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INTRODUCTION
Osteoporosis is a long-term disease that makes bones weaker and more likely to break. This is particularly prevalent for older people and women who have gone through menopause. Osteoporosis influences more than 200 million people throughout the world, subsequently causes 8.9 million fractures every year, which poses a major health risk, especially for older people (Johnell and Kanis, 2006). About fifty million people in India have osteoporosis or osteopenia, which gets worse when individuals don't move frequently enough, there are significant variations in the level of education and income, and individuals don't know enough concerning dietary supplements and physical activities (Mithal et al., 2014).
In the last ten years, there have been a lot of global efforts to improve education, screening programs, and preventive measures for osteoporosis. Even though there are international awareness campaigns and research is getting better, osteoporosis is still not well-known or treated often enough, especially in Fast-Growing Developing Countries (FGDNs) like India. Many studies done in different parts of India have shown that postmenopausal women fail to consume enough calcium and Vitamin D, never get enough exercise, eat inadequately, and don't know much about osteoporosis (Vijayakumar et al., 2023).
In India, socioeconomic and cultural factors significantly influence adherence to preventive measures and the frequency of healthcare visits. In rural and semi-urban areas, traditional beliefs, low literacy rates, and limited access to healthcare services hinder awareness and early intervention, making the situation particularly urgent. A decade-long trend analysis shows that people still don't know enough about the risk factors for osteoporosis that can be changed and those that can't, like having a low body mass index, going through menopause early, not getting enough nutrients, being inactive, and having other health problems like diabetes and thyroid problems.
Furthermore, there exists a paucity of understanding concerning the influence of lifestyle factors, including regular physical activity, a nutritious diet, and sunlight exposure, on bone health. There remains a deficiency of region-specific data illustrating the interplay of clinical, demographic, and behavioral factors in influencing osteoporosis knowledge and risk perception. This is especially important for individuals living in South India, even though previous research has highlighted the importance of community-based health education (Yamamoto et al., 2024). Therefore, the present study aimed to assess the level of knowledge, beliefs, and preventive practices related to osteoporosis among postmenopausal women and to examine the association of selected sociodemographic, clinical, and lifestyle factors such as age, education, income, physical activity, and dietary habits with osteoporosis awareness and risk perception (Senthilraja et al., 2019).
MATERIALS AND METHODS
Evaluation for Diagnosis
Dual-Energy X-ray Absorptiometry (DXA) was the primary method used to find out whether an individual possessed osteoporosis. DXA is the most accurate way to determine Bone Mineral Density (BMD) at the lumbar spine and femoral neck. Quantitative Ultrasound (QUS) experienced a non-invasive way for assessing the quality of bones and the risk of fractures. Bone Turnover Markers (BTMs) like serum osteocalcin, C-Terminal Telopeptide (CTX), and Procollagen Type I N-Terminal Propeptide (P1NP) measured how much remodeling was going on. X-rays found broken bones and deformities, while MRIs found hidden fractures and problems with soft tissue.
Therapeutic Interventions
Pharmacological options included bisphosphonates (Alendronate, Risedronate) that inhibit osteoclast resorption; Selective Estrogen Receptor Modulators (SERMs) like Raloxifene for their bone-protective effects; Denosumab, a RANKL-targeting monoclonal antibody, to reduce breakdown; and Teriparatide, a recombinant parathyroid hormone analog, for anabolic formation. Adding calcium and Vitamin D to diet helped with mineralization.
Management without Medications
Strategies included weight-bearing and resistance exercises to make bones and muscles stronger, nutritional counseling to make sure people got enough calcium and Vitamin D, quitting smoking and drinking less alcohol, and preventing falls through balance training, assistive devices, and changes to the home.
Study Design and Assessment
A mixed design (cross-sectional, randomized controlled, cohort) evaluated the prevalence, efficacy, and outcomes of osteoporosis in postmenopausal women aged 50 years and older. The information included medical histories, physical exams, DXA/BMD scans, and BTM analyses. The results looked at how BMD, fracture rates, knowledge gains, and quality of life changed. The actions taken followed the Helsinki Declaration and GCP standards, and The institutional review board gave their approval (SVCOP/EC/00119/2024),srivijay vidhalaya college of pharmacy, Dharmapuri.
