Relationships between osteoporosis health belief, self-efficacy and knowledge, calcium intake and physical activity with bone health status among undergraduates at Universiti Putra Malaysia

Osteoporosis is a serious public health issue, which affects men and women, young and old. The prevalence of osteoporosis in Asian countries is higher than in western countries due to the fact that the Asian population has much lower body mass index and shorter height. The objective of this cross-sectional study was to determine the relationship between osteoporosis health belief, self-efficacy and knowledge, calcium intake, physical activity and body weight with bone health status among engineering undergraduates at Universiti Putra Malaysia, as well as to determine the significant predictors of bone health status. Data on socio-demographic, family history of osteoporosis, OHBS, OSES and OKT were collected through a self-administered questionnaire. Milk consumption pattern and intake of calcium supplements and dietary calcium intake was assessed by using a semiquantitative food frequency questionnaire (SFFQ) while the physical activity level was assessed by using the International Physical Activity Questionnaire (IPAQ). Weight,high, and bone health status were measured by using a weighing scale (TANITA), body meter (SECA) and ultrasound machine (QUS-2™). The OHBS, Osteoporosis Selfefficacy Scale (OSES) and Osteoporosis Knowledge Test (OKT) instruments were copyrighted and permission to use has been obtained from the authors. Data were analyzed by using the Statistical Package for Social Science (SPPS) version 16. A total of 279 respondents (male =50.9%, female=49.1%) who fulfilled the selection criteria participated in this study. The majority of the respondents were Malays. The mean age of the respondents was 20.01 ±0.79 years. The mean weight, height, and Body Mass Index (BMI) of the respondents were 56.60±12.27 kg, 1.63 ± 0.08 m and 21.18±4.06 kg/m², respectively. Based on the BMI classification, 24.4% of them were underweight (BMI<18.5 kg/m²) and 4% of them were obese (BMI 30kg/m²). A majority (93.9%) of the respondents reported no family history of osteoporosis. The total means scores for OHBS and scores for OSES were 128.68±13.08 and 63.11±17.06, respectively. The mean score for OKT was 9.73±3.00. The mean dietary intake calcium was 683.10±339.20 mg per day. A majority (68.1%) of respondents did not achieve the FOA/WHO recommendation and only less than one-quarter (31.9%) achieved the Malaysian Recommended Nutrient Intake (RNI) for dietary intake calcium. The mean of Met-min was 2061.59±2075.87 MET-min per week. Less than half (48.2%) of the respondents had high level of physical activity (total MET-min per week>1500). The mean Broadband Ultrasound Attenuation (BUA) was 97.76±16.36 dB/MHz. According to the diagnostic criteria for osteoporosis by WHO (1994), 91.8% of respondents had normal bone mass, 7.9% were osteopenic and 0.4% were osteoporosis. About 37.6% of the respondents reported that they drink milk and the common type of milk consumed was low fat milk (41.6%). A total of 10.1% of the respondents were taking calcium supplement. This study showed significant correlation between perceived seriousness toward osteoporosis and health motivation with dietary calcium intake. Also, there was a negative, significant correlation between perceived barriers to exercise(r= -0.133, p <0.05). The result also revealed that OKT was not significant by related with dietary calcium intake and physical activity. The result also revealed a significant relationship between score of OSES of taking calcium with dietary calcium intake (r=0.134, p<0.05) and between score of OSES to exercise with physical activity (r=0.279, p<0.05).total score of OSES and knowledge about osteoporosis were significantly correlated (r=0.169, p<0.05). The result revealed that there were significant correlation between BUA with calcium intake (r=0.275, p<0.05), and with physical activity (r=0.282, p<0.05) and body weight and BMI were significant with BUA. Factors contributing significantly to BUA in young adults were calcium intake, physical activity, weight and height ( R=0.442, R2= 0.195, F=9.521). Based on the OHBS perceived seriousness toward osteoporosis was significant predictor for dietary calcium intake and while self-efficacy to exercise was a significant predictor for physical activity. Using the multivariable regression model, the factors which contribute significantly to bone health in young adults were dietary calcium intake, physical activity, weight and height. In conclusion, these findings indicated that the majority of the respondents had below average calcium intake. They had moderate osteoporosis health beliefs and high self efficacy as well as knowledge. Therefore, there is a need to formulate appropriate campaigns and educational programs is to create awareness about osteoporosis and the importance of dietary calcium and exercise in promoting optimal bone health among young adults and to reduce risk of osteoporosis in the later years.

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