During the last 10 years, we have witnessed an impressive increase in the number of studies examining knowledge about osteoporosis. The aim of the present paper is to examine the status of research on knowledge about osteoporosis by reviewing and analyzing the current literature as it pertains to assessment of knowledge about osteoporosis, factors associated with knowledge, and relationship between knowledge about osteoporosis and participation in health-related behaviors. Finally, future directions in the field are discussed. Many of the studies are still characterized by the lack of a theoretical framework, as well as by various methodological flaws. Serious deficits in knowledge are reported among healthy and diagnosed women and men, as well as among health professionals. Educational interventions are accompanied by an increase in knowledge, but no change in behavior. There is need to expand the research on knowledge about osteoporosis, especially in an effort to increase its impact on the prevention and early diagnosis of the disease. The deficits found in the knowledge of both the general population and among health care professionals, should be addressed by providing updated and reliable information through appropriate health promotion and professional venues.

Knowledge about osteoporosis: assessment, correlates and outcomes.

Background: Osteoporosis knowledge is an important contributor to improving exercise and
calcium intake behaviour. However, there are few validated instruments for measuring
osteoporosis knowledge levels. The aim of this study was to design a valid and reliable instrument
to measure osteoporosis knowledge in Australian women.
Methods: A 20 item instrument with true, false and don't know responses was drafted, based on
the Osteoporosis Australia Osteoporosis Prevention and Self-management course and the
information leaflet "Understanding Osteoporosis". The scoring range was 1 to 20. This was
administered to a 467 randomly-selected, healthy women aged 25–44 years. Questionnaire
performance was assessed by Flesch reading ease, index of difficulty, Ferguson's sigma, inter-item
and item-total correlations, Cronbach's alpha and principal component factor analysis.
Results: Flesch reading ease was higher than desirable at 45, but this was due to the use of the
word osteoporosis in many items. Of the individual items 17 had an index of difficulty less than 0.75.
The questionnaire had a Ferguson's sigma of 0.96, a Cronbach's alpha of 0.70 and factor analysis
consistent with only one factor (osteoporosis knowledge) being measured. Levels of osteoporosis
knowledge were low with a mean score of 8.8 out of 20 which suggests the OKAT may be sensitive
to change.
Conclusions: The OKAT for measuring osteoporosis knowledge has good psychometric
properties in Australian 25–44 year old females. While it should be applicable to other Caucasian
populations, this will require confirmation by further research.

The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the Osteoporosis Knowledge Assessment Tool (OKAT)

Background: Osteoporosis knowledge is an important contributor to improving exercise and calcium intake behaviour. However, there are few validated instruments for measuring osteoporosis knowledge levels. The aim of this study was to design a valid and reliable instrument to measure osteoporosis knowledge in Australian women. Methods: A 20 item instrument with true, false and don't know responses was drafted, based on the Osteoporosis Australia Osteoporosis Prevention and Self-management course and the information leaflet "Understanding Osteoporosis". The scoring range was 1 to 20. This was administered to a 467 randomly-selected, healthy women aged 25–44 years. Questionnaire performance was assessed by Flesch reading ease, index of difficulty, Ferguson's sigma, inter-item and item-total correlations, Cronbach's alpha and principal component factor analysis. Results: Flesch reading ease was higher than desirable at 45, but this was due to the use of the word osteoporosis in many items. Of the individual items 17 had an index of difficulty less than 0.75. The questionnaire had a Ferguson's sigma of 0.96, a Cronbach's alpha of 0.70 and factor analysis consistent with only one factor (osteoporosis knowledge) being measured. Levels of osteoporosis knowledge were low with a mean score of 8.8 out of 20 which suggests the OKAT may be sensitive to change. Conclusions: The OKAT for measuring osteoporosis knowledge has good psychometric properties in Australian 25–44 year old females. While it should be applicable to other Caucasian populations, this will require confirmation by further research.

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Blood lipids, red cell volume, heart volume, dynamic spirometry, electrocardiograms made at rest and during exercise, and maximal oxygen uptake were determined in 29 former athletes 45 to 70 years old. The subjects had been very successful competitors in endurance events before the age of 30, but for at least 10 years preceding this study had been sedentary. Maximal oxygen uptake averaged 40 ml/kg/min which is 20% higher than that of sedentary middle-aged men but 25% lower than that of still active athletes of the same ages. Vital capacity, forced expiratory volume, and maximal voluntary ventilation showed normal values. Heart volume was large in relation to maximal oxygen uptake and was of the same magnitude as in still active athletes. Red cell volume was also large in relation to maximal oxygen uptake, but normal in relation to the body weight. Cholesterol in serum averaged 260 mg/100 ml. Values for neutral fat averaged 1.6 mM, which was higher than that for still active athletes. In the athletes still...

