Journal of Education and Health Promotion

Abstract BACKGROUND: Osteoporosis, the fourth most common disease in the world, affects the elderly
and postmenopausal women and imposes a great financial and social burden on individuals and
society. Furthermore, it has a significant impact on the quality of patients’ life. This study tries to
take an effective step toward improving the quality of patients’ life by developing and evaluating the
self‑care program of women with osteoporosis.
MATERIALS AND METHODS: In this research, a hybrid sequential design of quantitative and
qualitative type consisting of three phases is used. This mixed‑method study aimed to develop and
evaluate a self‑care program for women with osteoporosis.
CONCLUSION: Familiarity with the needs of these patients and the use of self‑care programs and
considering social, cultural, and psychological factors could be effective steps to improve the health
of women with osteoporosis. These steps can improve the quality of life and reduce the costs of
treatment for this group of women.

Abstract Osteoporosis is a systemic skeletal disease that is associated with negative physical and psychosocial
consequences, so understanding the effective strategies that can be used in the prevention of
osteoporosis is especially important. The aim of this study was to integrative review the published
interventional of nonpharmacological studies regarding the prevention and treatment of osteoporosis
among menopausal women. In this systematic review, databases such as PubMed, PsycInfo, Web
of Science (ISI), Scopus, ScienceDirect, EmBase, Cochrane library, Google scholar, and Iranian
databases, such as Scientific Information Database and Magiran, were searched. The latest search
was performed between “November 2020 and December 2020” separately by two researchers and
then double‑checked by them. The quality of the included studies was assessed using the Jadad
score calculation tool. Twenty eight randomized controlled trials and quasi‑experimental studies were
included in this current study. The quality assessment indicated that 19 studies had acceptable (good)
methodological quality and also 9 studies had weak methodological quality. The main results of this
study were classified in three main categories such as exercise or physical activity training (n = 15),
educational sessions (n = 11), and other interventions (n = 2). The results of most included studies
showed that nonpharmacological strategies such as physical activity and educational interventions
are considered as the appropriate actions to prevention of osteoporosis among menopausal women
so implementing these strategies can be a good alternative for women with contraindication of
hormone therapy or therapeutic treatment.

Abstract Osteoporosis is a specific condition which is characterized by low bone mineral density (BMD) and
deterioration of bone structure resulting in an increased susceptibility to fractures. It contributes to a
great deal of morbidity and mortality, and is a large burden to the healthcare system, especially in the
case of the elderly population. In the last four decades, a plethora of studies have reported characteristic
oral radiographic findings in the early stages of osteoporosis, suggesting the possible use of oral
radiographic signs for the early detection of the condition. Digital orthopantomographs (OPGs) are
usually taken for the screening of dental patients during routine dental evaluations. These radiographs
and the characteristic changes seen on them may have a significant role in the screening for initial
osteoporotic changes. A number of precise radiomorphometric indices of the mandible have also
been developed to allow quantification of the mandibular bone mass for identification of the initial
signs of osteoporosis. The present review focuses on the possible role of panoramic radiographs in
the initial screening for osteoporosis in dental clinics in high‑risk groups.

Abstract BACKGROUND: Osteoporosis is mainly characterized by a low bone mineral density and a sharp
architectural and biomechanical deterioration in bone tissue required to maintain bone homeostasis.
The theory of planned behavior (TPB) can be considered as one of the leading theories when designing
an evidence‑based intervention. This study was carried out based on the TPB to determine the effect
of an educational intervention aimed at mothers on the prevention of osteoporosis in female students.
MATERIALS AND METHODS: A total of seventy mothers of lower secondary school students
in Tehran, Iran, participated in this experimental study which was conducted in 2019–2020. The
participants were randomly assigned to two groups, namely experimental and control groups. Based
on the TPB, a demographic and a researcher‑made questionnaire consisting of five sections were
used in order to collect data. The validity and reliability of the questionnaires were confirmed before
data collection. Four 45–60 min training programs were delivered to the subjects using the TPB.
Data were collected before, immediately after, and 1 month following the training program. Finally,
IBM SPSS Statistics 21 was used for statistical analysis.
RESULTS: No significant difference was observed in terms of attitude, subjective norms, perceived
behavioral control, behavioral intention, and osteoporosis prevention‑related behavior between the
experimental and control groups before proceeding with the intervention (P > 0.05). However, the
mean scores of attitude, subjective norms, perceived behavioral control, behavioral intention, and
behavior were significantly higher in the experimental group compared to those of the control group
following the educational intervention (P < 0.05).
CONCLUSION: It can be concluded that such interventions based on the TPB can, in fact, produce a
significant effect on osteoporosis prevention‑related behaviors. Thus, it can serve as a useful model
for planning educational interventions.

