Effectiveness of a Web-Based Osteoporosis Awareness Education Program Based on the Health Belief Model Among Female University Students at Risk

Osteoporosis is a common disease worldwide. According to the World Health Organization criteria, osteoporosis is defined as a bone mineral density (BMD) 2.5 standard deviations or more below the mean value (T score < - 2.5 SD) for young, healthy women. It is known as a silent disease leading to millions of osteoporotic fractures annually worldwide. The World Health Organization (WHO) has declared osteoporosis as the main enemy of human health, along with heart attack, stroke and cancer.

Osteoporosis can progress without symptoms for a long time. It is also known as a problem with high mortality, morbidity and cost as well as preventing the individual's daily life activities. Symptoms of osteoporosis include deterioration of body posture, back and lower back pain and fractures. Fractures can be caused by minor traumas and are most common in the spine, wrist and hip bones.

Risk factors for osteoporosis are divided into modifiable and non-modifiable causes. Modifiable risk factors include dietary calcium deficiency, physical inactivity, low body mass index, smoking and alcohol consumption and long-term medication use. Gender, age, race, fair skin and genetic characteristics are considered as non-modifiable osteoporosis risk factors. Although osteoporosis is a problem for both genders, most of the research on osteoporosis focuses on women. This is because women are more likely to develop osteoporosis and subsequent fractures than men. This is because men develop more bone mass during growth and more muscle mass that provides skeletal integration. In addition, men do not go through menopause and have a shorter life expectancy than women. Therefore, they have less time to develop the disease.

In a meta-analysis conducted in five continents, the prevalence of osteoporosis was reported to be 18.3% worldwide (prevalence of osteoporosis in women worldwide is 23.1% and prevalence of osteoporosis in men worldwide is 11.7%). In 2018, another systematic review and meta-analysis based on World Health Organization (WHO) diagnostic criteria in the Eastern Mediterranean showed that the prevalence of osteoporosis was 24.4% between 2000 and 2017 (prevalence of osteoporosis was 24.4% in women and 20.5% in men). Fracture is the most important complication of osteoporosis. In the United States, the lifetime probability of osteoporosis-related fracture for every woman and every man is estimated to be one in two and one in five, respectively. Among European women, the lifetime probability of hip fracture is reported to be 7-25% and major osteoporotic fractures at age 50 are reported to be approximately 50%. In Turkey, osteopenia was found in half and osteoporosis in ¼ of people over the age of 50, and the rate of osteoporosis-related hip fractures has increased over the years. In Turkey, hip fractures are more common in urban areas and in physically inactive people (TOD). In addition, a study reported that 6.9% of Turkish women aged 18-49 years have a moderate to high risk of osteoporosis. The direct medical cost of osteoporosis is estimated to be 12.2-17.9 billion dollars per year worldwide.

In women, physical inactivity, reduced calcium and vitamin D intake, age, menstrual cycle changes, smoking and alcohol consumption impair bone mass density, which is shaped early in life, doubles by age 20 and shrinks rapidly by age 50. Therefore, it is important for young women to maintain bone mass early in life (in the first three decades of life), increase women's knowledge about the disease and adopt a healthy lifestyle to reduce the risk of osteoporosis among women.

Osteoporosis knowledge and awareness has been an important topic in different international studies. Most of these studies have found a lack of knowledge and awareness about osteoporosis in women of different age groups, as well as lack of exercise and calcium intake practices and less self-efficacy or confidence in preventive behaviors. Most of these studies focused on knowledge and found that there is insufficient knowledge about osteoporosis, especially among female university students, and that although they have positive self-efficacy towards exercise and negative self-efficacy towards calcium intake, their knowledge and perceptions are not shown in their behaviors. This age group, which coincides with the university period, is important. Because bone density doubles at the age of 20. Many university students may not have reached peak bone mass. Behaviors developed with sufficient knowledge can bring the bone mass to the level it will reach. Therefore, increasing awareness and knowledge about osteoporosis is thought to be of great value in improving bone health in this age group.

Osteoporosis is a disease that can be prevented by raising awareness of the society since childhood. For this purpose, children and young people should gain proper nutrition and exercise behaviors, which are social strategies to prevent osteoporosis. In developing health behaviors for osteoporosis, not only information but also health beliefs of individuals are important. In preventing osteoporosis, the health belief model is effective in education to increase individuals' perceptions of osteoporosis health, perceptions of benefits and motivation and to decrease their perceptions of barriers. This model directs individuals to engage in desired health behaviors as a motivational tool. Therefore, it is used to protect and improve the health of young women at risk of osteoporosis.