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Osteoporosis Risk Factors among Working Women

Authors:
American Journal of Nursing Research, 2017, Vol. 5, No. 4, 148-157
Available online at http://pubs.sciepub.com/ajnr/5/4/6
©Science and Education Publishing
DOI:10.12691/ajnr-5-4-6
Osteoporosis Risk Factors among Working Women
Amina Abd Elrazek Mahmoud, Samah Said Sabry*
Community Health Nursing Department, Faculty of Nursing, Benha University, Qaluobia Governorate, Egypt
*Corresponding author: samahsaid662@yahoo.com
Abstract Osteoporosis is a significant public health problem with serious consequences. The aim of this study
was to assess the risk factors of osteoporosis among working women, and develop health educational guidelines to
prevent/reduce osteoporosis at Benha City. Research design: A descriptive correlation research design was utilized
to conduct the study. Setting: The study was conducted at two Toshiba Elaraby Factories, they named; Benha
Toshiba Elarabyfactory at Qaluobia Governorate, and Quesna Toshiba Elarabyfactory at Elminofyia Governorate.
The sample included 10% from 3650 working women (365) working women they were selected as randomly from
the above mentioned setting. Tools: One tool was developed by the researchers: Osteoporosis structured
interviewing questionnaire: It consisted of six parts: Part I: Concerned with socio-demographic characteristics of the
working women. Part II: Concerned with the obstetric history Part III: history of osteoporosis. Part IV: Medical and
family history Part V: assess the Women's' knowledge about osteoporosis disease Part VI: risk factors of
osteoporosis and life style: Results of this study showed; the highest percentages of women were found within age
groups from 40-49 years (36.4%). Postgraduate's education represented the highest percentage (34.8%), only 7.7
were continuous movement. and 75.3% are from rural area. 63.3% of working women had good total knowledge
score. 77.8% of the study subjects are suffering from osteoporosis. 63.3% had family history of osteoporosis. This
study concluded that the common risk factors identified were; family history, lack of exercises, irregular exposure to
sunlight, and insufficient taken protein and vitamin D. Also; osteoporosis health guideline were needed for
prevention/ reduction of osteoporosis. The study recommended community based health programs on osteoporosis
that targeted a wide audience should be implemented. 3- further studies are needed to evaluate the effect of
osteoporosis health guideline in the prevention of osteoporosis.
Keywords: osteoporosis, risk factors, health educational guideline
Cite This Article: Amina Abd Elrazek Mahmoud, and Samah Said Sabry, Osteoporosis Risk Factors
among Working Women.” American Journal of Nursing Research, vol. 5, no. 4 (2017): 148-157. doi:
10.12691/ajnr-5-4-6.
1. Introduction
Osteoporosis is a disease in which the density and
quality of bones reduce. It is a silent thief, producing no
symptoms until a fragility fracture occurs. Quality of life
of the individual can negatively affected by osteoporosis
as all living activities of the individual was deteriorated
related to pain and increased dependency on other may
cause social isolation, self-esteem decrease, body image
changes and depression. Moreover, Osteoporosis is a serious
metabolic bone disease to negative effect on economic that
causes loss of labour, loss of work and use of expensive
medicine for a very long time and hospital long stay [1].
Osteoporosis is a silent "epidemic" that has become a
major health hazard in recent years, afflicting over 2000
million people worldwide [2]. As projected by [3] the
prevalence osteoporosis has reached to endemic proportion
where approximately 75 million people in Europ and
America are suffering from osteoporosis and worldwide 9
million fractures are solely due to osteoporosis every year.
[4] estimated that approximately 30% of all postmenopausal
women have osteoporosis in the US and Europe. Women
are 8 times more at risk of osteoporosis than men so that;
abut 200 million women worldwide suffer from the disease.
Osteoporosis includes several controllable and
uncontrollable risk factors. The uncontrollable factors are
gender, family history, ethnicity and race, advancing age,
postmenopausal status and body frame size. Environmental
risk factors (controllable) include low activity level,
sedentary lifestyles over many years, smoking, alcohol
abuse, and inadequate diet including eating disorders, low
calcium intake, low vitamin D intake. Excessive
consumption of soft drinks and caffeinated drinks cause
calcium loss via the kidney. Caffeine use of more than
three cups of coffee every day might increase calcium
excretion in the urine and it affects bone health [5].
Bone mass and bone density increase the most during
childhood and adolescence in both sexes, and usually peak
bone mass is maximized by the age of 30. For most
women, bone mass remains stable until menopause, when
the loss of estrogen in conjunction with aging is associated
with a decline in bone mineral density. Studies indicate
that young adults can increase their peak bone mineral
density, promote long term bone health, and reduce the
149 American Journal of Nursing Research
risk of disease later in life by following a well-balanced
diet including calcium-rich food, physical activity and
health lifestyle practices [6,7].
