Advertisement

Factors influencing self-care in postmenopausal women with osteoporosis: The Guardian Angel® multicentric longitudinal study

      Highlights

      • This study sought to identify factors that influence healthy behaviors, to enable the development of tailored interventions.
      • Lifestyle modifications, a balanced diet, and psychoeducational interventions should represent a successful approach to the enhancement of self-care activities.
      • Our study showed there are positive associations between self-care and body mass index, smoking and recent fractures.

      Abstract

      Objectives

      To investigate the factors influencing self-care in a consecutive sample of postmenopausal osteoporotic Italian women.

      Study design

      This was a multicentric, longitudinal study (Guardian Angel) conducted across several osteoporosis centres throughout Italy.

      Main outcome measures

      Sociodemographic and clinical data (age, education, employment status, body mass index (BMI), fracture history) were collected at baseline, while self-care behaviours were assessed at baseline, and at one, three and six months from enrolment with the Self-Care of Osteoporosis Scale (SCOS). The SCOS has a total score ranging from 15 to 75 for women who take osteoporosis drugs, while for those who do not take any osteoporosis drug the score is between 13 and 65. Higher scores indicate better self-care. A three-level general linear mixed model with a random intercept for participants and regions was implemented to investigate the possible associations of the sociodemographic and clinical factors with longitudinal SCOS scores.

      Results

      The sample (n= 1525) had a mean age of 72.1 years (standard deviation [SD] = ±10.07), with a high proportion retired (64.2%) and with a low education level (45.8%). Approximately half of the women declared taking multiple medications (70.14%) and osteoporosis pharmacotherapy (69.7%). Average longitudinal SCOS scores ranged between 53.17 and 56.68, indicating a satisfactory level of self-care. There were significant and positive relationships between SCOS scores and time (p < 0.001) and number of medications taken (p < 0.001). Negative relationships were found between SCOS and BMI scores (p= 0.013), smoking status (p < 0.001) and presence of recent fractures (p < 0.001).

