Osteoporosis is a serious and growing public health issue. A systemic skeletal disorder, it is characterized by a decline in bone mass, a loss of bone structure, an increase in bone fragility and an increased risk of fracture. It is a significant factor in fractures, which causes discomfort, disability, expensive rehabilitation, poor quality of life and early mortality [1-3]. 

Around 200 million women are thought to be affected by osteoporosis worldwide and the disease's risk rises with advancing age. The burden of the disease continues to be too much for developing nations to handle. Poor results are the result of this, along with low literacy rates and a lack of knowledge about the risk factors and symptoms [4,5].

Numerous factors have been recognized as osteoporosis risk factors. These include menopause before age 45, prolonged amenorrhea unrelated to menopause, nulliparity, prolonged lactation, a diet low in calcium and vitamin D, poor intestinal absorption of calcium, lactose intolerance, excessive caffeine or alcohol consumption, Asian or Caucasian race, advancing age, family history of osteoporosis or fragility fractures, a low body mass index, smoking, sedentary lifestyle and prolonged treatment with thyroid hormones, glucocorticoids, anticonvulsants and aluminum antacids [2,6].

There is evidence to support the idea that understanding osteoporosis has a significant role in osteoporosis preventative behaviour. Programs for prevention should focus on spreading awareness about osteoporosis therapy and modifiable risk factors (smoking, inactivity, poor diet, multiparity). Calculating the degree of knowledge can benefit public health initiatives [3,7]. 

Various international studies examined participants' knowledge of osteoporosis. The majority of this research discovered that people of different age groups lacked information and awareness of osteoporosis, along with deprived application and reduced self-efficacy or confidence toward exercise and calcium consumption, which were determined as protective behaviors [4-7].

Few research has investigated osteoporosis knowledge and health attitudes in Himachal Pradesh, despite the fact that they are linked to the adoption of preventative behavior. Therefore, the purpose of this study is to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among people living in Tribal region of Himachal Pradesh.

Objectives of the Study

To evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among people living in Tribal region of Himachal Pradesh

Research Methodology

• Research Approach: Descriptive

• Research Design: Cross Sectional Hospital Based Survey 

• Setting of the Study: Ortho OPD of Regional Hospital, Keylong in District Lahaul and Spiti of Himachal Pradesh

• Study Duration: July 2022 to September 2022

• Study population: Ortho OPD patients in Regional Hospital, Keylong in District Lahaul and Spiti of Himachal Pradesh

• Sample Size: 400 assuming 50% adults have adequate knowledge, beliefs and practices of osteoporosis preventive measures, 5% absolute error, 95% confidence level and 5% non-response rate.

• Sampling Technique: Convenience Sampling Technique

• Sampling Criteria: First five patients attending the Ortho OPD of Regional Hospital, Keylong everyday were selected till the completion of sample size after explaining the purpose of the study. Informed consent/assent was taken from them and confidentiality of the selected participants was also maintained 

• Inclusive Criteria: Patients selected during the day of data collection in study setting and who were willing to participate in the study

• Exclusion Criteria: Patients who were not willing to participate in the study 

• Development of Tool-Knowledge related questionnaires

Description of Tool

• Section A: Socio-demographic characteristics of the patients (Age, Gender etc.)

• Sections B: Questions regarding knowledge, beliefs and practices of osteoporosis preventive measures

• Validity of Tool: By the experts in this field

• Permission: Obtained from the concerned head of the Regional Hospital, Keylong

• Data collection: By the researcher themselves and patients were given 5 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage, mean standard deviation etc

• Ethical Considerations: Participants confidentiality and anonymity were maintained

The goal of the current study was to evaluate the knowledge, beliefs and practices of osteoporosis preventive measures among people living in Tribal region of Himachal Pradesh. In the present study 26.25% (105) of the Patients fall were below 40 years of age while 73.75% (295) were above 40 years. 56.5% (226) of patients were male and 43.5% (174) were female.

Table 1: Knowledge About Risk and Preventive Factors of Osteoporosis Among Participants

Table 2: Beliefs of Participants Regarding Osteoporosis

Table 3: Showed That Female Of Himachal Pradesh Had Moderate Self-Efficacy in Practicing Osteoporosis Recommended Practices

Table 1 described the knowledge of participants regarding osteoporosis risk factors and preventive factors. It revealed that Participants had a relatively low level of knowledge regarding risk factors and preventive factor for osteoporosis

The opinions of the participants on osteoporosis are shown in Table 2. The risk of developing osteoporosis, perceptions of obstacles to calcium consumption, perceptions of advantages of calcium intake, perceptions of the seriousness of osteoporosis and health motivations toward osteoporosis were all shown.

