The association of osteoporosis knowledge and beliefs with preventive behaviors in postmenopausal breast cancer survivors

Abstract

Background Postmenopausal breast cancer survivors (PBCS) are at increased risk of bone loss and fractures due to age-related decline of estrogen, and this risk is compounded by aromatase inhibitor cancer therapy. Several patient-level targetable risk factors can mitigate osteoporosis risk; however, adequate health behavior and risk perception in this population are underreported. The goal of this study was to evaluate osteoporosis knowledge and beliefs and assess their association with engagement in osteoporosis preventive behaviors among PBCS. Methods In this cross-sectional descriptive study, early stage I–IIIA PBCS (ages 55–86 years) completed the Facts on Osteoporosis Quiz, Osteoporosis Health Beliefs Scale, and Osteoporosis Preventive Behaviors questionnaires. Participants who were non-English speaking or declined to participate were excluded. Clinical and sociodemographic information were obtained from chart review and baseline questionnaire, respectively. Fisher’s exact test, Student t-test, and Wilcoxon Mann–Whitney tests were used where appropriate to assess the association between knowledge and beliefs with engagement in osteoporosis preventive behaviors. Results The mean participant age was 66.1 years with 20% self-reporting as non-Hispanic White, 40% non-Hispanic Black, 27% Hispanic, and 13% other. Approximately 83% of the cohort had estrogen receptor positive breast cancer and received a bone density scan within the last six years. Osteoporosis knowledge (10.5 ± 3.4), seriousness (14.9 ± 3.8), and susceptibility (14.0 ± 3.5) mean scores were low among PBCS. Most PBCS (75%) were adherent to calcium and vitamin D supplements, but only 47% reported engagement in strength-training exercises. Married/partnered, higher osteoporosis knowledge and health motivation scores were associated with strength-training exercise. After adjustment for marital status and osteoporosis knowledge, only health motivation score remained significantly associated with strength-training exercise (OR 5.56, 95% CI 1.35–22.93). Conclusions PBCS are highly motivated to keep a healthy lifestyle despite limited osteoporosis knowledge, perceived risk, and susceptibility. However, < 50% participated in strength-training exercise. Our findings suggest that oncologic care should include osteoporosis and fracture prevention strategies, directed at encouraging cancer survivors to increase their engagement in osteoporosis preventive behaviors, particularly strength-training exercises.

Knowledge of osteoporosis prevention among people with endocrine disorders: A cross‐sectional study

“…Osteoporosis is an increasingly prominent problem worldwide and causes a significant disease burden due to its high morbidity, disability, and mortality (Shen et al, 2022). Elevating knowledge and creating awareness of osteoporosis can effectively prevent and treat the condition by increasing the likelihood of early detection (Bailey & Lin, 2021). It is thus essential to assess the knowledge level related to osteoporosis prevention among high‐risk populations to guide effective and targeted intervention programs.…”

Knowledge and understanding risk factors and preventive measures for osteoporosis in women: results of a survey in 502 women with and without a migration background

“…A study among postmenopausal breast cancer survivors showed low mean score concerning osteoporosis knowledge. Only 47% reported commitment in strength-training exercise [ 47 ]. Another study evaluating osteoporosis knowledge in women with premature ovarian insufficiency and early menopause showed that there are knowledge gaps regarding risk factors and treatment options [ 48 ].…”

Breast cancer, aromatase inhibitors, and bone health

“…In one study, researchers found that the great majority (80%) of women being treated with AIs for postmenopausal breast cancer wanted to be proactive to prevent bone loss but that they had little knowledge about osteoporosis. 29 The women in the study knew the importance of calcium and vitamin D supplementation, but most did not know the importance of weight-bearing exercise and strength training. 29 Thus, initial interventions include education with a focus on reducing modifiable risk factors.…”

“…29 The women in the study knew the importance of calcium and vitamin D supplementation, but most did not know the importance of weight-bearing exercise and strength training. 29 Thus, initial interventions include education with a focus on reducing modifiable risk factors. Lifestyle changes that promote bone health include cessation of cigarette smoking and reduction or cessation of alcohol consumption, increasing physical activity including weight-bearing activities, and minimizing the risk of falling.…”