Statistical Analysis
Data were entered into Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) version 21. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used to summarize sociodemographic, clinical, and lifestyle variables. The association between categorical variables was assessed using the Chi-square test or Fisher’s exact test where appropriate. Independent t-test or one-way Analysis of Variance (ANOVA) was applied to compare mean BMD values and knowledge scores across different groups. Correlation analysis was performed to examine the relationship between osteoporosis knowledge and clinical or lifestyle factors. A p-value of less than 0.05 was considered statistically significant.
RESULTS
The sociodemographic and clinical characteristics of 141 postmenopausal women are presented in Table 1. The largest age group was 61-65 years (29.78%), followed by 50-55 years (25.53%), 56-60 years (24.82%), and 45-50 years (19.85%), with no significant association (p=0.936). Most participants were overweight (44.84%), while 33.33% had normal weight and 21.27% were obese (p=0.984). The majority attained menopause between 46 and 50 years (73.04%), and most had experienced menopause for 1-10 years (63.82%), with no significant associations (p>0.05).
| Age (in years) | No of Patients (n) | Percentage (%) |
|---|---|---|
| 45-50 | 28 | 19.85 |
| 50-55 | 36 | 25.53 |
| 56-60 | 35 | 24.82 |
| 61-65 | 42 | 29.78 |
Most participants had no formal education (79.43%), and homemakers constituted the largest occupational group (69.50%), followed by labourers (14.89%) and skilled workers (9.92%), with no significant association (p=0.723). Overall, the cohort largely comprised older, overweight, minimally educated homemakers, and none of the variables showed statistically significant relationships.
Table 2 shows that 53.9% of participants belonged to nuclear families and 46.09% to joint families (p=0.166). Most women (65.24%) reported no comorbidities, while diabetes mellitus (16.31%) and hypertension (11.34%) were the most common conditions among those affected (p=0.119). Musculoskeletal pain was highly prevalent, with 88.65% reporting back or joint pain (p=0.835). Only 36.17% received adequate health information from physicians.
| Types of family | Number of patients (n) | Percentage (%) |
|---|---|---|
| Joint | 65 | 46.09 |
| Nuclear | 76 | 53.9 |
| Mean±SD | 70.5±7.778 | |
| P value | 0.166 | |
| Co-morbidities | ||
| Hypertension | 16 | 11.34 |
| Hypertension and Diabetes | 8 | 5.67 |
| BP, Diabetes and Hypercholesterimia | 1 | 0.79 |
| Chest pain | 1 | 0.79 |
| Diabetes | 23 | 16.31 |
| No | 92 | 65.24 |
| Mean±SD | 23.5±34.64 | |
| P value | 0.119 | |
| Back pain/joint pain | ||
| Yes | 125 | 88.65 |
| No | 16 | 11.34 |
| Mean±SD | 70.5±77.07 | |
| P value | 0.835 | |
| Information received by the physician | ||
| Yes | 51 | 36.17 |
| No | 90 | 63.82 |
| Mean±SD | 70.5±27.57 | |
| P value | 0.593 | |
| Category of drug | ||
| Analgesic | 125 | 88.65 |
| Antibiotic | 57 | 40.42 |
| Antacid and antiulcer | 128 | 90.78 |
| Anti-inflammatory | 105 | 74.46 |
| Miscellaneous | 74 | 52.48 |
| Surgical pain | 16 | 11.34 |
| Nerve pain | 15 | 10.63 |
| Mean±SD | 74.29±47.63 | |
| P value | 0.225 | |
| Commonly prescribed drug | ||
| Aceclofenac and paracetamol | 69 | 48.93 |
| Dynapar | 88 | 62.41 |
| Aceclofenac, paracetamol and serratiopeptidase | 25 | 17.73 |
| Ceftriaxone | 31 | 21.98 |
| Amikacin | 31 | 21.98 |
| Pantoprazole | 41 | 29.07 |
| Ranitidine | 31 | 21.27 |
| Domperidone and pantoprazole | 13 | 9.21 |
| Domperidone and rabeprazole | 26 | 18.43 |
| Deflazacort | 69 | 48.93 |
| Dexajet | 26 | 18.43 |
| Gutfeel | 30 | 21.27 |
| Beta DD ( B-Complex Vitamin) | 10 | 7.09 |
| Mean±SD | 36.64±22.72 | |
| P value | 0.046 |
Analgesics and gastroprotective drugs were commonly prescribed, including antacids/anti-ulcer drugs (90.78%), painkillers (88.65%), and anti-inflammatory drugs (74.46%) (p=0.225). Frequently used medications included Dynapar (62.41%), aceclofenac with paracetamol (48.93%), and deflazacort (48.93%), and medication use showed a statistically significant association (p= 0.046).