Given that osteoporosis has long-term impacts on health, it is essential that individuals are better informed about the risk factors that contribute to this disease. People must understand osteoporosis, how to avoid it and how to carry out the preventative behaviors in order to make decisions regarding prevention. In order to assess people living in the Himachal Pradesh Tribal region's knowledge, attitudes and habits on osteoporosis prevention, this study was carried out.

The current study's findings regarding the characteristics of the study participants showed that they had a relatively poor degree of knowledge about various risk factors and preventative methods for osteoporosis. They also generally had modestly favorable ideas about osteoporosis and a small level of self-efficacy in putting such thoughts into reality.

Getting adequate calcium and vitamin D can maintain the bones strong and prevent osteoporosis, according to studies conducted all around the world. The bones become weaker and more prone to breaking due to osteoporosis. Bone density is enhanced by calcium and vitamin D. Because it facilitates the body's absorption of the calcium in your diet, vitamin D is crucial. The sun is where we get the majority of our vitamin D. Fatty fish (salmon, herring and mackerel), liver, eggs and fortified foods like margarine and low-fat milks also contain trace amounts of vitamin D. It's improbable that most people will receive enough vitamin D from their diets on their own. If someone is concerned that they are not getting enough vitamin D, supplements are required [8-10].

Building and keeping strong, healthy bones requires eating a healthy, balanced diet that includes a variety of foods and getting enough calcium. The body will extract calcium from your bones if there is not enough calcium in the blood. In order to maintain bone density, it's crucial to consume enough calcium in the diet. The biggest calcium content is found in dairy products, although there are many additional calcium-rich foods, like spinach and almonds. Calcium supplements are required if a person cannot obtain enough calcium from diet alone [11].

Weight-bearing exercise promotes bone density and enhances balance, hence lowering the risk of falls. Osteoporosis that is already advanced is not treated. Some general suggestions are: Pick weight-bearing exercises like jogging, brisk walking, tennis, netball, or dancing. Swimming and cycling are great non-weight-bearing exercises for numerous health reasons, but they do not stimulate bone formation. Jumping and rope skipping are two examples of high-impact exercises that can be incorporated into a regimen. Another crucial exercise for bone health is strength training (also known as resistance training). In order to grow and sustain muscular strength, muscular endurance and muscular mass, resistance must be given to a muscle. Strength training is crucial for maintaining or even increasing bone mineral density, which is important for managing and preventing osteoporosis [8,12].

Stop smoking, as smokers have lower bone density than non-smokers, get some sun (skin exposure needs to occur most days of the week to allow enough vitamin D production), drink alcohol in moderation (excessive alcohol consumption increases the risk of osteoporosis) and limit caffeinated beverages (excessive caffeine can affect the amount of calcium that our bones absorb). It is advised to limit your daily intake of cola, tea, or coffee to two to three glasses [8].

There are typically no warning signs or symptoms of osteoporosis, so most people are unaware they have it until a fracture occurs. Due of this, osteoporosis is frequently referred to as the "silent illness". Even though osteoporosis can affect anyone at any age, it most frequently affects older adults, particularly older women. Although some males are also affected, osteoporosis primarily affects women in their middle and later years. There are no distinct signs or symptoms of osteoporosis. It does, however, raise the possibility of severe or disabling fractures. If you have osteoporosis, changing your lifestyle and receiving medical care can stop additional bone loss and lower your risk of fractured bones [2,12,13].

The current study found that residents of Himachal Pradesh's tribal areas lacked enough understanding of osteoporosis and were not properly implementing prevention measures. This was primarily caused by a lack of understanding of how deadly osteoporosis is. In order to improve people's lifestyles and promote awareness of osteoporosis prevention, public health interventions should be established. Furthermore, it might be crucial for next research on attitudes and practices connected to osteoporosis.

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2. Mayo Clinic. "Osteoporosis: Symptoms and Causes." Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968.

3. Wikipedia. "Osteoporosis." Wikipedia, https://en.wikipedia.org/wiki/Osteoporosis.

4. Cleveland Clinic. "Osteoporosis." Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/4443-osteoporosis.

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7. Better Health. "Osteoporosis." Better Health Channel, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis.

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9. Endocrine Web. "Role of Calcium and Vitamin D in Bone Health." EndocrineWeb, https://www.endocrineweb.com/conditions/osteoporosis/role-calcium-vitamin-d-bone-health.

10. NOF. "Calcium and Vitamin D." National Osteoporosis Foundation, https://www.nof.org/patients/treatment/calciumvitamin-d.

11. Help Guide. "Calcium and Bone Health." HelpGuide, https://www.helpguide.org/articles/healthy-eating/calcium-and-bone-health.htm.

12. Better Health. "Osteoporosis." Better Health Channel, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis.

13. NIA. "Osteoporosis." National Institute on Aging, https://www.nia.nih.gov/health/osteoporosis.