      Conclusions

      Several modifiable characteristics were associated with self-care behaviours in our sample of women with postmenopausal osteoporosis. Psychoeducational interventions are promising in this population to counteract unhealthy behaviours and, ultimately, to promote self-care.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Iolascon G.
        • Moretti A.
        • Toro G.
        • Gimigliano F.
        • Liguori S.
        • Paoletta M.
        Pharmacological therapy of osteoporosis: what's new?.
        Clin. Interv. Aging. 2020; 15https://doi.org/10.2147/CIA.S242038
        • Johnell O.
        • Kanis J.A.
        An estimate of the worldwide prevalence and disability associated with osteoporotic fractures.
        Osteoporos. Int. Oct. 2006; 17https://doi.org/10.1007/s00198-006-0172-4
        • Klibanski A.
        • et al.
        Osteoporosis prevention, diagnosis, and therapy.
        J. Am. Med. Assoc. 2001; 285https://doi.org/10.1001/jama.285.6.785
        • Borgström F.
        • et al.
        Fragility fractures in Europe: burden, management and opportunities.
        Arch. Osteoporos. 2020; 15https://doi.org/10.1007/s11657-020-0706-y
      1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis.
        Am. J. Med. 1993; 94https://doi.org/10.1016/0002-9343(93)90218-e
        • Hernlund E.
        • et al.
        Osteoporosis in the European Union: medical management, epidemiology and economic burden: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA).
        Arch. Osteoporos. 2013; 8https://doi.org/10.1007/s11657-013-0136-1
        • Upadhyaya G.K.
        • Iyengar K.
        • Jain V.K.
        • Vaishya R.
        Challenges and strategies in management of osteoporosis and fragility fracture care during COVID-19 pandemic.
        J. Orthop. Sep. 2020; 21https://doi.org/10.1016/j.jor.2020.06.001
        • Nuti R.
        • et al.
        Guidelines for the management of osteoporosis and fragility fractures.
        Intern. Emerg. Med. 2019; 14https://doi.org/10.1007/s11739-018-1874-2
        • Tella S.H.
        • Gallagher J.C.
        Prevention and treatment of postmenopausal osteoporosis.
        J. Steroid Biochem. Mol. Biol. 2014; 142https://doi.org/10.1016/j.jsbmb.2013.09.008
        • Ferizi U.
        • Honig S.
        • Chang G.
        Artificial intelligence, osteoporosis and fragility fractures.
        Curr. Opin. Rheumatol. 2019; 31https://doi.org/10.1097/BOR.0000000000000607
        • Lloyd B.D.
        • et al.
        Recurrent and injurious falls in the year following hip fracture: a prospective study of incidence and risk factors from the sarcopenia and hip fracture study.
        J. Gerontol. - Ser. A Biol. Sci. Med. Sci. 2009; 64https://doi.org/10.1093/gerona/glp003
        • Kelly R.R.
        • McDonald L.T.
        • Jensen N.R.
        • Sidles S.J.
        • LaRue A.C.
        Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions.
        Front. Psychiatry. 2019; 10https://doi.org/10.3389/fpsyt.2019.00200
        • Basilici Zannetti E.
        • et al.
        Development and testing of the quality of life osteoporosis scale - nonvertebral fractures (QoLOS-NVFX).
        Orthop. Nurs. 2021; 40https://doi.org/10.1097/NOR.0000000000000728
        • Riegel B.
        • et al.
        Characteristics of self-care interventions for patients with a chronic condition: a scoping review.
        Int. J. Nurs. Stud. 2020; https://doi.org/10.1016/j.ijnurstu.2020.103713
        • Oh E.G.
        • Yoo J.Y.
        • Lee J.E.
        • Hyun S.S.
        • Ko I.S.
        • Chu S.H.
        Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial.
        Res. Nurs. Heal. 2014; 37https://doi.org/10.1002/nur.21608
        • Olsen C.F.
        • Bergland A.
        The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial.
        Osteoporos. Int. 2014; 25https://doi.org/10.1007/s00198-014-2724-3
        • Lai P.S.M.
        • Chua S.S.
        • Chew Y.Y.
        • Chan S.P.
        Effects of pharmaceutical care on adherence and persistence to bisphosphonates in postmenopausal osteoporotic women.
        J. Clin. Pharm. Ther. 2011; 36https://doi.org/10.1111/j.1365-2710.2010.01210.x
        • Jeihooni A.K.
        • Hidarnia A.
        • Kaveh M.H.
        • Hajizadeh E.
        The effect of a prevention program based on health belief model on osteoporosis.
        J. Res. Health Sci. 2015; 15https://doi.org/10.34172/jrhs151803
        • Beaudoin C.
        • Bessette L.
        • Jean S.
        • Ste-Marie L.G.
        • Brown J.P.
        The impact of educational interventions on modifiable risk factors for osteoporosis after a fragility fracture.
        Osteoporosis Int. 2014; 25https://doi.org/10.1007/s00198-014-2618-4
        • Riegel B.
        • Jaarsma T.
        • Lee C.S.
        • Strömberg A.
        Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness.
        ANS. Adv. Nurs. Sci. 2019; 42https://doi.org/10.1097/ANS.0000000000000237
        • Riegel B.
        • Jaarsma T.
        • Strömberg A.
        A middle-range theory of self-care of chronic illness.
        Adv. Nurs. Sci. 2012; 35https://doi.org/10.1097/ANS.0b013e318261b1ba
        • Burrell S.
        • Frame H.
        • Ganguli S.N.
        • Iles S.E.
        • Khan A.
        Improving management of osteoporosis through simple changes in reporting fragility fractures.
        Can. Assoc. Radiol. J. 2013; 64https://doi.org/10.1016/j.carj.2013.09.001
        • Huas D.
        • et al.
        Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment.
        BMC Womens. Health. 2010; 10https://doi.org/10.1186/1472-6874-10-26
        • Gold D.T.
        Understanding patient compliance and persistence with osteoporosis therapy.
        Drugs Aging. 2011; 28https://doi.org/10.2165/11586880-000000000-00000
        • Shirazi K.K.
        • et al.
        A home-based, transtheoretical change model designed strength training intervention to increase exercise to prevent osteoporosis in Iranian women aged 40-65 years: a randomized controlled trial.
        Health Educ. Res. 2007; 22https://doi.org/10.1093/her/cyl067
        • Van Boven J.F.M.
        • De Boer P.T.
        • Postma M.J.
        • Vegter S.
        Persistence with osteoporosis medication among newly-treated osteoporotic patients.
        J. Bone Miner. Metab. 2013; 31https://doi.org/10.1007/s00774-013-0440-2
        • Basilici Zannetti E.
        • et al.
        Effect of tailored educational intervention to improve self-care maintenance and quality of life in postmenopausal osteoporotic women after a fragility fracture: the Guardian Angel® study.
        Ig. Sanita Pubbl. 2017; 73 (Accessed: Sep. 04, 2019. [Online]. Available): 65-76
        • Riegel B.
        • et al.
        Self-care for the prevention and management of cardiovascular disease and stroke.
        J. Am. Heart Assoc. 2017; 6https://doi.org/10.1161/JAHA.117.006997
        • Weinger K.
        • Beverly E.A.
        • Smaldone A.
        Diabetes self-care and the older adult.
        West. J. Nurs. Res. 2014; 36https://doi.org/10.1177/0193945914521696
        • Chen Z.
        • Fan V.S.
        • Belza B.
        • Pike K.
        • Nguyen H.Q.
        Association between social support and self-care behaviors in adults with chronic obstructive pulmonary disease.
        Ann. Am. Thorac. Soc. 2017; 14https://doi.org/10.1513/AnnalsATS.201701-026OC
        • Jørgensen H.S.
        • David K.
        • Salam S.
        • Evenepoel P.
        Traditional and non-traditional risk factors for osteoporosis in CKD.
        Calcif. Tissue Int. 2021; 108https://doi.org/10.1007/s00223-020-00786-0
        • Diana A.
        • et al.
        Cancer Treatment–Induced Bone Loss (CTIBL): state of the Art and Proper Management in Breast Cancer Patients on Endocrine Therapy.
        Curr. Treat. Options Oncol. 2021; 22https://doi.org/10.1007/s11864-021-00835-2
        • Cittadini N.
        • et al.
        Development and testing of a new instrumentto measure self-care in patients with osteoporosis:the self-care of osteoporosis scale.
        Int. J. Bone Frag. 2021; 1: 28-33
      2. J. Jiang and T. Nguyen, Linear and Generalized Linear Mixed Models and Their Applications. 2021.

