June 26, 2019
3 min read

Osteoporosis ‘knowledge gaps’ persist in women with early menopause, premature ovarian insufficiency

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Survey data suggest that women with premature ovarian insufficiency or early menopause have “unmet information needs” regarding their increased risk for osteoporosis and often practice suboptimal bone health-related behaviors, such as low calcium intake and inadequate exercise, according to findings published in Clinical Endocrinology.

Amanda Vincent

“Despite an increased risk for osteoporosis and concerns regarding bone health, our research indicates that women with premature ovarian insufficiency (POI) or early menopause have gaps in their understanding of bone health and osteoporosis,” Amanda Vincent, MBBS, BMedSci(Hons), PhD, FRACP, adjunct clinical associate professor and head of early menopause research at the Monash Centre for Health Research and Implementation at Monash University School of Public Health and Preventive Medicine, told Endocrine Today. “This impacts their health-related behaviors, as greater knowledge and self-efficacy was associated with an increased likelihood to have had a bone density screening performed, adequate calcium intake and exercise. Designing a bone health fact sheet with women with POI or early menopause resulted in the development of a resource for women that was perceived as acceptable and helpful.”

In a mixed-methods study, Vincent and colleagues first conducted an initial needs-analysis, recruiting 316 women with POI or early menopause (defined as menopause before age 40 or 45 years, respectively) to complete a printed or online survey between March 2017 and April 2018 (median age, 54 years; median age at menopause, 40 years). The survey assessed medical history and health-related behaviors, including the perceived importance of seven osteoporosis topics, assessed using a Likert scale, as well as dietary intake of calcium and physical activity. Women also completed the Osteoporosis Knowledge Assessment Tool (OKAT), the Osteoporosis Health Beliefs Scale (OHBS) and the Osteoporosis Self-Efficacy Scale (OSES). Using survey findings and current osteoporosis and POI and early menopause guidelines, the researchers then developed an initial bone health fact sheet, which was refined with the help of semi-structured interviews with 20 survey participants.

Within the survey cohort, nearly one-fifth of the women reported a diagnosis of osteoporosis and most reported suboptimal dietary calcium intake and physical activity, according to researchers. Most women were screened for osteoporosis (80%); however, only 27.3% of eligible women were current users of hormone therapy.

Survey data suggest that women with premature ovarian insufficiency or early menopause have “unmet information needs” regarding their increased risk for osteoporosis.
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In assessing osteoporosis knowledge, only eight of 19 items were correctly answered by more than 50% of the cohort, according to researchers. The main areas of knowledge gaps related to prevalence, signs and symptoms, risk factors, treatment options and postmenopausal bone loss. Researchers found that a higher OKAT score was predictive of calcium intake (OR = 1.126; 95% CI, 1.035-1.225) and screening (OR = 1.186; 95% CI, 1.077-1.305), but was not associated with increased exercise. Similarly, women with higher OHBS scores were more likely to undergo screenings for osteoporosis (OR = 1.027; 95% CI, 1.004-1.05) and a higher OSES score was predictive of higher calcium intake (OR = 1.04; 95% CI, 1.013-1.069) and exercise (OR = 1.117; 95% CI, 1.077-1.16).

Researchers identified five themes in designing the fact sheet from two interview rounds, including content, emotional response, design, perceived usefulness and clinical considerations. The final fact sheet was considered “acceptable and useful” in addressing osteoporosis-related knowledge gaps, according to researchers.

“When women with POI or early menopause better understand the need to address bone health and osteoporosis risk, it impacts their health-related behaviors, including screening and self-management,” said Vincent, also president of the Australasian Menopause Society. “We need to determine if the use of this fact sheet and related resources increases the understanding of bone health in women with POI or early menopause in the wider community, including women with different literacy levels, cultural background and languages.” – by Regina Schaffer

For more information:

Amanda Vincent, MBBS, BMedSci(Hons), PhD, FRACP, can be reached at the Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, 3168, Victoria, Australia; email: Amanda.vincent@monash.edu.


The POI/Early Menopause and Osteoporosis fact sheet is available for download at: https://www.monash.edu/__data/assets/pdf_file/0010/1515187/Early-Menopause_POI-and-Osteoporosis.pdf.

Disclosure: Vincent reports she has received honorarium from Amgen.