Table 3 summarizes medical history, lifestyle factors, and osteoporosis-related practices. Very few participants reported thyroid disorders (1.41%) or infertility issues (0.79%). Physical inactivity was common, with only 7.80% engaging in regular exercise. Calcium supplementation was reported by 28.36% and Vitamin D₃ supplementation by 24.11%. A family history of osteoporosis-related symptoms was noted in 28.36%, and 84.39% reported a past fracture. Only 36.17% had received osteoporosis-related information from physicians. No significant associations were observed (p>0.05).
| Sl. No. | Questions | Yes | No | p-Value | ||
|---|---|---|---|---|---|---|
| n | % | n | % | |||
| 1 | History of Thyroid | 2 | (1.41%) | 139 | (98.58%) | 0.814 |
| 2 | History of Infertility | 1 | (0.79%) | 140 | (99.29%) | 0.817 |
| 3 | History of Addiction | 27 | (19.14%) | 114 | (80.85%) | 0.72 |
| 4 | History of Back Pain/Joint Pain | 125 | (88.65%) | 16 | (11.34%) | 0.768 |
| 5 | Participant involved in Exercise | 11 | (7.80%) | 130 | (92.19%) | 0.791 |
| 6 | Taking Calcium supplement | 40 | (28.36%) | 101 | (71.63%) | 0.624 |
| 7 | Family history of symptoms related to Osteoporosis | 40 | (28.36%) | 101 | (71.63%) | 0.624 |
| 8 | Uses of Vitamin D3 | 34 | (24.11%) | 107 | (75.88%) | 0.675 |
| 9 | History of Fracture | 119 | (84.39%) | 22 | (15.60%) | 0.746 |
| 10 | Have you receive information about Osteoporosis by your Physician | 51 | (36.17%) | 90 | (63.82%) | 0.484 |
Dietary and activity patterns are presented in Table 4. Most women performed light household work (62.41%), while regular structured exercise was reported by only 16.31%. Daily milk consumption was high (81.56%), whereas fish intake was low. Most participants reported regular meal consumption (85.10%). No significant associations were found (p>0.05).
| A | Always | Sometimes | Never | Mean±SD | p-Value | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | |||||
| Postmenopausal Women doing light household work | 88 | (62.41%) | 33 | (23.4%) | 20 | (14.1%) | 47±36.09 | 0.899 | ||
| Postmenopausal Women heavy household work | 37 | (26.24%) | 54 | (38.29%) | 50 | (35.46%) | 47±8.88 | 0.618 | ||
| PMW doing Exercise | 23 | (16.31%) | 92 | (65.24%) | 26 | (18.43%) | 47±0.618 | 0.906 | ||
| B | Daily | <3days in a week | >3days in a week | Never | Mean±SD | P-value | ||||
| n | % | n | % | n | % | n | % | |||
| Frequency of milk consumption by PMW | 115 | (81.56%) | 4 | (2.83%) | 2 | (1.41%) | 20 | (14.18%) | 35.25±53.77 | 0.993 |
| Frequency of egg consumption by PMW88 | 24 | (17%) | 25 | (17.73%) | 55 | (39%) | 37 | (26.24%) | 35.25±14.43 | 0.974 |
| Frequency of fish consumption by PMW | 21 | (14.89%) | 5 | (3.54%) | 19 | (13.47%) | 96 | (68.08%) | 35.25±41.12 | 0.991 |
| Frequency of food consumption by PMW | 120 | (85.10%) | 10 | 7.09% | 10 | 7.09% | 1 | 0.70% | 35.25±56.65 | 0.993 |
Beliefs and understanding regarding osteoporosis are shown in Table 5. A large proportion (93.61%) expressed fear of falls and fractures, and many recognized osteoporosis as a serious condition. Participants were aware of preventive measures such as adequate calcium intake, Vitamin D exposure, and avoidance of smoking and excessive caffeine. Some variables showed statistically significant associations (p<0.05).
