Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study

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Abstract

Background

Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility.

Objective

This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia.

Methods

A total of 72 adolescents (female: n=51, 71%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book.

Results

There was a significant increase in the median knowledge score, which was 40.6% (IQR 31.3%-46.9%) during the pretest and 71.9% (IQR 53.9%-81.3%) during the posttest ( P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98%) and exhibited sedentary behavior (pretest: 51/62, 82%; posttest: 48/62, 77%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97%), liked the graphics (71/72, 99%), and approved of the layout (60/72, 83%) and font size (66/72, 92%) used.

Conclusions

The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change.

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Most cited references 67

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The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations

C Weaver, C. Gordon, K. Janz … (2016)

Lifestyle choices influence 20–40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. Lifestyle Factor Grade Macronutrients Fat D Protein C Micronutrients Calcium A Vitamin D B Micronutrients other than calcium and vitamin D D Food Patterns Dairy B Fiber C Fruits and vegetables C Detriment of cola and caffeinated beverages C Infant Nutrition Duration of breastfeeding D Breastfeeding versus formula feeding D Enriched formula feeding D Adolescent Special Issues Detriment of oral contraceptives D Detriment of DMPA injections B Detriment of alcohol D Detriment of smoking C Physical Activity and Exercise Effect on bone mass and density A Effect on bone structural outcomes B Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years—a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one’s genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.

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The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis

Nader Salari, Hooman Ghasemi, Loghman Mohammadi … (2021)

Background Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide. Methods A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I 2 test, and the publication bias was assessed by the Begg and Mazumdar’s test at the significance level of 0.1. Results After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15–105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2–20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I 2 : 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8–26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6–14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3–59.7) and a sample size of 2989 people with the age range 18–95 years. Conclusion According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.

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Prevalence of Osteoporosis and Fracture in China : The China Osteoporosis Prevalence Study

Linhong Wang, Wei Yu, Xiangjun Yin … (2021)

This cross-sectional study evaluates the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures among adults 40 years or older in mainland China by sex, age group, and urban vs rural residence. Question What is the prevalence of osteoporosis and clinical and vertebral fracture in the adult population of mainland China? Findings In this cross-sectional study of 20 416 individuals, the prevalence of osteoporosis among adults 40 years or older was 5.0% among men and 20.6% among women, and the prevalence of vertebral fracture was 10.5% among men and 9.7% among women. Meaning These findings suggest that recommendations for screening and treatment of fractures should include both men and women in China. Importance The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known. Objective To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China. Design, Setting. and Participants This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate. Main Outcomes and Measures Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography. Results A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture. Conclusions and Relevance In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

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Author and article information

Contributors

Nor Aini Jamil:

ORCID: http://orcid.org/0000-0002-5689-0730

Jashwiny Dhanaseelan:

ORCID: http://orcid.org/0009-0001-5548-161X

Nurin Athirah Buhari:

ORCID: http://orcid.org/0009-0004-3919-5498

Journal

Journal ID (nlm-ta): JMIR Pediatr Parent

Journal ID (iso-abbrev): JMIR Pediatr Parent

Journal ID (hwp): JPP

Journal ID (publisher-id): pediatrics

Journal ID (index): 30

Title: JMIR Pediatrics and Parenting

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2561-6722

Publication date Collection: 2024

Publication date (Electronic): 26 August 2024

Volume: 7

Electronic Location Identifier: e56611

Affiliations

[1 ]departmentCentre for Community Health Studies , Faculty of Health Sciences, Universiti Kebangsaan Malaysia , Jalan Raja Muda Abd Aziz, Kuala Lumpur, 50300, Malaysia, 60 392897081

Author notes

Nor AiniJamilMSc, PhD, Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, Kuala Lumpur, 50300, Malaysia, 60 392897081; ainijamil@ 123456ukm.edu.my

None declared.

[*]

all authors contributed equally

Author information

Nor Aini Jamil http://orcid.org/0000-0002-5689-0730

Jashwiny Dhanaseelan http://orcid.org/0009-0001-5548-161X

Nurin Athirah Buhari http://orcid.org/0009-0004-3919-5498

Article

Publisher ID: 56611

DOI: 10.2196/56611

PMC ID: 11368018

PubMed ID: 39186008

SO-VID: 64c260bf-0f7f-4a83-896c-df3b2863d32a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Pediatrics and Parenting, is properly cited. The complete bibliographic information, a link to the original publication on https://pediatrics.jmir.org, as well as this copyright and license information must be included.

History

Date received : 21 January 2024

Date revision received : 26 June 2024

Date accepted : 03 July 2024

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