INTRODUCTION:

Osteoporosis is the commonest metabolic bone disease. It occurs when the rate of bone desorption exceeds the rate of bone formation. The main cause for osteoporosis in women is menopause and in men is senility. Bone serves as a store house for 99% of body’s calcium. Changes in calcium ion activity in the extracellular fluid affect multiple biological processes. Hence, special regulatory mechanisms are required to provide an overall control of this activity. If for any reason the serum calcium level falls below its normal value, the body can react in three ways: 1) it may increase intestinal absorption 2) it may decrease urinary excretion or 3) it may increase the release of calcium from bone¹.

Osteoporosis is characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhanced bone fragility. This increases the susceptibility to fracture. Osteoporosis is a silent disease, reflected only in a low bone density, till a fracture occurs. With increasing longevity of the Indian population, it is now being realized that, as in the West, osteoporotic fractures are a major cause of morbidity and mortality in the elderly. Based on 2001 census, approximately 163 million Indians are above the age of 50; this number is expected to increase to 230 million by 20151. Even conservative estimates suggest that of these, 20 per cent of women and about 10-15 per cent of men would be osteoporotic. The total affected population would, therefore, be around 25 million. If the lower bone density is shown to confer a greater risk of fracture, as is expected, the figure can increase to 50 million².

Today we live in a fast-moving world. Human life gets adjusted according to pace of these worlds. If this movement is hampered people get stagnated with the past thoughts and attitudes³. Physiologically movement takes place at joints. Disorders affecting these body parts, commonly called as musculoskeletal problems are the most common cause of restriction in daily life in most countries⁴.

Baby boomers are increasingly reporting mobility-related problems, such as climbing stairs, stooping down, and getting out of bed, current research should focus on prevention and symptomatic treatment of the disorder. The overall health condition of the people is far from optimistic, as poor health is afflicting 60 percent of the middle-aged, nearly 100 percent of the elderly and a sizable proportion of children⁵.

Preventive measures for osteoporosis are intake of protein diet, calcium supplementations, androgen, oestrogen, and vitamin -D. During the past decade osteoporosis has emerged as a major public health problem. In societies with aging populations, an increasing number of persons are at risk of fracture, the most detrimental outcome of osteoporosis. Osteoporosis was initially identified as a problem of westernized countries, but a rising number of fractures are occurring in Asia and South America, and the global estimates show steep increases in these regions. The demand on the health care system is therefore increasing, as are costs for society. Prevention of osteoporosis and fracture must be considered particularly for the elderly at highest risk. Awareness is needed at all levels, including decision making bodies, in order to raise the priority of, and effectively implement, strategies to reduce the number of persons suffering. Interventions for prevention of fractures must be cost-effective; therefore, strategies are needed to identify those who will benefit most from more costly secondary measures⁶.

STATEMENT OF THE PROBLEM:

Assess the effectiveness of Self-instructional module on prevention of osteoporosis among middle aged women who are attending orthopaedic outpatient department in selected hospital, Bangalore

OBJECTIVES OF THE STUDY:

1. To assess the pre test level of knowledge regarding prevention of osteoporosis among middle aged women.

2. To determine the effectiveness of Self-instructional module on prevention of osteoporosis among middle aged women.

3. To find out the association between post test knowledge score of middle-aged women regarding the prevention of osteoporosis with their selected demographic variables.

HYPOTHESIS:

H₁: There will be significant difference between the pre test and post test knowledge scores of middle-aged women regarding prevention of Osteoporosis.

H2: There will be significant association between post test knowledge of middle-aged women on prevention of osteoporosis and their selected demographic variables.

METHODOLOGY:

A Quantitative evaluative approach, pre-experimental - one group pre-test, post test design was chosen for the study. This study was undertaken in the Out Patient Departments of selected hospital, Bangalore. The samples for the present study comprised of 50 middle aged women who are attending OPD were selected through convenient sampling- a non probability sampling technique. A self administered structured knowledge questionnaire was used to assess the knowledge on prevention of osteoporosis among middle aged women.

RESULTS AND DISCUSSION:

Table 1: Frequency and percentage distribution of sample according to demographic characteristics

Demographic variables	Frequency	Percentage
Age in years
41-50	22	44
51-55	13	26
56-60	15	30
Religion
Hindu	22	50
Christian	15	30
Muslim	10	20
Education
No Formal Education	6	12
Primary	24	48
Secondary	6	12
Graduation	11	22
Post Graduation	3	6
Occupation
Unemployed	12	24
Daily Wages	14	28
Self Employed	9	18
Private	7	14
Government	8	16
Family monthly income
Below 5000	19	38
5,000-10,000	17	34
Above 10,000	14	28
Food pattern
Vegetarian	12	24
Mixed	38	76
Previous history of illness
Nil	32	64
Hyper/Hypo parathyroidism	8	16
Rheumatoid arthritis	6	12
Gout	4	8
Family history of osteoporosis
Yes	32	64
No	18	36
Source of information
No information	14	28
Mass media	17	34
Relatives/Friends	9	18
Health professionals	10	20

Table 2: Area wise mean, SD, mean percentage of middle aged women pre test knowledge scores.

No	Knowledge areas	Max score	Pretest Level of knowledge
No	Knowledge areas	Max score	Mean	SD	Mean (%)
1.	General information and risk factors	7	2.80	1.2	40.0
2.	Clinical manifestation and diagnostic evaluation	4	2.36	1.2	59.0
3.	Prevention	15	5.38	2.4	35.9
4	Treatment	4	1.80	1.1	45.0
	Over all	30	12.34	4.2	41.1

Table 3: Area wise comparison of pre and post test knowledge scores of means, sd, and the mean percentage on prevention of osteoporosis.

SI. No.	Knowledge	Max score	Respondents knowledge						Difference in the mean %
			Pre test			Posttest
			Mean	SD	Mean %	Mean	SD	Mean %
1	General information	7	2.80	1.2	40.0	5.56	0.9	79.4	39.4
2	Clinical manifestations	4	2.36	1.2	59.0	3.66	0.7	91.5	32.5
3	Prevention	15	5.38	2.4	35.9	11.46	1.4	76.4	40.5
4	Treatment	4	1.80	1.1	45.0	3.36	0.7	84.0	39.0
	Overall	30	12.34	4.2	41.1	24.04	2.1	80.1	39.0

Figure 1: Percentage wise distribution of middle aged women by their pre and post test knowledge score

Table 4: Association between post test knowledge scores of middle-aged women with their demographic variables N=50

SI. No.	Demographic variables	Df	Chi-square	Table value	Level of Significance
1.	Age	2	7.70	5.991	P<0.05	Significant
2.	Religion	2	2.15	5.991	P>0.05	Not Significant
3.	Education	4	3.42	9.49	P>0.05	Not Significant
4.	Occupation	4	7.53	9.49	P>0.05	Not Significant
5.	Family monthly income	2	0.74	5.991	P>0.05	Not Significant
6.	Food pattern	2	5.90	5.991	P<0.05	Significant
7.	Previous history of illness	4	15.69	9.49	P<0.05	Significant
8.	Family history of osteoporosis	1	6.42	3.841	P<0.05	Significant
9.	Source of information	3	3.37	7.815	P>0.05	Not significant