Al-Qahtani AM, Al-Qahtani NS, Al-Qahtani FS, Alfaifi SH, Alshehri DM, et al. (2020) Knowledge and Attitude of Osteoporosis among Female Patients Attending Najran University Hospital, KSA. J Fam Med Dis Prev 6:130.

Research Article | OPEN ACCESS DOI: 10.23937/2469-5793/1510130

Knowledge and Attitude of Osteoporosis among Female Patients Attending Najran University Hospital, KSA

Awad M. Al-Qahtani1, Nasser S. Al-Qahtani2, Faisal S. Al-Qahtani2, Sami H. Alfaifi2, Dhafer M. Alshehri3, Rishi K. Bharti2*, Ayoub A. Al-shaikh2, Shehata Farag2 and Syed E. Mohmood2

1Department of Family and Community Medicine, Najran University, Saudi Arabia

2Department of Family and Community Medicine, College of Medicine, King Khalid University, Saudi Arabia

3Observing Physician, KFSHRC, Saudi Arabia



The bone is a living organ that continues in growth before and after the puberty. Osteoporosis (OP) is characterized by deterioration in the micro-architecture of bone tissue that leads to increased bone frailty and susceptibility to fragility (low trauma) fractures. Preventive measures including patient education and exercise can reduce hip fractures related to osteoporosis.


A cross-sectional study was conducted to achieve the objectives and all women and their family members attending University Hospital were included in the study during May & June 2019.


The mean age of the study sample was 28.17 ± 9.76. The maximum number of women were belonging to (21-30 Yrs.) age group and constitute (51.5%) of the total attending women. More than half (51.3%) study women were single. The main source of osteoporosis knowledge was electronic media. Nearly 87.8% of the surveyed women heard about osteoporosis. However, 25.2% were unaware that the disease is directly responsible for disabling hip fractures and a potential outcome of the disease is death not known to 43.4%, aging and smoking are the risk factor know to 62.5% and 54.9% of the surveyed women respectively. Only 40.6% of the respondents could correctly identify the consumption of coffee is a risk factor. Menopause is a risk factor known to, 55.9% of the respondents and 49.3% respondents were agree to use of hormone replacement therapy.


The overall prevention knowledge of osteoporosis among participants was moderate (76.74%); however, a considerable number of surveyed women in our study are unaware of the risk factors and the consequences of osteoporosis.


Osteoporosis (OP), Post-menopausal women, Knowledge, Prevention


No disease has attracted attention in the last 2 decades all over the world, such as osteoporosis [1]. During childhood and adolescence bone formation is dominant. In adulthood, the bone goes through a process of removal and replacement through life.'' Most of the adult skeleton is replaced about every 10 years [2].

The limited awareness by physicians and the public about how to effectively predict fracture is a major contributory factor for the occurrence of OP-related fractures [3]. Secondly, early detection of OP remains largely opportunistic, and its confirmation is dependent on clinician referral for objective assessment of bone health [4]. Bone density is best assessed by Dual Energy X-Ray Absorptiometry (DEXA) at the hip [5].

More than half of all women and one-third of all men will experience osteoporotic fractures if they live long enough [6,7]. And people who created greater reserves of calcium during their youth have more bone mass to be destructed in the osteoporosis-endangered age [8]. The most suitable activities regarding osteoporosis prevention are rather weight-bearing activities or activities using some sports tools when there are created a burden upon the bones [9]. Higher intake of alcohol, caffeine and cola beverages associated with OP and Drinks like Coca Cola contain a lot of phosphorus which leads to hypocalcemia and osteoporosis [10]. Caffeine consumption may increase urinary excretion calcium and subsequently reduce bone mineral density among postmenopausal women but not in young adult women [11].

Prynne, et al. [12] report revealed association between fruit and vegetable consumption and bone mineral status in 5 age and sex cohorts. Intriguingly, the results indicate significant positive associations.