Abstract BACKGROUND: Osteoporosis is considered a health problem that can be simply prevented by
lifestyle modifications in adolescence. Therefore, this study was conducted to investigate the effects
of protection motivation theory (PMT)‑based training on osteoporosis‑preventive behaviors in female
high school students in Zahedan, Iran.
MATERIALS AND METHODS: The present quasi‑experimental study was performed on 240 female
high school students who were selected by a multistage sampling technique in Zahedan in
2019–2020. To collect the data, a multipart questionnaire was distributed among the participants
in three stages, namely at the baseline, immediately, and 2 months after the intervention. This
instrument consisted of demographic information, socioeconomic status, knowledge, PMT constructs,
and preventive behaviors. The intervention group was subjected to educational content. The
collected data were analyzed in SPSS software (version 22) by descriptive and analytical tests
(i.e., Chi‑square, independent t‑test, and ANOVA).
RESULTS: Based on the results, the intervention and control groups showed no significant
difference in terms of the mean score of knowledge, theoretical constructs, and preventive behaviors
at the baseline (P > 0.05). However, the two groups were significantly different in terms of the
mentioned variables immediately and 2 months after the intervention (P = 0.001). Mean score of
preventive behaviors, the two groups also demonstrated a significant difference (i.e., calcium intake,
physical activity, and sunlight exposure) 2 months after the intervention, compared to before the
intervention. (P = 0.001).
CONCLUSION: The findings of the present study were indicative of the PMT effectiveness, which
can, therefore, be used as a framework for designing educational programs regarding osteoporosis
prevention.

Abstract BACKGROUND: Osteoporosis is a common disease in women over age 45 years.
Calcium intake is among the factors that help prevent osteoporosis. Identifying the social‑cognitive
determinants of calcium intake can have a major role in the development of osteoporosis prevention
programs.
MATERIALS AND METHODS: This cross‑sectional study was conducted on 400 women
aged <50 years from 10 health centers by cluster sampling in Isfahan in 2016. A hypothetical
social‑cognitive model was assessed using path analysis, and the fit indices and explanatory power
of the model were assessed. The constructs, including self‑efficacy, outcome expectations, social
support, and self‑regulation, were taken as the explanatory variables and calcium intake as the
criterion variable.
RESULTS: The mean age of the participating women was 34.07 years (standard deviation = 7.99)
(range = 19–50), and their mean calcium intake was reported as 909.94 (12. 6) mg/day. The
conceptual model was able to explain 73% of the variance in calcium intake and had good fit indices.
Self‑regulation was identified as the strongest predictor of calcium intake, and outcome expectation
was eliminated from the model since it was the weakest explanatory factor of calcium intake.
CONCLUSIONS: The theoretical model of this study is recommended as a suitable framework for
the development of targeted osteoporosis prevention interventions.

Abstract BACKGROUND: Osteoporosis is one of the major problems associated with aging and is more
common among women than men. This study was designed to modify osteoporosis‑related behaviors
in female students based on the transtheoretical model (TTM).
MATERIALS AND METHODS: This quasi‑experimental study was conducted on female
secondary school students. The sample size was determined 100 by using Altman’s nomogram,
including 50 cases and 50 controls. Participants were completed the Demographic Information and
Osteoporosis‑Related Behavior Questionnaire based on TTM. Evaluation of the data showed that
each participant was at what stage of change in physical activity and preventive dietary behavior
of osteoporosis. The content of the training package was designed, and for the intervention group,
2‑h training sessions were held weekly by the instructor in accordance with the stage of change
for 2 months, and the booklet was provided with the appropriate contents of the stage of change.
Three months after the completion of training, the questionnaires were completed by intervention
and control groups. Statistical analysis was performed using SPSS 23 software.
RESULTS: Concerning the stages of change in physical activity and nutrition, a significant difference
was before and after the intervention in the intervention group (P < 0.001), while no significant
difference was observed in the control group. After the intervention, there was a significant difference
in the self‑efficacy and some subconstruct of processes of change, but there wasnot a significant
difference in the decisional balance.
CONCLUSION: Educational intervention based on TTM has been successful in achieving the goal of
modifying osteoporosis‑related behaviors in female students. The results of this study can be used
by health planners to plan and implement health promotion interventions that will undoubtedly help
reduce the burden of disease.