        • Browne W.J.
        Applying MCMC Methods to Multilevel Models.
        UK: University of Bath., 1998
        • Stawski R.S.
        Multilevel Analysis: an Introduction to Basic and Advanced Multilevel Modeling.
        Struct. Equ. Model. A Multidiscip. J. 2013; 20https://doi.org/10.1080/10705511.2013.797841
        • Press S.
        Stata Statistical Software: Release 16.
        StataCorp LLC, 2019
        • Ibrahim J.G.
        • Molenberghs G.
        Missing data methods in longitudinal studies: a review.
        Test. 2009; 18https://doi.org/10.1007/s11749-009-0138-x
        • Cocchieri A.
        • et al.
        Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care.
        Eur. J. Cardiovasc. Nurs. 2015; 14https://doi.org/10.1177/1474515113518443
        • Amininezhad F.
        • et al.
        Bone characteristics and metabolic phenotypes of obesity in an Iranian Elderly population: bushehr Elderly Health Program (BEHP).
        Arch. Osteoporos. Dec. 2021; 16https://doi.org/10.1007/s11657-021-00953-2
        • Hayes-Watson C.
        • et al.
        Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey.
        COPD Res. Pract. 2017; 3https://doi.org/10.1186/s40749-017-0022-0
      3. M.U. Keen and A.K.R. Reddivari, Osteoporosis In Females. 2020.

        • Baccaro L.F.
        • Conde D.M.
        • Costa-Paiva L.
        • Pinto-Neto A.M.
        The epidemiology and management of postmenopausal osteoporosis: a viewpoint from Brazil.
        Clin Interv Aging. 2015; 10https://doi.org/10.2147/CIA.S54614
        • Bonafede M.
        • Shi N.
        • Barron R.
        • Li X.
        • Crittenden D.B.
        • Chandler D.
        Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data.
        Arch. Osteoporos. 2016; 11https://doi.org/10.1007/s11657-016-0280-5
        • Tarantino U.
        • et al.
        Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology.
        J. Orthop. Traumatol. 2017; 18https://doi.org/10.1007/s10195-017-0474-7
        • Alvaro R.
        • et al.
        Bone care nurses and the evolution of the nurse's educational function: the Guardian Angel® research project.
        Clin. Cases Miner. Bone Metab. 2015; 12https://doi.org/10.11138/ccmbm/2015.12.1.043
        • Riegel B.
        • et al.
        Self-care research: where are we now? where are we going?.
        Int. J. Nurs. Stud. 2021; 116https://doi.org/10.1016/j.ijnurstu.2019.103402