The lack of vitamin D also contributes to osteoporosis [12]. Sunshine exposure is a natural source of vitamin D with about 10 to 15 minutes of sunlight several days a week is enough for human body produces adequate quantities of Vitamin D [13]. Lack of exercise makes bone deteriorated [14]. Physical activities regularly play a role as a glue to keep calcium stay in to keep bone, a strong bone [15].

The aim of study was to determine the knowledge and attitude of osteoporosis among female patients attending Najran university hospital during May & June 2018.

Material and Methods

A cross-sectional study conducted in Najran city situated in Southwestern Saudi Arabia, Najran University hospital located at the Prince Masha’al discrete area. It serves more than 30000 people around this hospital. It contains more than 17 specialized clinics with a fast growing in different medical health services. The study population included adult female patients attending Najran University Hospitals. A validated questionnaire after extensive literature review & revised by professors of Endocrinology, Family Medicine Doctors & statistician. Any female known to have osteoporosis & female attending orthopedic clinics were included in the study. Total coverage of all female attending during May & June 2019. A well-trained female nurse distributed the questionnaire to the target population. They have been asked to fill the questionnaire and submit it on the same day.

The data analyzed by using SPSS software version 17 with most appropriate statistical tests (e.g. Chi square test, ANOVA, or student t test). P. value is considered significantly if its value found < 0.05.


Table 1 showing the demographical distribution of the study women. The mean age of the study sample is 28.17 ± 9.76 Years with minimum and maximum age were12 Yrs. and 62 Yrs. respectively. The total 286 of study women were included in the study and further divided into four age groups. The maximum number of women were belonging to (21-30 Yrs.) age group and they were (51.5%) followed by (< 21 Yrs. and 31-40 Yrs) age group and they were in both cases (18.5%) of the total study women. And women were also divided into five categories based on their education level.

Table 1: Demographical data of the study women (n = 286). View Table 1

Maximum study women were having bachelor degree and they constituted 67.8% followed by Postgraduate women and they were 11% of the total study women of 294. Out of 308 study women only 68 has declared about their job. The majority of the women were having no job and they constituted 95.6% of the total 68 study women who declared their job status. Out of 308 study women only 174 has declared monthly income. The maximum number of women (51.7%) had an income of (< 5000 SR) followed by (38.5%) having an income of (5000-10000 SR) whereas (2.9%) of study women who declared the monthly income had > 15000 SR.

Single constituted majority of the study women and they were (51.3%) followed by married and they constituted (43.3%) of the total study women.

Table 2 shows nearly 87.7% surveyed women heard about osteoporosis and the main source of knowledge of the study women was found to be TV which accounted for 32.4% followed by internet 30.7% and friends accounted for 18.1% of the total study women.

Table 2: General Knowledge of the osteoporosis of the study women. View Table 2

Table 3 showing study participant’s overall means of knowledge of risk factors of osteoporosis is 76.74%.

Regarding the risk factor items of the questionnaire; 24.5% of the study women answered they don't know osteoporosis is directly responsible for hip fracture. A potential outcome of the disease is death not known to 44.6% of the women whereas 39.2% disagree with the statement. However, 62.2% were aware of ageing is a risk factor for osteoporosis on the other hand 20.1% of the study women thought males are at more risk than females whereas 45.1% has no idea about which gender is more prone to osteoporosis but 34.7% answered correctly as being a male gender is not a risk factor for osteoporosis. Race and smoking are a risk factor known to 22.6% and 57.3% of study women respectively.

Table 3: Knowledge of the osteoporosis risk factors of study women (n = 286). View Table 3

Lack of vitamin D, which is produced by sun exposure, leads to osteoporosis. The relation between decreasing the risk of osteoporosis with exposure to sun light known to 59.9% and 41.1% Study women were aware coffee consumption is significantly associated with increased risk for osteoporosis.

Heredity and having small body frame are a risk factor known to 49.6% and 40.1% of study women respectively. Lack of exercise, menopause and some medicine are a risk for developing osteoporosis known to 66.5%, 56.9% and 53.6% of the study women respectively.