Insufficient awareness of osteoporosis and related
education are among the most important reasons for
osteoporosis. A number of studies have investigated the
role of knowledge in preventing the development of
osteoporosis and reported that women have serious
deficits in knowledge, and educational interventions are
useful in increasing knowledge. Health education can
decrease the overall costs of health care by preventing
expensive complications of chronic illnesses. Implementation
of education program is one strategy that can produce
changes in osteoporosis preventive behaviors [8].
Working women are more likely to have osteoporosis
because they stay along time at working place, in addition
to permanently and continuously strive to take care of
family, causing pressure psychologically and neurologically
turns into membership worsen with passage of time as
well as lack of exposure to sunlight and unhealthy food
intake integrated disease [9].
Community health nurse (CHN) play an important role
regarding decrease the risk of osteoporosis among
working women through educating them about avoiding
risk factors and maintaining healthy life style, following
good nutrition, doing exercise and preventing falls among
these behaviors, also increase awareness of women
regarding osteoporosis symptoms that help early diagnosis
of the disease, encourage help-seeking behaviors and
decrease complications [10].
1.1. Significance of the Study
Osteoporosis is a disease in which the density and
quality of bones reduce. It is a silent thief, producing no
symptoms until a fragility fracture occurs. Osteoporosis is
considered a major health problem in Egypt as 6.5% of
females aged 20 years and above suffers from osteopenia
and 12.6% of women in the same age group suffer from
osteoporosis. Egyptian women have generally lower bone
mineral density compared to women in western countries
[11].
[4] estimates that osteoporosis affects about 200 million
women worldwide. This study is important because the
majority of women don’t realize that osteoporosis can lead
to a significant loss of height, a painful stooped posture
and broken hips. Women wrongly think that brittle bones
and fragile body are an inevitable part of growing older.
Prevention of osteoporosis is extremely important since
the disease may leave a woman unable to care for herself.
Everyday activities like lifting groceries or walking down
stairs become difficult tasks. Women with osteoporosis
may lose the independence, they have enjoyed for years
because of painful fractures or disability resulting from a
broken hip so community health nurse plays important
role in prevention of osteoporosis.
1.2. Aim
This study aimed to 1-assess the risk factors of
osteoporosis among working women, and 2-develop
health guidelines to prevent/ reduce osteoporosis.
1.3. Research Questions
To fulfill the aim of this study the following research
questions formulated: 1-What are the risk factors of
osteoporosis among studied sample. 2-What is the
knowledge of studied sample regarding osteoporosis?
3-What is the relationship between risk factors and
osteoporosis among studied sample?
2. Subjects and Methods
2.1. Research Design
A descriptive correlation research design was utilized to
conduct the study.
2.2. Setting
The study was conducted at two Toshiba Elaraby
Factories, they named; Benha Toshiba Elaraby' factory at
Qaluobia Governorate, and Quesna Toshiba Elaraby'
factory at Elminofyia Governorate.
2.3. Subjects
The studied sample included 10% from 3650 working
women (365) working women they were selected as
randomly from the above mentioned setting. The study
sample was selected as follow:
Number of selected
women
Total number of
women
Factory Name
170 women 1700 Quesna factory
195 women 1950 Benha factory
2.4. Tools of Data Collection
One tool was developed by the researchers after
extensive review of the related literature.
Osteoporosis structured interviewing questionnaire:
It consisted of the following six parts:
Part one: Concerned with socio-demographic
characteristics of the working women included five items
as age, marital status, educational level, nature of work,
and place of residence.
Part two: Concerned with the obstetric history
included seven items as age of menarche, having children,
number of children, breastfeed, contraceptive method,
menstruation, and remove the ovary.
Part three: Designed to assess history of osteoporosis
which included 4 items e.g.; inflammation in the joints,
difficulty in walking, lower back pain, and muscle’s
weakness.
Part four: Medical and family history: It included the
following items: family history of osteoporosis, chronic
diseases, history of falls and fractures, treatment;
medications (thyroid treatment, hormonal treatment,
corticosteroid, antidepressant, anticoagulant drugs and
immune-suppresive).
Part five: Designed to assess the women's' knowledge
about osteoporosis disease which included (27) items
American Journal of Nursing Research 150
divided into 3 sub items as (11) about general information
about osteoporosis, (10) about risk factors of osteoporosis,
and (6) about osteoprotective factors. Scoring system;
The total knowledge scores were considered good if the
score of the total knowledge 75 % ( 20), considered
average if it is equals 50- < 75% (14-20), and considered
poor if it is less than 50% (<14).
Part six: Risk factors of osteoporosis and life style e.g.;
exercise smoking, alcohol and caffeine intake, appetite
loss, protein eating, sun exposure, and body mass index.