| Questions | Strongly agree | Agree | Disagree | Neutral | Strongly disagree | p-value | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| n | % | n | % | n | % | n | % | n | % | ||
| Do you have any fear related to Falling and having a fracture | 132 | 93.61 | 8 | 5.67 | 1 | 0.709 | 0.449 | ||||
| Do you think Osteoporosis is Serious disease | 56 | 39.7 | 58 | 41.1 | 22 | 50.6 | 3 | 2.12 | 2 | 1.41 | 0.151 |
| Osteoporosis affects women only | 41 | 29.07 | 43 | 30.4 | 25 | 17.7 | 1 | 0.709 | 31 | 21.9 | 0.0445 |
| Most important to build bone Strength is between the age of 9&30 | 43 | 30.49 | 45 | 31.9 | 32 | 22.69 | 14 | 9.92 | 7 | 4.96 | 0.046 |
| If you suffer from Osteoporosis, you are more like to have a spine or hip fracture or other fragility fracture | 49 | 34.7 | 34 | 24.1 | 40 | 28.36 | 7 | 4.96 | 11 | 7.8 | 0.056 |
| Having a fragility fracture would increase your risk of having another one | 48 | 34.04 | 45 | 31.91 | 24 | 17.02 | 17 | 12.05 | 7 | 4.96 | 0.051 |
| The ideal time to make bones strong and increase bone mass is before the age of 25 years | 42 | 29.78 | 37 | 26.24 | 30 | 21.27 | 22 | 15.6 | 10 | 7.09 | 0.018 |
| A Calcium rich diet has a protective effect of osteoporosis | 51 | 36.17 | 38 | 26.95 | 23 | 16.31 | 17 | 12.05 | 12 | 8.51 | 0.038 |
| Children at 9-17 years of age get enough calcium from one glass 0f milk each day to prevent osteoporosis | 47 | 33.33 | 44 | 31.2 | 27 | 19.1 | 16 | 11.34 | 7 | 4.96 | 0.048 |
| Physical activity increase Osteoporosis risk 0.041 | 47 | 33.33 | 38 | 26.95 | 40 | 28.36 | 6 | 4.25 | 10 | 7.09 | 0.06 |
| Lean women have higher osteoporosis risk compared to overweight obese | 42 | 29.78 | 48 | 34.04 | 24 | 17.02 | 19 | 13.47 | 8 | 5.67 | 0.041 |
| High caffeine intake increase the risk of osteoporosis | 57 | 40.42 | 36 | 25.53 | 36 | 25.53 | 6 | 4.25 | 6 | 4.25 | 0.0911 |
| Low Vitamin D level results form decreased sun exposure time | 62 | 43.9 | 38 | 26.9 | 24 | 17.02 | 7 | 4.96 | 10 | 7.09 | 0.096 |
| Smoking increase the risk of osteoporosis | 62 | 43.97 | 27 | 19.14 | 31 | 21.98 | 10 | 7.09 | 11 | 7.8 | 0.081 |
| Aging a risk factor for osteoporosis | 75 | 53.19 | 38 | 26.19 | 13 | 9.21 | 10 | 7.09 | 5 | 3.54 | 0.18 |
| Hereditary is a risk factor for osteoporosis | 69 | 48.93 | 20 | 14.18 | 29 | 20.56 | 15 | 10.63 | 8 | 5.67 | 0.112 |
Table 6 presents correlations between osteoporosis knowledge and selected factors. Knowledge was significantly associated with age (p=0.032) and education level (p=0.001). Preventive practices such as calcium supplementation (p=0.014), Vitamin D₃ supplementation (p=0.018), receiving information from physicians (p<0.001), and engaging in exercise (p<0.001) were also significantly related to higher knowledge levels. Clinical factors including fracture history (p=0.050) and musculoskeletal pain (p=0.041) showed significant correlations.
| Variables | High Knowledge (%) | Moderate Knowledge (%) | Low Knowledge (%) | p-Value |
|---|---|---|---|---|
| Age (in Years) | ||||
| 45-55 | 52.6 | 36.8 | 10.5 | 0.032 |
| 56-65 | 43.7 | 39.1 | 17.2 | |
| >65 | 25 | 50 | 25 | |
| Educational Status | ||||
| SSLC and above | 66.7 | 27.8 | 5.5 | 0.001 |
| Uneducated | 32.1 | 40.2 | 27.7 | |
| Calcium Supplementation (Yes) | 57.5 | 30 | 12.5 | 0.014 |
| Vitamin D3 Supplementation (Yes) | 61.8 | 26.5 | 11.7 | 0.018 |
| History of Fracture (Yes) | 49.6 | 34.4 | 16 | 0.05 |
| Received Info on Osteoporosis from Physician (Yes) | 68.6 | 25.5 | 5.9 | <0.001 |
| Exercise Participation (Yes) | 72.7 | 18.2 | 9.1 | <0.001 |
| Back/Joint Pain History (Yes) | 48.8 | 35.2 | 16 | 0.041 |
Overall awareness and perceptions are summarized in Table 7. Most participants recognized osteoporosis as a serious disease (80.80%) and feared fractures due to falls (93.61%). Awareness of risk factors such as ageing, inadequate sunlight exposure, family history, smoking, and excessive caffeine intake was moderate. Preventive knowledge regarding early bone development, calcium-rich diet, and regular exercise was also reported. Overall, postmenopausal women demonstrated moderate understanding of osteoporosis risk factors and prevention.
