Raising Awareness ' of Risky Women of Osteoporosis towards Healthy Lifestyle

Osteoporosis is a major threat to public health today and the most common bone disease world wide. Osteoporosis is a disease in which the density and quality of bone is reducing and increasing the risk of fracture. There is an increased awareness that osteoporosis is an international health care concern that affects millions of individuals worldwide, women are four times more likely than men to develop the disease. Therefore, raising awareness of risky women of osteoporosis towards healthy lifestyle can help the maintenance of healthy behaviors and reduction of life style factors that inhabit bone density. So, the aim of this study was raising the awareness' of risky women of osteoporosis towards healthy lifestyle. A quasi experimental design was used. The study was conducted from September 2008 up to January 2009, and the sample included 130 women. Three tools were developed by the researchers to cover the actual life style and assess the knowledge about osteoporosis and its prevention before and after awareness session and evaluate these sessions by using 3 points lickert scale. Results revealed that 65.4% of women preferred fatty and starch food, 84.6% of them were drinking black tea, cola or coffee while 57.6% lacked physical exercises. There was significant difference (p≤ 0.05) between studied women mean score of life style pre and post implementation of awareness session regarding dietary habits and exercises. Study concluded that studied women had unhealthy life style which may lead to osteoporosis. However, raising awareness’ had positive effect on their life style.


INTRODUCTION
Osteoporosis is a major public health problem, which has enormous social and economic impact around the world. (1)teoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 stander deviations below peak bone mass.The term "established osteoporosis" includes the presence of a fragility fracture.
Osteoporosis is mostly common in women after menopause when it is called postmenopausal, and it occurs in anyone in Bull High Inst Public Health Vol.39 No.2 [2009]   the presence of particular hormonal disorders and other chronic diseases or as results of medications. (2)e prevalence rate of osteoporosis in Egypt was 5.237.182persons in 2004. (3)teoporosis Foundation predicts that by 2015, 41 million people aged 50 years or older will experience osteoporosis unless something is done to improve early diagnosis and treatment. (4)fe style is the way of living of individuals, families (households), and societies, which they manifest in coping with their physical, psychological, social, and economic environments on a day-today basis (5) .
Physical inactivity and a sedentary lifestyle as well as impaired neuromuscular function (e.g., reduced muscle strength, impaired gait and balance) are risk factors for developing fragility fractures, (6) Smoking can lead to lower bone density and higher risk of fracture and this risk increases with age. (7)Prolonged use of corticosteroids is the most common cause of secondary osteoporosis.It is estimated that 30-50% of patients on long-term corticosteroid therapy will experience fractures. (8)Early menopause and removal of ovaries can increase the risk of osteoporosis.In addition to dietary style such as drinking Cola and caffeine, lack of calcium and vitamin D intake, as well as increase salty food intake. (9)entifying and treating women at risk of fracture who have not yet sustained a fracture-will substantially reduce the longterm burden of osteoporosis.Reducing the risk of first fracture from 8% to 2% can reduce the 5-years fracture incidence from approximately 34% to 10%. (10) the other hand, sunlight exposure can increase Bone Mass Density (BMD) of vitamin D deficient bone and lead to prevention of non vertebral fractures. (11)4) Nursing profession plays a significant role in the prevention and detection of osteoporosis, as well as in the management of osteoporosis.There is an increased awareness that osteoporosis is an international health care concern that affects millions of individuals worldwide. (12)juries and the resulting potential A study done in Egypt revealed that Egyptian women did not know much about osteoporosis, however the incidence of osteoporosis was increased with menopause age.There exists a need for an awareness campaign in order to educate them about this important stage of their lives. (15)Egyptian women must be informed about the risks involved with some of the traditional health beliefs and practices that leads to osteoporosis.
Healthcare providers have a challenge and responsibility to develop an acceptable approach for osteoporosis prevention. (16)erefore, this study was carried out in order to raise the awareness' of risky women of osteoporosis towards healthy lifestyle.

