Document Type : Research Article (s)


1 Assistant Professor and Community Medicine Specialist, Faculty of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 MSc in Social Sciences Health Education, Faculty of Management & Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Known as a health and medical problem in the community, osteoporosis (OP) is the most prevalent metabolic bone disease. The most facile approach to dealing with osteoporosis is prevention and lifestyle modification. In adolescents, in particular, lifestyle plays the most important role in preventing from osteoporosis in the adulthood. This study was conducted to determine the level of osteoporosis preventive lifestyle and awareness among 13-15-year-old students in Garmsar city in 2018.
Methods: This descriptive cross-sectional study was conducted on 400 high school students selected by two-stage cluster sampling method in Garmsar city in 2018. The data were collected with a three-part questionnaire containing 38 questions related to personal data and measurement of the awareness and lifestyle dimensions associated with osteoporosis prevention, including habits (smoking cigarettes and hookah and exposure to the sun to mention a few), nutrition, and physical activity. Cronbach’s alpha of awareness (0.84), habits (72. 5), and nutrition (0.72) was calculated to specify the reliability of the tool and the content validity was calculated with Lawshe method containing CVR (0.9) and CVT (0.86). For data analysis, use made of descriptive statistics and multiple linear regression by SPSS software version 24.
Results: The results of awareness dimension with merely 42.77% correct answers indicated the low awareness of students. The dimension of habits in the preventive lifestyle was in optimal condition with a score of 61.1%. With scores of 33.4 and 25.2%, physical activity and activity without mobility were optimum (score: 70%). There was a direct and significant correlation between students’ awareness and their performance regarding osteoporosis (p <0.05). A direct correlation was further observed between awareness and lifestyle (r=0.255).
Conclusions: The studied population had inadequate awareness and poor lifestyle. Given the existing risk factors, it is necessary to pay close attention to education and lifestyle changes in adolescents and their families.


1. Soleymanian A, Niknami S, Hajizadeh E, Shojaeizadeh D, Montazeri A. Development and validation of a health belief model based instrument for measuring factors influencing exercise behaviors to prevent osteoporosis in pre-menopausal women (HOPE). BMC Musculoskelet Disord. 2014;15:61. doi: 10.1186/1471-2474-15-61. [PubMed: 24581300]. [PubMed Central: PMC3996026]. ## 2. Munch S, Shapiro S. The silent thief: osteoporosis and women’s health care across the life span. Health Soc Work. 2006;31(1):44-53. doi: 10.1093/hsw/31.1.44. [PubMed: 16550847]. ## 3. Winzenberg TM, Oldenburg B, Frendin S, De Wit L, Jones G. A mother-based intervention trial for osteoporosis prevention in children. Prev Med. 2006;42(1):21-6. doi: 10.1016/j.ypmed.2005.11.006. [PubMed: 16336993]. ## 4. Lesan S, Mirheydari Z, Sotoudeh G, Khajeh Nasiri F, Koohdani F. Osteoporosis related food habits and behaviors: a cross-sectional study among female teachers. Hayat. 2011;16(3):86-94. Persian. ## 5. The Middle East & Africa Regional Audit. Epidemiology, costs & burden of osteoporosis in 2011. 2011b [Internet]. Available from: ## 6. Park DI, Choi-Kwon S, Han K. Health behaviors of Korean female nursing students in relation to obesity and osteoporosis. Nurs Outlook. 2015;63(4):504-11. doi: 10.1016/j.outlook.2015.02.001. [PubMed: 26187090]. ## 7. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182(17):1864-73. doi: 10.1503/cmaj.100771. [PubMed: 20940232]. [PubMed Central: PMC2988535]. ## 8. Stránský M, Rysavá L. Nutrition as prevention and treatment of osteoporosis. Physiol Res. 2009;58 Suppl 1:S7-S11. [PubMed: 19857038]. ## 9. Paget SA. Hospital for special surgery manual of rheumatology and outpatient orthopedic disorders: diagnosis and therapy. 