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Abstract
Osteoporosis is considered a serious public health concern due to its important worldwide prevalence. Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe. Aging of populations worldwide will also contribute to a major increase of the incidence of osteoporosis in postmenopausal women. About 40%–50% of women and 13%–30% of men will sustain one or more fragility fractures in their remaining lifetime.
In the 40 to 50 years age female group, 42% had low BMD. At the age of 60 years, about half of the females had osteopenia, while one third of the elderly population (65 to over 80 years of age) are osteoporotic.
It is a chronic disease requiring chronic treatment. However, as this condition produces little or no symptoms, patients go undiagnosed until a fracture occurs and the osteoporosis is more severe. Hence, disease prevention and early diagnosis are particularly important. Nevertheless, effective diagnostic tools are currently not available to assist Primary Care physicians in detecting individuals at risk for developing osteoporosis and associated fractures in the future. Identifying osteoporosis risk factors will aid Primary Health Care physicians in selecting patients for evaluation and intervention. That is why it is important to assess not only the risk factors associated with osteoporosis per se, which are fairly well-known, but also their prevalence in the general population.
The aim of the present study was to study osteoporosis risk assessment for adult females through family practice in Alexandria by:
1- Assessment of the knowledge and perception of family physicians concerning risk assessment, screening and prevention of osteoporosis.
2- Screening of the adult females attending the study health facilities for risk assessment of osteoporosis.
3- Validation of the osteoporosis risk assessment tool used.
4- Assessment of knowledge of the adult females about osteoporosis risk factors and prevention.
5- Planning local appropriate guidelines for prevention of osteoporosis through family medicine practice.
To conduct the present study the following techniques were used:
1- A self-administered questionnaire was designed to assess the knowledge of all family physicians included in the study about osteoporosis risk assessment, screening and prevention.
2- A self-administered questionnaire was designed to assess the perception of all family physicians included in the study about osteoporosis risk assessment, screening and prevention.
3- A questionnaire was designed to assess osteoporosis risk factors among the females above 45 years of age.
4- The Simple calculated Osteoporosis Risk Estimation tool (SCORE) was used to assess osteoporosis risk among the studied females, where those having Score ≥ 6 are considered at risk of osteoporosis and osteoporotic fractures.
5- A sub- sample of 54 females were subjected to bone mineral density measurement by using bone ultrasonography.
6- An interview questionnaire was designed to assess the knowledge of the 384 chosen adult females included in the study concerning osteoporosis risk factors, screening and prevention.
7- For the seek of planning local appropriate guidelines for prevention of osteoporosis through family medicine practice, systemic literature review of the available international evidence based osteoporosis AGREE appraised guidelines was performed through internet search. Then, assessment of the applicability and adaptation of recommendations to target setting was performed inconsistence with the results of the current study. Finally it was modified for local use in Alexandria family medicine facilities.
Data were subjected to statistical analysis and interpretation.
The results of the present study could be summarized as follows:
1- Large percentage of the family physicians in the studied family health facilities are young general practitioners.
2- There is lack of training programmes related to musculoskeletal problems for the family physicians.
3- Osteoporosis-related knowledge of family physicians is satisfactory and scored good in (30%) of them, fair in (60%), and poor in (10%).
4- There was a significant difference in physicians’ knowledge in relation with the years of experience, post graduate qualifications, family medicine speciality versus other specialities and training related to musculoskeletal problems.
5- The level of perception of the family physicians about osteoporosis was high in (92%) and moderate in (8%) of them. And was positively correlated to the knowledge score of the physicians, but there was no statistically significant difference in the physicians’ perception score in relation to any of their general characteristics.
6- Osteoporosis risk factors are prevalent among the studied above 45 years old females including: low calcium intake (96.1%), physical inactivity (75.6%), un-exposure to sunshine (40.5%), early menopause (18.4%), maternal history of osteoporosis (18.4%), and less frequent risk factors including smoking (1%) and alcohol consumption (0.3%).
7- The majority of the females are obese (72.2%), and another (21.6%) are overweight, with a mean weight of (86.46± 18.49 kgs).
8- More than quarter of the studied females (26.2%) are at risk of developing osteoporosis according to their assessment by the Simple Calculated Osteoporosis Risk Estimation tool SCORE. Meanwhile, the prevalence of osteoporosis among them was (35%) measured by quantitative bone ultrasonography.
9- At the recommended cut-off point of 6, SCORE had a sensitivity of (42.1%) to detect osteoporosis (t score < or = -2.5 SD), a specificity of (88.6%), a positive predictive value of (66.7%), and a negative predictive value of (73.8%).
10- The level of knowledge of the females scored poor in (62.6%) of them, fair in (35.1%), and good in (2.3%).
11- The level of knowledge of the females was statistically affected by sociodemographic characteristics, being higher in the younger, more educated and also significantly related to the occupation of the females.
12- There is no scientifically sound evidence based osteoporosis guidelines at the national level.
Accordingly the following can be recommended:
Local evidence-based family practice guidelines for the prevention and management of osteoporosis should be developed, disseminated and implemented, upon which, the family physicians should be educated and trained. Those guidelines should include the comprehensive, continuous, holistic approach for the counselling, lifestyle modification, screening and early detection of the disease integrated in the other primary care services provided for the females in all age groups with special care for the post-menopausal ones. Lastly, health education of the females concerning this problem should be a priority.