Scoring system; for each item was given as follows: 1if
yes, and zero if no.
Validity test
The tools were revised for content validity by 3 juries
who were experts in the Community Health Nursing
Specialties, for clarity, relevance, comprehensiveness,
and applicability. According to their suggestions, the
modifications were applied.
Reliability test
Reliability of the tools was applied by the researcher for
testing the internal consistency of the tool, by
administration of the same tools to the same subjects
under similar condition on one or more occasion. Answers
from repeated testing were compared (test-retest
reliability). = (0.78)
2.5. Operational Design
2.5.1. Preparatory Phase
Preparation of the study design and data collection tools
was based on reviewing current and past, local and
international related literature about various aspects of
internet addiction by using periodicals journal, magazines,
books and computer search to construct the tool of the
study.
2.5.2. Legal Aspect for Ethical Considerations
Oral consent was been obtained from each women
before conducting the interview and given a brief
orientation to the purpose of the study. They were also
reassured that all information gathered would be
confidential and used only for the purpose of the study.
No names were required on the forms to ensure anonymity
and confidentiality.
2.5.3. Pilot Study
A pilot study was conducted to assess tools clarity and
applicability. It has also served in estimating the time
needed for filling the form of the study. It has also served
in determining the needs of women which have been taken
in consideration during developing the educational health
guideline. It represented 10% of the sample (36 women);
they were included from the study sample.
2.5.4. Field work
Official letter from Faculty of Nursing - Benha
University to Toshiba El-Araby factories were prepared
and delivered to the administration of factories in Benha
and Quesna/Menofyia City. Permission from administration
was obtained to interviewing the working women. Oral
consent of the working women was taken to participate in
the study.
Data were collected throughout the period from
beginning of August 2016 till January 2017. The
researcher visited the selected factories from 9 am - 1 pm,
and sometimes afternoon according the present of working
women. Three days/week by rotation (Saturdays,
Mondays and Tuesdays). The fieldwork was performed in
the following sequence: In each factory, study aim and
importance was clarified to the head master and studied
women to gain their support and cooperation. In each
factory, the researcher explained the study purpose to the
women. Questionnaire sheets were distributed to women
in the factory, and they were asked to fill them
individually.
An educational health guideline. It consisted three
phases;
Phase 1: Assessment, collected data, and detect needs
of the working women.
Phase 2: Developing a health educational guideline
according to needs of the working women.
Phase 3: Content of health educational guideline:
Included the modifiable risk factors of osteoporosis in the
forms of:
1-Alcohol and smoking prevention.
2- Balanced diet and exposure to sun.
3- Adequate physical exercises
4- Effective falls prevention.
5- Low body mass index.
6- Medical treatments affecting bone health.
7- Importance of follow up especially for post-
menopausal women and those with family history of
osteoporosis.
8- Periodic follow up especially in case of chronic
diseases.
3. Statistical Analysis
The collected data were verified prior to computerized
entry; statistical analysis was done by using the Statistical
Package for Social Science (SPSS) version 20. Data were
presented in tables by using mean, standard deviation,
number, percentage distribution, and Pearson correlation.
Statistical significance was considered at: no Significant if
p->0.05, Significant if p-<0.05 and Highly Significant if
p-<0.001.
4. Results
Table 1 shows that the highest percentages of women
were found within age groups from 40-49 years (36.4%)
and 30-39 years (24.1%) with Mean± SD = 40.15 ± 10.44.
66.3 were Married. Regarding their educational level;
postgraduates represented the highest percentage followed
by highly educated group (34.8% & 28.5%) respectively.
80.3% of the participants were working with moderate
movement and only 7.7 were continuous movement.
75.3% were from rural area.
Table 2 shows that; regarding obstetrical history, the
mean age of menarche was 12.86 ± 0.8 year old. High
percentage of women had children and breastfed their
babies (56.4%, 73.2%) respectively. Also shows that,
71.3% of the participants didn‘t use any family planning
151 American Journal of Nursing Research
methods, 80% of them reported the menstruation still
present and only 9.3% of them removed their ovaries.
Table 3 demonstrates that more than three quarters of
the studied sample 78.4% had inflammation in the joints
and 63.3 % had difficulty in walking. As well as 87.4% of
the studied sample had low back pain and 77.0% had
weakness in their muscles.
Table 4 explains that; 63.3% of working women had
good total knowledge score regarding osteoporosis while
12.6% of them had poor total knowledge score.
Figure 1 illustrates that 22.2% do not have osteoporosis
while 77.8% of the study subjects are suffering from it.
Table 5 reveals that; 26.6% of the study subjects are
overweight, 31% are at risk of obesity and 23.8% are
obese with a mean ± SD (30.14 ± 5.46).
