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


      • 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.



      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.


      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).


      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.


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