It was surprise to notice, the protective role of tea known to only 25.7% of the study women while 71.5% of study women were aware that calcium-rich diet has a protective role against osteoporosis.

With respect to walking for shopping for pleasure; 56.6% of study women have a false idea and thought it will protect against osteoporosis.

High intake of salt, which is associated with high blood pressure, can also cause higher loss of calcium in the urine, 39.1% of study women were aware that salty diet may cause to lose calcium and is a risk factor for developing osteoporosis. Presence of osteoporosis in first degree relative is a risk factor and only 39.4% of the girls asked were aware of this.

Table 4 reveals a small number of study women 14.7% exposed them self to the sunlight and majority of them 63.6% exposed for ≤ 15 minutes. Combination of estrogen-progestin oral contraceptives increase the risk for osteoporosis later in life and 9.4% of study women found using oral contraceptive pills.

Table 4: Attitude of the study participants towards Osteoporosis (n = 286). View Table 4

Vitamin-D and Calcium is playing an important role in preventing osteoporosis but only 23.8% uses vitamin-D and 15% uses Calcium tablets prescribed to them by physicians. Chronic diseases found in 15% of the study women.

Milk is rich in calcium, it was found 36.6% of the studied women uses milk and 67.3% of them consumption daily. Of the study 32.9% women exercise daily and majority of them 37.12% doing for (15-30) Minutes per day.

Table 5 shows the patients' perceptions of which risk and lifestyle factors affect their disease.

Table 5: Prevention attitude of Osteoporosis among the study participants (n = 286). View Table 5

Prevention of osteoporosis is possible by adopting calcium rich food eating habit. Of the study women 75.6% aware of the fact that prevention of osteoporosis is possible and 84% have acknowledged its treatment. Calcium rich diet, calcium supplement is addition to the dietary calcium and vitamin-D is helpful in preventing osteoporosis and known to study women 92.4%, 90.4% and 89.4% respectively.

Female reproductive hormone Oestrogen appears to be the most important sex steroid in preventing osteoporosis in women and 51.5% of study women aware of it.

Meat, Coffee, Sugar and Margarine are the risk and associated with osteoporosis and known to 48.5%, 40.9%, 82.8%, 78.8% and 73.3% of the study women respectively.

More than 90% of the study women aware the role of dairy products in prevention of osteoporosis and stated 98.1% milk, 93.3%, Chees and 94.7% Yoghurt as a protective food against osteoporosis. Olive oil, Fruits and vegetables known to 83.1% and 98.1% of the study women respectively.

Table 5, as regards to knowledge of the studied women about foods that rich in calcium and which can prevent osteoporosis.

It was found that the majority of the studied women were known to the preventive effect of 'diary products' stated (98.1%) milk, yoghurt 94.7% and 93.1% women stated cheese as a rich source of calcium. Other products, which helpful in protecting against osteoporosis such as Olive oil and fruits and vegetables were known to 83.1% and 98.1% of study women respectively.


In order to prevent osteoporosis effectively it is necessary to have the knowledge about the lifestyle risk factors, the positive attitudes towards them and to practice in a corresponding, suitable way.

Our study evaluated the general perception of osteoporosis among patients attending University Hospital in Najran, as well as their knowledge of lifestyle, risk factors, and preventive measures. The results of our study, which are consistent with those of other reports, indicate that several aspects of patients' knowledge and life style could be improved [16-19].

The results of the current study showed that media sources, such as television and radio were used more often than healthcare professionals to obtain disease related information. This is in agreement with the study by Al Attia, et al. which identified magazines, newspapers, and television as the major source of information among patients [18].

Thus, we recommend that media outlets should be used to deliver disease specific information, as Logsdon, et al. have shown such to be effective [20,21].

Primary osteoporosis is observed mainly in postmenopausal women and in elderly people. Secondary osteoporosis, on the other hand, is related to predisposing conditions such as genetic diseased, immobilization, use of medicine (medical treatment) [22].