Table 6 reveals that; 34.6% of those without
osteoporosis and 18.7% of those with osteoporosis
practice exercises. Also 41.9% of those without
osteoporosis and 22.5% of those with osteoporosis expose
themselves to sunlight. Results find that; 58.1% of those
without osteoporosis and 32.4%of those with osteoporosis
eating enough protein. Regarding appetite loss; results
revealed that; 33.3% of those without osteoporosis and
34.9%of those with osteoporosis were suffering from
appetite loss.
Table 7 shows that; concerning passive smoking,
66.2% of those without osteoporosis and 69.7% of those
with osteoporosis respectively are exposed to passive
smoking. As for drinking alcohol; all studied women
100% are not drinking alcohol. While 45.7 of those
without osteoporosis and 72.5% of those with
osteoporosis respectively drink tea and coffee and cola.
Table 8 reveals that; 38.3% and 63.3% of the study
subjects without osteoporosis and those with osteoporosis
respectively have family history of osteoporosis. 55.6% of
those without osteoporosis and 48.2 of those with
osteoporosis have previous fracture. Also 61.7% of those
without osteoporosis and 55.9% of those with
osteoporosis have chronic illness.
Figure 2 illustrates that; only 2.7% of the studied
sample with osteoporosis take immunosuppressive, 7.1%
take antidepressant, 9% take corticosteroid, 21.4% take
hormonal therapy, 43% take antiepileptic, and 67% of
them take anticoagulant.
Table 9 Shows that; there were high statistically
significant correlation between age, family history of
osteoporosis (P < 0.001), fall down 2 years age (P < 0.05)
and the presence of osteoporosis among the study working
women, while there were not statistically significant
correlation between education and the presence of
osteoporosis among the study working women (P > 0.05).
Table 10 Shows that; there were high statistically
significant correlation between drugs, hormonal therapy,
smoking (P < 0.001), drinking tea and coffee (P < 0.05)
and the presence of osteoporosis among the study working
women.
Table 11 Shows that; there were high statistically significant
correlation between eating protein, body mass index, loss
of appetite (P < 0.05), exercises and the presence of
osteoporosis among the study working women (P < 0.001)
Table 1. Distribution of the studied working women according to
their socio-demographic characteristics (n= 365)
Socio-Demographic Characteristics No. %
Age in years
< 30 57 15.6
30- 88 24.1
40- 133 36.4
50- 67 18.4
60+ 20 5.5
Mean±SD = 40.15 ± 10.44
Marital status
Single 38 10.4
Married 242 66.3
Widowed 48 13.2
Divorced 37 10.1
Education level
Illiterate 13 3.6
Basic education 25 6.8
Middle education 96 26.3
High education 104 28.5
Postgraduates 127 34.8
Nature of work
Continuous movement 28 7.7
Setting for long time 44 12.0
Moderate movement 293 80.3
Residence
Rural 275 75.3
Urban 90 24.7
Table 2. Distribution of the studied working women according to
their obstetric history (n=365).
Obstetric History No. %
Age of menarche:- Mean ± SD = 12.86 ± 0.8
Have children: 206 56.4
Yes
Number of children (n= 206) X±SD = 3.03 ± 1.2
Breastfeed her babies:-
Yes 267 73.2
No 98 26.8
Using Contraceptive method:
No 260 71.3
IUD 20 19.2
Pills 50 21.9
Injection 35 9.6
Menstruation still present:
Yes 292 80.0
No 73 20.0
Remove the ovary:
Yes 34 9.3
No 331 90.7
American Journal of Nursing Research 152
Table 3. Distribution of the studied working women according to
their history of osteoporosis (n= 365)
Present History of Osteoporosis
No.
Inflammation in the joints
Yes
286
No 79 21.6
Difficulty in walking
Yes
231
No 134 36.7
Lower back pain
Yes
319
No 46 12.6
Muscle’s weakness
Yes
281
No
84
Table 4. Distribution of total knowledge' score of the studied
working women regarding osteoporosis (n=365)
Total' Knowledge
Good
Average
Poor
No.
%
No.
%
No.
%
General information of osteoporosis
80
24.9
271
74.2
14
3.83
Risk factors of osteoporosis 104 28.5 159 43.6 102 27.9
Osteoprotective' factors
166
45.5
147
40.3
59
16.1
Total items
231
63.3
88
24.1
46
12.6
Table 5. Distribution of the studied working women; according to
their body mass index BMI (n= 365)
Body Mass Index
No
%
20- 25.9 (underweight)
68
18.6
26-30.9 (over weight)
97
26.6
31- 35.9
(at risk of obesity) 113 31.0
36+ (obese)
87
23.8
Mean ± SD= 30.14 ± 5.46
Table 6. Distribution of exercises, eating enough protein, loss of
appetite and sun exposure among the studied working women
(n = 365)
Working women
with osteoporosis
(n=284)
Working women
without osteoporosis
(n= 81)
Risk factors
%
No.