| Knowledge Indicator | % Agree / Strongly Agree |
|---|---|
| Fear of fracture due to falling | 93.61% |
| Osteoporosis is a serious disease | 80.80% |
| Bone strength builds between age 9-30 | 62.39% |
| Spinal/hip fracture risk with osteoporosis | 58.80% |
| Fragility fracture increases future fracture risk | 65.95% |
| Bone mass increase ideal before 25 years | 56.02% |
| Calcium-rich diet is protective | 63.12% |
| Physical activity lowers osteoporosis risk | 60.28% |
| Lean women at higher osteoporosis risk | 63.82% |
| High caffeine increases osteoporosis risk | 65.95% |
| Low Vitamin D from poor sun exposure | 70.80% |
| Smoking increases osteoporosis risk | 63.11% |
| Aging as a risk factor | 79.38% |
| Hereditary as a risk factor | 63.11% |
DISCUSSION
The results indicate that postmenopausal women are both aware of and have inadequate awareness of osteoporosis. A significant amount of individuals (80.80%) considered osteoporosis was a serious disease, and many individuals (93.61%) had fears of falling and fractured a bone, which shows that they were very aware of the risk of fractures. The general population were also relatively aware of major risk factors, such as becoming older (79.38%) and not becoming sufficient sunlight (70.8%) to get sufficient amounts of Vitamin D. However, knowledge about preventive behaviors and early bone health was still only moderate. Only 56.02% of individuals were aware that peak bone mass is reached before age 25, and only 60.28% of individuals acknowledged that physical activity protects bones. Studies conducted among postmenopausal women in India and other developing regions have reported similar patterns of moderate osteoporosis awareness accompanied by deficiencies in preventive knowledge, where educational achievement and access to health information significantly influenced knowledge levels (Yammamoto et al., 2024; Senthilraja et al., 2019; Ibrahim et al., 2023).
In this study, preventive measures were insufficient despite a high incidence of musculoskeletal symptoms, as only a minority of participants engaged in regular exercise (7.8%) or utilized calcium (28.36%) and Vitamin D3 supplements (24.11%). Similar findings were reported by Nelapati (2022) and Pai MV., (2017), who noted low levels of preventive behavior despite moderate awareness of osteoporosis risk factors. There was a strong link between educational level and knowledge levels. This is accordance with previous studies that found that women with higher levels of education are more aware of osteoporosis and take steps to prevent it (Tabor et al., 2022).
Another important finding was that doctors didn't play an integral part in counseling regarding osteoporosis. More than half of the individuals who participated part indicated that they didn't get any knowledge from their healthcare providers. Similar deficiencies in physician-patient communication concerning osteoporosis prevention have been documented in community-based studies in developing nations (Ungan and Tümer, 2001). Furthermore, participants maintained misconceptions about the risk factors for osteoporosis and the consequences of their lifestyle decisions. In general, the results show that postmenopausal women need targeted community-based educational programs that focus on early bone health, changing their lifestyles, and counseling by doctors to help them avoid osteoporosis.
CONCLUSION
This study demonstrates that despite numerous postmenopausal women recognizing osteoporosis as a critical health concern and fearing fracture risks, preventive strategies such as regular exercise, calcium intake, and Vitamin D supplementation are still insufficiently carried out. A strong relationship existed between higher osteoporosis knowledge aspects including an education level, getting information from healthcare professionals, and living a healthy lifestyle. The findings underscore the necessity of advancing health education, improving physician counseling, and promoting preventive lifestyle changes to elevate osteoporosis awareness and reduce fracture risk in postmenopausal women. To help individuals avoid osteoporosis, healthcare professionals should focus on screening individual’s early, educating patients, and promoting awareness in the community. Pharmacists and healthcare may assist patients gain knowledge about bone health, supplements, and lifestyle changes. Women who have gone through menopause should be encouraged to stay active, eat well, and see their physicians on time to maintain healthy bones and mitigate potential problems.