis awareness through targeted educational programs, which in turn could enhance preventive measures and reduce fracture risk.
Declarations
Data Availability
Raw data are available upon request from the corresponding author.
Human Subjects
Informed consent was obtained from all participants.
Animal Subjects
All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of Interest
In compliance with the ICMJE uniform disclosure form, all authors declare the following
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work
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