%
No.
Practicing exercises
18.7
53
34.6
28
Yes
81.3
231
65.4
53
No
Exposure to sunlight
22.5
64
41.9
34
Yes
77.5
220
58.1
47
No
Eating enough protein
32.4
92
58.1
47
Yes
67.6
192
41.9
34
No
Loss of appetite
34.9
99
33.3
27
Yes
65.1
185 66.7 54 No
Table 7. Distribution of smoking, alcohol drinking, and drinking tea
and coffee among the studied working women (n= 365)
Working women
with osteoporosis
(n=284)
Working women
without osteoporosis
(n= 81)
Risk factors
%
No.
%
No.
Passive smoking:
69.7
198
64.2
52
Yes
30.3
86
35.8
29
No
Drinking alcohol:
0.0
0.0
0.0
0
Yes
100.0
284
100.0
81
No
Drinking tea and coffee and cola:
72.5
206
54.3
44
Yes
27.5
78
45.7
37
No
Figure 1. Percentage distribution of osteoporosis among the studied working women (n= 365)
Yes
No
77.8%
22.2%
Distribution of the studied sample in relation to suffering from the disease
With Osteoporosis
153 American Journal of Nursing Research
Table 8. Distribution of family history of osteoporosis, chronic illness, falls within previous two years and previous fractures among the studied
working women (n=365)
Medical & Family History
Working Women Without
Osteoporosis (n=81)
Working Women With
Osteoporosis (n=284)
No.
%
No.
%
Family history of osteoporosis
31
38.2
180
63.3
Chronic illness in form of (hypertension, diabetes, heart disease)
50
61.7
159
55.9
Fall down 2 years age
60
74.0
170
59.8
Previous fractures
41
55.6
137
48.2
Figure 2. Percentage distribution of drugs taken among the studied working women (n=365)
Table 9. Correlation between age, education, family history of
osteoporosis, fall down 2 years age and osteoporosis among the
studied working women (n= 365)
Working Women
Osteoporosis
R
p- value
Age
0.36
0.000
Education
- 0.10
0.070
Family history of osteoporosis
0.22
0.000
Fall down 2 years age 0.010 0.05
Table 10. Correlation between drugs, hormonal therapy, smoking,
drinking tea and coffee and the presence of osteoporosis among the
studied working women (n= 365)
Working Women Osteoporosis
R
P- value
Drugs
Anticoagulant
0.216
0.00
Anticonvulsants
0.222
0.00
Hormonal therapy
0.246
0.00
Smoking
0.267
0.001
Drinking tea and coffee
0.190
0.002
Table 11. Correlation between eating protein, body mass index, loss
of appetite, exercises and the presence of osteoporosis among the t
studied working women (n= 365)
Working Women
Osteoporosis
r
P- value
Eating protein 0.266 0.001
Body mass index
0.392
0.000
Loss of appetite
-0.179
0.021
Exercises
0.377
0.000
5. Discussion
Osteoporosis has recently been recognized as a major
public health problem; it is no longer confined to the
growing older population but has implications for all age
groups [5]. Millions of people around the world suffer
from osteoporosis because it is a silent killer disease.
Osteoporosis is a systemic disease characterized by
decrease in skeletal bone mass. Osteoporosis makes the
bones weak and liable to fractures specially the bodies of
the vertebra. Risk factors fall into two main categories,
modifiable, which are those we can change and fixed,
those we can't change. Though there is no way to control
the fixed risk factors, which include age, gender, and
family history, there are strategies that can lessen their
effect [4].
It was found that, the highest percentages of women
were found within age groups from 40-49 (had their
menopause) in more than one third and 30-39 years in
about one fourth of osteoporosis women's with Mean± SD
= 40.15 ± 10.44, with a high statistically significant
correlation between age at menopause, and the presence of
osteoporosis among the study working women, as shown
in Table 1. This result was in harmony with study
conducted by [2] who made a study about osteoporosis
found that Mean age of participated women was 43.7 ±
1.3 years and a statistically significant correlation was
found between osteoporosis among the subjects and their
age. Also, the same results was revealed by [12] who
showed that, two thirds of participants were 50 years old
0%
10%
20%
30%
40%
50%
60%
70%
9%
7.10%
67%
43%
2.70%
21.40%
corticosteroid
antidepresant
anticoagulant
antiepileptic
immunesuppressive
hormonal therappy
American Journal of Nursing Research 154
or above. A recent study done by [13] who found that,
advanced age was risk factor for osteoporosis.