Abstract BACKGROUND: In chronic diseases such as osteoporosis, understanding the factors that improve
prevention, such as health literacy (HL), is essential in reducing the incidence of these diseases.
This study aimed to determine the association between HL and adoption of osteoporosis‑preventive
behaviors among students in Qazvin.
SUBJECTS AND METHODS: This is a cross-sectional study in which 375 female students
(aged 15–18 years) at high schools (grades 10th, 11th, and 12th) in Qazvin city were selected, in
2019. Sampling method was multistage. To collect data, the standardized questionnaire for measuring
HL in adolescents (health literacy measure in adolescents), in addition to another questionnaire for
assessing osteoporosis‑preventive behaviors, was used. Data were analyzed using SPSS 22 by
descriptive statistics and logistic regression. The association considered significant when P < 0.05.
RESULTS: The mean scores of adoption of osteoporosis‑preventive behaviors and HL were
22.43 ± 5.60 and 70.84 ± 12.58, respectively. Logistic regression showed that there was a significant
association between the adoption of osteoporosis‑preventive behaviors and HL (P = 0.001). In
addition, the association between the adoption of osteoporosis‑preventive behaviors and age was
also significant (P = 0.048 and odds ratio = 3.35).
CONCLUSIONS: Young students and those of low HL showed less adoption of osteoporosis‑preventive
behaviors. Therefore, it is necessary to pay more attention to design educational programs that may
raise the knowledge and awareness of those students about such these diseases, mainly prevention.

Abstract Background: The Index used for osteoporosis detection was BMD measured in L2
, L3
, and L4
vertebrae. We compared the density of the vertebrae to select the one with maximum change
in the density for decreasing the cost and the time. Methods and Materials: Ninety seven
osteoporotic post-menopausal women with a mean age of 61.78 ± 8.48 (50 - 86) years and
a mean body mass index (BMI) of 24.75 ± 2.66 (kg/m2
) (18 - 30) without any known diseases
and on any medication affecting bone mineral density (BMD) were examined at osteoporosis
section of a teaching hospital. The vertebral bodies (L2 - L4
) of participants were measured
by using a dual energy X-ray absorptiometry system (DEXA). To investigate if the BMD
measurement of a single vertebra could replace the total L2 -
L4
 measurement, the mean BMDs
and the correlations of the L2 -
L4
 were compared. Results: Among the 97 studied women, the
mean BMI was 24.75 ± 2.66. The mean BMD of L2
, L3
, and L4
 vertebrae were 0.7199, 0.7258,
and 0.7402, respectively. There was no significant difference between the mean BMD of L2
 and
L3
 vertebrae (P > 0.05), suggesting a strong relationship between L2
 and L3
. The mean BMD
in the L4
 vertebra was significantly higher than the other two vertebrae (P < 0.05), Statistical
analysis showed that the BMD in all three L2
, L3
, and L4
 vertebrae were associated with BMI
(r > 0 and P < 0.05), but there was no significant relationship between BMD and age in the
three L2
, L3
, and L4
 vertebrae (r ≅ 0 and P > 0.05). Conclusion: Since the mean BMDs of L2
and L3
 were not significantly different, and due to a very high correlation between L2
 and L3
, we
recommend the measurement of L2
 rather than L2 - L4
 in order to save patient scanning time,
cost, and the patient X-ray exposure.

Abstract Background: Osteoporosis is a systemic skeletal disorder characterized by reduction of
one mass, deterioration of bone structure, increasing bone fragility, and increasing fracture
risk. Prevention of osteoporosis during childhood and adolescence is one of the most
important issues in World Health Organization. The purpose of this study was to determine
the effect of Health Belief Model based intervention on promoting nutritional behaviors
about preventive osteoporosis among the second grade middle school girl students.
Materials and Methods: This was an experimental intervention study, the research population
being 130 students who were randomly divided into groups, experimental (66) and control (64).
Before the educational program, Health Belief Model based standard questionnaire and Food
Frequency Questionnaire (FFQ) questionnaire were filled up by both the groups. The standard
questionnaire was completed three times (before, immediately, and 2 months after education)
and FFQ questionnaire was completed two times (before and 2 months after education) by
the students. After pre‑test, four educational session classes in the experimental group were
performed. Finally, data collected were analyzed by SPSS 18 computer software. Results: The
result of this study showed a significant increase in the mean score of knowledge, perceived
susceptibility, seriousness, benefits, barriers, as well as taking health action among girl
students in the experimental group. Conclusion: The findings of the present study confirmed
the practicability and effectiveness of the Health Belief Model based educational program in
promoting nutritional behaviors about prevention of osteoporosis.