Physiological Analysis of Middle-Aged and Old Former Athletes

Vadstena is a small community in the county of Ostergotland, Sweden, where a project began in 1989 to prevent osteoporosis and to lower the expected incidence of osteoporotic fractures. Persons aged 40-70 years who had a low bone mineral density (BMD) value at screening of the distal radius by single-photon absorptiometry (SPA) were invited to participate in a training study during one year. The definition of low BMD was a densitometry value below -1 SD (standard deviation) from a sex- and age-specific reference value (z-score). Fifteen persons wanted to exercise in a group and 15 persons wanted to become a control group. All participants answered a questionnaire about lifestyle, occupation, diseases, medication and heredity. Clinical tests were made regarding mobility of the joints and muscles, balance and physical fitness. BMD for the hip and the lumbar spine were assessed by dual-energy X-ray absorptiometry (DXA) before and after the investigation period. The training programme was carried out for 60 min twice a week during one year and had the intention to improve bone mass, muscle strength and flexibility, balance skill and aerobic capacity. After the training period there was a significant increase in BMD at the greater trochanter (P < 0.01), in balance skill (standing on one leg with closed eyes and "ski step"-test) (P < 0.05) and in oxygen uptake capacity (P < 0.05) in the exercise group. In the control group, there was a significant increase in BMD at the lumbar spine (P < 0.05). However, these results should be judged with caution because several participants were over the age of 60, and at that age degenerative changes in the lumbar spine may increase to a greater or lesser extent. Regular weight-bearing exercises during one year seem to influence BMD at the greater trochanter in a training group comprising both women and men. However, our study was small in number and further training studies are needed to assess the effect of weight-bearing training on bone mass in different sex- and age-specific groups.

Effects of physical exercise on bone mass, balance skill and aerobic capacity in women and men with low bone mineral density, after one year of training--a prospective study

Knowledge of osteoporosis in a Swedish municipality--a prospective study.

Under designations like small areas action research and intervention, directed ‘ground-up’ health promotion and prevention in the population form an important part of the ongoing medical systems development. There is recent evidence of the success of community intervention against cardiovascular disease. In osteoporosis, however, there is still a lack of conclusive data on both the logics and logistics of such an approach. Since 1988, a county health policy program has been formulated and implemented in Ostergotland, Sweden, following the principles and guidelines of the WHO HFA 2000 declaration. Vadstena (n ≈ 7,600) was chosen for a local and generalizable osteoporosis prevention project mediated by the primary care organization by means of health promotion and education in the community. In the present report we emphasize that community intervention is an important new advancement of the medical systems, where the basic research questions include operational and management aspects as equally vital and measurable requisites and results as other performance and outcome variables. We found that a community intervention trial against osteoporosis is both motivated and feasible and in this report wish to provide evidence on these crucial issues of logics and logistics.

Logics and Logistics of Community Intervention Against Osteoporosis: An Evidence Basis

try. Forearm BMD was measured in amount of physical activity in a populaPhysical activity may ineuence bone

Association Between Physical Activity and Forearm Bone Mineral Density in 20-72-year-olds

To examine associations between calcium intake in the diet, lifestyle factors, and forearm bone mineral density (BMD) in order to identify population subgroups for targeting by screening programs. A questionnaire was sent to a random sample of 15 of the inhabitants aged 20-79 years from 2 Swedish municipalities, and the subsample from one of the municipalities was invited to measurement of BMD. The survey response rate was 74 (n=1,1121,510) and participation in BMD measurements was 68 (n=448659). Only a tendency (p=.085) toward direct association between calcium intake and forearm BMD was found, and the best multiple regression model was retained to explain BMD excluded calcium intake. Low calcium intake was, instead, in complementary analyses, found to be correlated with the factors old age, female sex, and urban residence in the best multiple regression model. Population subgroups whose calcium intake is in a range that justifies preventive action could be identified. Screening programs staffed by public health nurses can thereby be informed regarding the subgroups of the population that are at the highest risk of insufficient calcium intake. © 2007, Blackwell Publishing, Inc.

John Waller

Papers

Knowledge of osteoporosis in a Swedish municipality--a prospective study.

Logics and Logistics of Community Intervention Against Osteoporosis: An Evidence Basis

Association Between Physical Activity and Forearm Bone Mineral Density in 20-72-year-olds

Prevalence and Correlates of Insufficient Calcium Intake in a Swedish Population