Regarding the educational level of studied sample;
postgraduates represented the highest percentage in more
than one third of studied sample, followed by highly
educated group also in more than one quarter of studied
sample respectively, a statistically significant negative
correlation was found between client's education and the
presence of osteoporosis. Most of studied sample were
working with moderate movement. This result was in
harmony with study conducted by [14] who revealed that;
highly educated group also in more than one quarter of
studied sample and less than half of the participants were
working with moderate movement. Also, this result was in
harmony with study conducted by [15] who founded that,
highly educated group also in less than half of studied
sample and most of studied sample were working with
moderate movement.
This study reveals that; three quarters of studied sample
were from rural residents. In contrast to the study results
[2] who founded that, more than three quarters of studied
sample were from urban residents. This result might be
related to the high prevalence of malnutrition in rural areas.
The difference between the two studies might be related to
the higher number of study subjects from rural area.
Regarding obstetrical history, the mean age of menarche
was 12.86± 0.8 year old. High percentage of women had
children and breastfed their babies (56.4%, 73.2%) respectively.
Also, less than three quarters of the studied sample didn‘t
use any family planning methods, most of them reported
the menstruation still present and only less than one tenth
of them removed their ovaries. This result was in harmony
with study conducted by [14] who revealed that, the mean
age of menarche was 12.86 ± 0.8 year old. High
percentage of women had children and breastfed their
babies (56.5%, 70.8%) respectively. Also more than three
quarters of the participants didn‘t use any family planning
methods and only 2.2% of them removed their ovaries.
Regards to participant’s family history of osteoporosis,
demonstrates that most of the studied sample had family
history of the disease, more than three quarters of the
studied sample had inflammation in the joints and two
thirds had difficulty in walking. As well as most of them
had low back pain and more than three quarters had
weakness in their muscles. [17] who revealed that; most of
working women had low back pain. It in contrast to the
study results of [5] who made a study to assess
osteoporosis knowledge among female adolescents in
Egypt who revealed that, most of the studied sample had
no family history of the disease. More than three quarters
of the sample had no inflammation in the joints and only
more than one third had difficulty in walking. As well as
more than half of the studied sample had no low back pain
and about three quarters had weakness in their muscles.
Results revealed that, two thirds of working women had
good total knowledge score regarding osteoporosis while
twelve percent of them had poor total knowledge score. In
contrast to the study results conducted by [11,16] who
conduct a study about osteoporosis who revealed that,
highly percentage of the studied sample had poor total
knowledge score regarding osteoporosis. The difference
between the two studies might be related to the higher
number of study subjects highly education. While this
result was in harmony with study conducted by [17] who
revealed that, most of working women had good total
knowledge score regarding osteoporosis during and post
health education. The difference between the two studies
might be related to the higher number of study subjects
highly education.
Results revealed that, more than three quarters of
studied sample who have osteoporosis had history of
osteoporosis with high statistically significant correlation.
On the same line, the study done by [18] revealed a
significant association between family history and the
prevalence of osteoporosis. Also this finding was similar
to the study done by [19] where osteoporosis was
significantly associated with family history that increase
the probability of developing osteoporosis. In contrast
with the study results of [5] who revealed that, most of the
studied sample had no family history of the disease. This
difference could be attributed to the sample selection.
Overweight and obesity were prevalent among the
studied sample, it's found that, less than one quarter of
them being overweight and obese with a mean ± SD
(30.14 ± 5.46). This result was in harmony with study
conducted by [14] who revealed that, quarter of them
being overweight and obese with a mean ± SD (27.8±5.6).
Also, this result was in harmony with study conducted by
[2] who revealed that, quarter of them being overweight
and obese with a mean ± SD (30.00 ± 6.87). The explanation
of [20] indicated that, excessive fat mass may not protect
humans from osteoporosis and in fact, increased fat mass
is associated with low total bone mineral content and high
fat diet, often a cause of obesity, has been reported to
interfere with intestinal calcium absorption and therefore
contributing to low calcium absorption. The researchers of
the present study agree with Caos explanation.
Regarding practicing exercises, slightly more than one
third of patients without osteoporosis and around twenty
percent of those with osteoporosis were practicing
exercises. A statistically significant correlation was found
between exercises and the presence of osteoporosis among
the study working women. These results supported by the
study conducted by [21] who found that, most of study
working women with osteoporosis did not exercise
regularly. On the same line, the study done by [22] who
revealed a higher prevalence of osteoporosis amongst
Indians as compared to the individuals from more
developed countries and this prevalence's in early growth
years of life and lack of physical training in youth is
responsible for the large share of this prevalence. Might be
related to the least confidence in performing exercise and
lack of community support for women to exercise.
Physical exercise requires strong determination and many
Egyptian women neglect it when they encounter obstacles
such as violating social codes.