Postmenopausal osteoporosis and osteoporosis of ageing are the commonest forms of the disorder. Of the study women aware of menopause as a risk factor and they accounted for 55.9%. Postmenopausal osteoporosis expresses itself clinically as a fracture.

In a study by Sujic, et al. that included 1735 fragility fracture patients, 93% of the participants did not think that their fracture was caused by osteoporosis [23].

Fractures of the hip are more common in women [24]. Of the study women 71.3% were aware of this and 38.9% aware that male is less susceptible to osteoporosis.

Within the first year after hip fracture, there is a death rate of 2-20%. Age is known to be a major factor, affecting both male and female osteoporosis [25]. It is also well known that bone mass decline with age and the reduction is more marked among women than men [25].

The disease has a strong genetic component [26]. And current study shows 47.3% of the study women aware heredity may be a risk of osteoporosis.

A calcium-rich diet is considered important in the prevention of osteoporosis [27]. Most prospective intervention studies have shown a significant effect of high intake of calcium in women after the menopause [28].

The protective nature of calcium rich diet to osteoporosis known to 69.2% study women and 88.8% thought it is essential to use calcium-rich diet for the prevention of osteoporosis.

Protein malnutrition and starvation have marked detrimental effects on bone. On the other hand, a high protein intake may result in high rates of cortical bone loss [27,28]. Meat is main source of high protein. Of the study 53.5% women aware meat is a risk for osteoporosis.

Coffee is risk for osteoporosis known to 84.6%. Whereas tea protective against it known to 24.5% of the study women. Several studies have suggested that the consumption of coffee is associated with a significant increase in risk of fracture [29-31].

The consumption of tea was found to be a protective factor in some studies [29,31]. The current study results shows 24.5% of the study women aware of this.

Physical activity is also an important aspect in prevention of osteoporosis [32]. The knowledge about the physical activity (physical exercise) is quite good 32.9% among the study women.

In the current study lack of exercise as a risk factor for osteoporosis was known to 64.7% of the study women. According to a study carried out in north-east England [33], lack of exercise as a risk factor for osteoporosis was known to 29% of the participants which is less than the finding of this study. Oestrogen appears to be the most important sex steroid in preventing osteoporosis in women [34]. In current study, the role of oestrogens in preventing osteoporosis was known to 48.3% of the study women whereas in north-east England study [34], the role of oestrogens in preventing osteoporosis was known to 74.9% of study participants which is more than the finding of the current study. Smoking seems to be a very important risk factor according to the literature [35]. Current study shows 54.9% of the study women aware smoking is a risk factor of osteoporosis. Some medications may cause osteoporosis, especially with long-term use [36]. In current study, more than half of study women were aware of this. Excess salt (sodium) intake is considered to be one of the causes of calcium loss. Of the study women 38.1% aware of this.


In conclusion, the overall prevention knowledge of osteoporosis among participants was moderate (76.74%); however, a considerable number of surveyed women in our study are unaware of the risk factors and the consequences of osteoporosis. The overall risk knowledge of osteoporosis among participants was 45.7%. Television and radio should be targeted in efforts to raise awareness and provide health education. Future research should examine perceptions in a larger sample of patients, as well as in the general population. This should aid in building and directing future modalities for the prevention and treatment of osteoporosis.

A superficial familiarity with osteoporosis may be giving women a false sense of security about the disease, its severity and its potential impact on their lives. Therefore, we have to conduct public seminars and design leaflets on osteoporosis in addition to making personal efforts in order to make them aware of the disease while there is a chance of changing the risks.


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Al-Qahtani AM, Al-Qahtani NS, Al-Qahtani FS, Alfaifi SH, Alshehri DM, et al. (2020) Knowledge and Attitude of Osteoporosis among Female Patients Attending Najran University Hospital, KSA. J Fam Med Dis Prev 6:130.