CORR - 2026-07-21 - Journal Article
What Are the Attitudes, Awareness Levels, and Practices of Bone Health Among Women Age 40 to 65 Years With Limited Income in China?
Zhou Y, Sun Y, Zhang D, Li C, Wang Z, Wang M, Liu Z, Yang F, Su M, Pang X, Jin R, Xu F, Chen X, Zhang L, Teng Y, Tao M
Topics
Key Takeaway
Despite 61% of low-income Shanghai women aged 40–65 valuing bone health, only 12% used calcium supplementation, 9% used vitamin D, and 4% had ever undergone DEXA screening.
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Summary
This cross-sectional survey assessed bone health attitudes, knowledge, and practices among low-income women aged 40–65 across seven Shanghai districts in 2023. Of 6,429 approached, 6,068 (94%) completed valid questionnaires; multivariable linear regression identified higher education (β=1.18), marriage (β=1.14), and regular physical activity (β=1.28) as positive predictors of knowledge scores, while hypertension (β=-0.73) and diabetes (β=-1.10) were negative predictors. A pronounced attitude-practice gap was documented: high perceived importance of bone health did not translate into supplementation, exercise, or screening uptake.
Key Limitation
The researcher-developed, unvalidated questionnaire introduces measurement bias and prevents direct comparison of knowledge scores with other published cohorts.
Original Abstract
BACKGROUND
Osteoporosis can cause painful, disabling, fatal fractures and impose substantial socioeconomic burdens. Because menopause-related bone loss accelerates during midlife, women with limited income may have difficulty accessing screening, counseling, and bone-healthy nutrition before the first fragility fracture occurs. Assessing bone-health awareness and preventive practices in this group may help identify modifiable gaps and guide targeted prevention for low-income midlife and older women.
QUESTIONS/PURPOSES
(1) What were the attitudes, awareness, and preventive practices regarding bone health among women age 40 to 65 years with limited income in Shanghai, China? (2) Which sociodemographic and health-related factors were associated with bone-health knowledge scores?
METHODS
We conducted a multidistrict, cross-sectional survey from January to September 2023. We approached 6429 eligible women with limited income at 10 health facilities and community outreach sites in seven Shanghai districts; 94% (6068) completed valid questionnaires and were included in the analysis. Eligible participants were 40 to 65 years of age, had lived in Shanghai for at least 5 years, and received minimum living security assistance. We believe that this group likely is representative of women in this demographic in Shanghai, and may be relevant to similar urban and periurban populations in China and parts of Asia. Data were collected using a researcher-developed questionnaire on osteoporosis knowledge, attitudes, and practices. Multivariable linear regression was used to identify factors associated with knowledge scores.
RESULTS
A clear attitude-practice gap was observed. Although 61% (3698 of 6068) of participants considered bone health important, preventive practice was uncommon in the overall cohort: 12% (720) reported calcium supplementation, 9% (520) reported vitamin D supplementation, and 2% (106) reported menopausal hormone therapy use. Twenty percent (1228) selected dual-energy x-ray absorptiometry (DEXA) as their preferred screening method, while 4% (226) had previously undergone DEXA. Higher educational attainment (β = 1.18; p < 0.001), being married (β = 1.14; p < 0.001), and regular physical activity (β = 1.28; p < 0.001) were associated with slightly higher knowledge scores. Hypertension (β = -0.73; p < 0.001) and diabetes (β = -1.10; p < 0.001) were associated with slightly lower scores.
CONCLUSION
Although most participants believed that bone health was important, women age 40 to 65 years with limited income in Shanghai had limited bone-health knowledge and generally did not take preventative steps that could have improved their bone health.
CLINICAL RELEVANCE
These findings support practical, bone-health education in women's screening programs, community clinics, and chronic disease visits. These materials should be tailored to the anticipated reading levels of the populations served. Programs should explain calcium and vitamin D sources, weightbearing exercise, DEXA referral, and postfracture follow-up. Our findings may also be relevant to other urban and periurban populations in China and in other parts of Asia with similar social and economic characteristics.