This study reveals that; less than half of studied sample
without osteoporosis and only twenty percent of studied
sample with osteoporosis were exposing themselves
regularly to sunlight. In the same context, a study done by
[23] who revealed that, sun exposure was among the risk
factors for osteoporosis. [24] revealed significant correlation
between the incidence of osteoporotic vertebrae and
exposure to sunlight. Also, this result was in harmony
with study conducted by [2] who revealed that, less than
half of studied sample without osteoporosis and only
155 American Journal of Nursing Research
thirteen percent of studied sample with osteoporosis were
exposing themselves regularly to sunlight. According to
[15] usually 10-15 minutes exposure of the hands, arms
and face two or three times a week is enough to satisfy the
body’s vitamin D requirement.
Results revealed that, one quarter of those with
osteoporosis and more than half of those without osteoporosis
were eating enough proteins with a high statistically
significant correlation between eating protein and the
presence of osteoporosis among the study working women.
In the same context, a study done by [23] found the risk
factors for osteoporosis as reported by the respondents as
lack of intake of dairy products. The study done by [24]
revealed a significant correlation between the incidence of
osteoporotic vertebrae and dairy, white meat consumption.
Regarding appetite loss; results revealed that slightly
more than one third of study working women without
osteoporosis and more than one third those with
osteoporosis were suffering from appetite loss. This result
was in harmony with study conducted by [2] who revealed
that, more than one third of study working women without
osteoporosis and less than one third those with osteoporosis
were suffering from appetite loss.
Concerning passive smoking, more than two thirds of
clients without osteoporosis and more than two thirds
those with osteoporosis respectively are exposed to
passive smoking. There were a statistically significant
correlation between smoking and the presence of
osteoporosis among the studied working women. Study by
[23] on the occurrence of risk factors for osteoporosis.
Almost the same results were found by [25] found that,
smokers were few in both cases and the controls.
Literatures from UJK, Australia, and USA Europe also
indicated that, cigarette smoking is a risk factor for the
development of osteoporosis, the reason is that nicotine
and toxins in cigarettes affect bone health from many
angles. Cigarette smoke generates huge amounts of free
radicals molecules that attack and overwhelm the body's
natural defenses. The result is a chain-reaction of damage
throughout the body, including cells, organs, and
hormones involved in keeping bones healthy [15].
Results revealed that, all studied women are not
drinking alcohol. In contrast to the study results conducted
by [2] who revealed that, slightly more than one third of
clients without osteoporosis and almost one quarter of
clients with osteoporosis were drinking alcohol with a
statistically significant correlation. This may be attributed
to the fact that many people hesitated to tell the truth
about the frequency and amount of alcohol intake due to
high religiosity in the study area.
Results revealed that, less than half of clients without
osteoporosis and about three quarters those with
osteoporosis were drinking tea, coffee and cola
respectively. A statistically significant correlation was
found between drinking tea and coffee and the presence of
osteoporosis among the study working women. The study
done by [25] revealed that, more than three quarters of the
cases and more than three quarters controls consume
coffee<2cups a day but no significant association was
found between caffeine intake and osteoporosis. This
might be the fact that, yet caffeine intake increases urinary
calcium output and it is among the risk for osteoporosis
that leads to fractures.
Results revealed that; more than one third of studied
women without osteoporosis and two thirds with osteoporosis
respectively have family history of osteoporosis was
significantly associated with family history that increases
the probability of developing osteoporosis. Finding was
similar to the study done by [19] who showed that
significantly associated with family history that increases
the probability of developing osteoporosis.
Results revealed that, more than half of those without
osteoporosis and less than half of those with osteoporosis
have been falling down during the previous two years ago
and have fracture previous two years ago with a
statistically significant correlation. The same results were
reported by [26] who revealed that, were women fracture
occurred more frequently in those with a history of falling
in the year prior to the survey. Also, the same results were
conducted by [2] who revealed that, about two third of
those with osteoporosis have been falling down during the
previous two years and slightly less than half of those also
had pervious fractures two years ago with a statistically
significant correlation.
The study revealed that, less than two thirds of those
without osteoporosis and more than half of studied sample
with osteoporosis were having chronic illness in the form
of hypertension, diabetes and heart disease. This finding is
similar to the study done by [18] were a significant
association was found between chronic disease such as
diabetes, hypertension, ischemic heart disease and the
prevalence of osteoporosis. Also [27] showed that, the
most common medical problem encountered were type
two diabetes mellitus followed by thyroid health problems,
rheumatoid and kidneys diseases. Also, this result was in
harmony with study conducted by [14] who revealed that,
twelve percent had history of diabetes and hypertension.
Regarding the drugs taken among the study working
women, two point seven percent of the studied samples
were taking immune-suppressive drugs. Also, the same
results were conducted by [2] who revealed that, around two
percent of the study subjects were taking immune-suppressive
drugs. According to [28,29] revealed that, post transplantation,
bone mineral density increases the risk of fractures
and consequently, reduces quality of life and increases
mortality.
