Authors
Yang Zhou, Yixuan Sun, Dongyao Zhang, Changbin Li, Zhijie Wang, Mei Wang, Zhou Liu, Fengyun Yang, Minjun Su, Xixia Pang, Ruifu Jin, Fengyin Xu, Xuelian Chen, Lin Zhang, Yincheng Teng, Minfang Tao
Published in
Clinical orthopaedics and related research. Jul 21, 2026. Epub Jul 21, 2026.
Abstract
Osteoporosis can cause painful, disabling, fatal fractures and impose substantial socioeconomic burdens. Because menopause-related bone loss accelerates during midlife, women with limited income may have difficulty accessing screening, counseling, and bone-healthy nutrition before the first fragility fracture occurs. Assessing bone-health awareness and preventive practices in this group may help identify modifiable gaps and guide targeted prevention for low-income midlife and older women.
(1) What were the attitudes, awareness, and preventive practices regarding bone health among women age 40 to 65 years with limited income in Shanghai, China? (2) Which sociodemographic and health-related factors were associated with bone-health knowledge scores?
We conducted a multidistrict, cross-sectional survey from January to September 2023. We approached 6429 eligible women with limited income at 10 health facilities and community outreach sites in seven Shanghai districts; 94% (6068) completed valid questionnaires and were included in the analysis. Eligible participants were 40 to 65 years of age, had lived in Shanghai for at least 5 years, and received minimum living security assistance. We believe that this group likely is representative of women in this demographic in Shanghai, and may be relevant to similar urban and periurban populations in China and parts of Asia. Data were collected using a researcher-developed questionnaire on osteoporosis knowledge, attitudes, and practices. Multivariable linear regression was used to identify factors associated with knowledge scores.
A clear attitude-practice gap was observed. Although 61% (3698 of 6068) of participants considered bone health important, preventive practice was uncommon in the overall cohort: 12% (720) reported calcium supplementation, 9% (520) reported vitamin D supplementation, and 2% (106) reported menopausal hormone therapy use. Twenty percent (1228) selected dual-energy x-ray absorptiometry (DEXA) as their preferred screening method, while 4% (226) had previously undergone DEXA. Higher educational attainment (β = 1.18; p < 0.001), being married (β = 1.14; p < 0.001), and regular physical activity (β = 1.28; p < 0.001) were associated with slightly higher knowledge scores. Hypertension (β = -0.73; p < 0.001) and diabetes (β = -1.10; p < 0.001) were associated with slightly lower scores.
Although most participants believed that bone health was important, women age 40 to 65 years with limited income in Shanghai had limited bone-health knowledge and generally did not take preventative steps that could have improved their bone health.
These findings support practical, bone-health education in women's screening programs, community clinics, and chronic disease visits. These materials should be tailored to the anticipated reading levels of the populations served. Programs should explain calcium and vitamin D sources, weightbearing exercise, DEXA referral, and postfracture follow-up. Our findings may also be relevant to other urban and periurban populations in China and in other parts of Asia with similar social and economic characteristics.
PMID:
42480103
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.
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