5th ed. Philadelphia: Lip-pincott Williams & Wilkins; 2006. ## 10. Kargar M, Jamali Moghadam N, Moattari M. The Effect of Osteoporosis Prevention Education by Peers and Health personnel on Self-efficacy of Adolescents with Nephrotic Syndrome. IJN. 2013;26(81):44-53. Persian. ## 11. Ahmadinea E, Maleki A, Mousavi Nasab N. Study of preventive lifestyle of osteoprosis among zanjanian girls’ students. Avicenna J Nurs Midwifery care. 2013;21(2):28-38. Persian. ## 12. Weaver CM, Gordon CM, Janz KF, Kalkwarf HJ, Lappe JM, Lewis R, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporos Int. 2016;27(4):1281–1386. doi: 10.1007/s00198-015-3440-3. [PubMed: 26856587]. [PubMed Central: PMC4791473]. ## 13. Hernandez-Avila M, Colditz GA, Stampfer MJ, Rosner B, Speizer FE, Willett WC. Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women. Am J Clin Nutr.1991;54(1):157-63. doi: 10.1093/ajcn/54.1.157. [PubMed: 2058578]. ## 14. Yekefallah L, Vaezi A, Pazokian M, Yekefallah F, Samieefard F. Study of Lifestyle and Preventive Behaviors of Osteoporosis among Adolescents in Qazvin. JSSU. 2012;20(3):259-68. Persian. ## 15. Welk GJ, Corbin CB, Dale D. Measurement issues in the assessment of physical activity in children. Res Q Exerc Sport. 2000;71:S59-73. [PubMed: 10925827]. ## 16. Vered I, Werner P, Shemy G, Stone O. Nurses’ knowledge and perceptions about osteoporosis: a questionnaire survey. Int J Nurs Stud. 2008;45(6):847-54. doi: 10.1016/j.ijnurstu.2007.01.011. [PubMed: 17362958]. ## 17. Anderson KD, Chad KE, Spink KS. Osteoporosis knowledge, beliefs, and practices among adolescent females. J Adolesc Health. 2005;36(4):305-12. doi: 10.1016/j.jadohealth.2004.03.007. [PubMed: 15780785]. ## 18. von Hurst PR, Wham CA. Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutr. 2007;10(7):747-53. doi: 10.1017/S1368980007441477. [PubMed: 17381949]. ## 19. Mirzaaghaee F, Moinfar Z, Eftekhari S, Karimi Khezri M, Mazidi M, Aliramezani M et al. The amount of knowledge in Iranian female adolescents student about osteoporosis and its risk factors. Hayat. 2006;12(3):43-50. Persian. ## 20. Afrasiabi S, Gashmard R, Malchi F, Rabiee Z, Bagherzadeh R, Hosein NezhadA, et al. Evaluation of knowledge, attitude and performance of high school girls about osteoporosis in 2011. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2016;18(184):20-28. doi: 10.22038/ijogi.2016.6734. Persian. ## 21. Saleh AM, Alahmadi AE, Rahman Almalki AB, Jaafari AA, Al-Hussan TH, Alfaifi MA, et al. Assessment of Osteoporosis Knowledge Test among Community Population in Abha City, KSA. The Egyptian Journal of Hospital Medicine. 2017;69(3):2176-2180. doi: 10.12816/0041078. ## 22. Dehghan Manshadi F, Azari A, Kouhpaayehzadeh J, Ghasemi M. Evaluation of knowledge, attitude and practice of female students participating in a summer camp Osteoporosis. New Rehabilitation. 2008;2(4):47-54. Persian. ## 23. Kostecka M. The role of healthy diet in the prevention of osteoporosis in perimenopausal period. Pak J Med Sci. 2014;30(4):763-8. doi: 10.12669/pjms.304.4577. [PubMed: 25097513]. [PubMed Central: PMC4121694]. ## 24. Munger RG, Cerhan JR, Chiu BC. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr. 1999;69(1):147-52. doi: 10.1093/ajcn/69.1.147. [PubMed: 9925137]. ## 25. Wyshak G. Teenaged girls, carbonated beverage consumption, and bone fractures. Arch Pediatr Adolesc Med. 2000;154(6):610-3. doi: 10.1001/archpedi.154.6.610. [PubMed: 10850510]. ## 26. Nobakht Motlagh F, Khani Jihoni A, Haidar Nia A, Kave M, Hajizadeh E, Babaee Haidar Abadi A, et al. Prevalence of Osteoporosis and its Related Factors in Women Referred to Fasa`s Densitometry Center. sjimu. 2013;21(4):150-158. doi: 10.7508/ISMJ.1395.01.005. Persian. ## 27. Takakura M, Nagayama T, Sakihara S, Willcox C. Patterns of health-risk behavior among Japanese high school students. J Sch Health. 2001;71(1):23-9. doi: 10.1111/j.1746-1561.2001.tb06484.x. [PubMed: 11221536]. ##