The current study revealed that, seven point one of
studied sample were taking antidepressant. [30] revealed
that, tee greater the severity of depression, the lower the
Bone Mineral Density. These finding are further supported
by a meta-analysis of 20 studies on the relationship between
depression and osteoporosis, which found that depressed
patients had lower BMDat all sites versus controls (spine,
femoral neck, and total femur) which is likely to increase
fracture risk. In the same context, the study done by [31]
identified in their review article that, antidepressant
treatments that act on serotonin pathways may therefore
be expected to have some impact on bone, bone mass, and
fracture rates. This might be the link between depression,
antidepressant use, and osteoporosis is becoming more
widely understood, and there is mounting evidence for
an effect of depression and antidepressants on fracture
rates.
The current study revealed that only less than one tenth
percent of those with osteoporosis were taking corticosteroid
treatment. [4] oral corticosteroids used in a number of
American Journal of Nursing Research 156
different chronic diseases contribute to an increased
prevalence of osteoporosis and an increased incidence of
fracture. Also, the study done by [24] revealed a
significant correlation between the incidence of osteoporotic
vertebrae and thyroid disorders, and drugs including
corticosteroids. Also, the same results were conducted by
[2] revealed that, only minority of those with osteoporosis
were taking corticosteroid treatment.
Results revealed that, less than one quarter of the
studied sample were taking hormonal therapy. While less
than half of the studied sample were taking antiepileptic or
anticonvulsants drugs with a high statistically significant
correlation between drugs, hormonal, antiepileptic or
anticonvulsants drugs and the presence of osteoporosis
among the study working women. The same results were
conducted by [2] who revealed that, around half of the
studied women with osteoporosis were taking antiepileptic
or anticonvulsants drugs with a high statistically significant
correlation. According to [32] hormonal, antiepileptic or
anticonvulsants drugs may cause bone loss, but the
mechanisms are unclear. There is accelerated vitamin D
metabolism, but anticonvulsants also may have direct
inhibitory effects on osteoblast differentiation, and valproate
and carbamazepine have anti-drogenic effect.
Results revealed that, more than two third of those with
osteoporosis were taking anticoagulants with a high
statistically significant correlation between anticonvulsants
drugs and the presence of osteoporosis among the study
working women. Study results were supported by [33,34]
found that, long term use of warfarin was associated with
a 25% increased risk osteoporotic fracture. Among those
with long-term use warfarin was most strongly associated
with vertebral fractures. The correlation between warfarin
use and fracture differed in men and women, long-term
warfarin use was significantly associated with osteoporotic
fractures in men but not women. Researchers of the present
study agree with this explanation. Additionally, oral
anticoagulant effects on bone metabolism are controversial.
Anticoagulants are vitamin K antagonists that interfere with
gamma-carboxyglutamate formation, and consequently
inhibit the accumulation of osteocalcin in the extracellular
matrix [31].
Overweight and obesity were prevalent among the studied
sample, and slightly more than one third of patient's with
osteoporosis were suffering from loss of appetite with a
high statistically significant correlation between loss of
appetite, body mass index and the presence of osteoporosis
among the study working women. On the same line, the
study done by [25] revealed that, BMI of the cases and
controls was almost similar. In addition, a significant
difference was found in the weight of the study participants
with a p-value of 0.004. The same results were conducted
by [2] who revealed that, a statistically significant correlation
between osteoporosis and obesity and appetite loss.
6. Conclusion
The study concluded that the common risk factors
identified were; family history, lack of exercises, irregular
exposure to sunlight, and insufficient taken protein and
vitamin D. Also; osteoporosis health guideline were
needed for prevention / reduction of osteoporosis.
7. Recommendations
Based on the findings of the present research the following
recommendations are suggested: 1- increase women's
awareness of osteoporosis risk factors and preventive
behaviors. 2- community based health programs on
osteoporosis that targeted a wide audience should be
implemented. 3- further studies are needed to evaluate the
effect of osteoporosis health guideline in the prevention of
osteoporosis.
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Community & Public Health Nursing is designed to provide students a basic grounding in public health nursing principles while emphasizing aggregate-level nursing. While weaving in meaningful examples from practice throughout the text, the authors coach students on how to navigate between conceptualizing about a population-focus while also continuing to advocate and care for individuals, families, and aggregates. This student-friendly, highly illustrated text engages students, and by doing so, eases students into readily applying public health principles along with evidence-based practice, nursing science, and skills that promote health, prevent disease, as well as protect at-risk populations! What the 8th edition of this text does best is assist students in broadening the base of their knowledge and skills that they can employ in both the community and acute care settings, while the newly enhanced ancillary resources offers interactive tools that allow students of all learning styles to master public health nursing. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved.
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