Study hypothesis
H: Awareness sessions on osteoporosis will help risky women to behave healthy life style

Research design
A quasi experimental design was used in the study

Setting
The study was carried out at the faculty of Nursing, Mansoura University.Bull High Inst Public Health Vol.39 No.2 [2009]   The minimum required subject to test the research hypothesis was 105 women according to Fleiss. (17)-level, two-sided = 0.05, -level = 0.01, proportion= 70% and null hypothesis value= 50%

Subjects
Subjects comprised 150 women who were at risk of osteoporosis out of 400 women who admitted to measure bone density; just 130 women at risk were willing to participate in the study.
The following measurements were done for all attended women: ▪ Bone density was measured by using DEXA scan Dual-energy X-ray absorptiometry, Women whose Tscore is between -1.0 and -2.5 were at risk and were included in the study according to WHO 1994. ( 18 ▪ Blood pressure.Women with more than 140/90 mmgh were also at risk according to Linda 2005. (19)searchers took into consideration the • Lack of dairy product intake.
• Drinking Colas, caffeine and increasing salt in food.
• Lack of vitamin D and calcium supplementary.
• Lack of exercise.
• Intake of cortisone, • Intake of hormonal replacement therapy or using hormonal contraception.In addition to smoking.e. Educational materials were prepared.

3-Data collection:
Data was collected during the period from September 2008 up to January 2009.

II-Implementation phase
1-Awareness session development: The researchers informed women at risk to attend the awareness sessions.

III-Evaluation and follow up phase
The same interview sheet was used to reassess women's life style and physical activity through telephone interview & personal interview after three months from the awareness session.

Statistical analysis
Data were analyzed by using SPSS software version 14.0.The level of significance was set at 0.05.Paired t-test was used to find out the difference in lifestyle and quality of life's scores before and after the awareness sessions.
Correlation coefficient person test was used to correlate the effect of lifestyle on physical abilities.

Written informed consent was obtained
Bull High Inst Public Health Vol.39 No.2 [2009]   from participated women.This consent included simple explanation of the aim of the study, and they were assured that their participation is voluntary, they can withdraw at any time and the collected data will be treated confidentially.

Results
Table (1) presents the Sociodemographic characteristics of the studied women working in Mansoura University.
)(34) Previous studies confirm the findings of the present study where significant changes in participants' lifestyle related to dietary habits and physical exercises were recorded after raising their awareness.This is confirmed by Blalock et al. ( 2000) (35) and Tussing and Novakofski (2005) (36) who reported that providing educational information regarding dietary prevention of osteoporosis raised women's awareness about increasing calcium intake and weight bearing exercise. (35,36)In addition Peterson et al. (2000) (37) , found that education cause effective changes in behavior for prevention of osteoporosis.

Conclusions
This study concluded that health education sessions about raising awareness of risky women to osteoporosis helped in improving their lifestyle in terms of dietary habits and physical exercise as well as their physical abilities in terms of movement and ability to work.Moreover, there was a significant positive correlation between the life style scores and physical abilities scores.

Recommendations
nations due to the significant costs associated with care and treatment.(12)Cultural beliefs of Egyptian women, manifested in lifestyle behaviors, may influence osteoporosis development.
presence of one or more of the following risk factors: lickert scale from 1 to 3 (1representing not at all, 2 representing yes to some extent and 3 representing yes all time) was used for parts three and part four.the topics related to osteoporosis ( definition of osteoporosis, high risk group, treatment, control and prevention and life style, risk factors and bad habits e.g., smoking, drink coffee & tea, physical activities and stressors .The evaluation questionnaire sheet was developed to assess the participant satisfaction regarding to training program in terms of program achieve their expectation, objectives, time, coordinators competent, organization, scientific materials, place where the session was held in.It consists of three likert scale; each item is rated from "unsatisfied= 1", "satisfied= 2" and "Strongly satisfied= 3".Methods I-Preparation phase 1-Administrative process: a. Official permission to conduct the study was obtained from the dean of the Faculty of Nursing, Mansoura University, and Vice president for community and environmental health.b.Announcement for the time of measuring bone density and awareness campaign sent to all faculties pilot study was carried out on five working women chosen randomly from the Faculty of Nursing and excluded from the study subjects.d.Reliability of the all tools was tested by using Crombach Alpha.Unrealistic items were omitted.Regarding to the knowledge test, the pre-tests indicated that the tool prepared for data collection were understandable and were able