INTRODUCTION:

Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. Osteoporosis is essential to affect 200 million women worldwide- approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-third of women aged 90.

Osteoporosis affects an estimated 75 million people in Europe, USA and Japan. Prevalence of osteoporosis ranging from 8% to 62% in Indian women of different age groups².

Calcium, an essential nutrient for the human body. Indication that inadequate dietary calcium intake may contribute to the etiology of osteoporosis and age-related bone loss. Approximately 99% of the total calcium stores are contained in the skeleton. The remaining stores are in the cells of soft tissue (0.9%) and in the bloodstream and extracellular fluid (0.1%), where they exert effects on the cardiovascular, nervous, and muscular systems. Calcium requirements for skeletal maintenance fluctuate throughout a woman’s life. Body can’t synthesize it. There is growing evidence for the importance of nutrition in the maintenance of bones and joints health. Nutrition imbalance with endocrine abnormalities may be involved in osteoporosis. Organ systems that play an important role in Calcium metabolism are Skeleton, Gastrointestinal tract and Kidney. The nutrient vitamin D is essential for the efficient intestinal absorption of calcium. In women with a vitamin D gross deficiency, not more than 10% to 15% of dietary calcium is absorbed³.

The period during which the female sexual cycle ceases and female sex hormones diminish rapidly to almost none at all is called Menopause. It occurs between 45-55 years of age. It is characterized by hot flushes, night sweats and various other psychological and biochemical changes occur. It also leads to metabolic bone disorders. With the onset of menopause, rapid bone loss occurs which is believed to average approximately 2% to 3% over the following 5 to 10 yrs, being greatest in the early postmenopausal years⁴.

Calcium requirements remain stable until menopause, when the bone resorption rate increases in association with the decrease in ovarian estrogen production. Calcium needs rise at that time because of decreased efficiency in the utilization of dietary calcium, which is due, in large part, to estrogen related shifts in intestinal calcium absorption and renal conservation. Osteoporosis occurs most commonly in postmenopausal women, and the incidence increases with age³. One factor that may limit calcium absorption is a lack of vitamin D resulting from age-related declines in several functions, including ingestion, cutaneous synthesis of the parent vitamin, renal synthesis of the active form of the vitamin (1, 25-dihydroxyvitamin D) and intestinal responsiveness². A cross-sectional study was done in a teaching hospital in southern India. The objective of the study was to assess the level of knowledge of osteoporosis among postmenopausal women referred for a dual-energy X-ray absorptiometry (DXA) scan. Data was collected using a validated questionnaire – Osteoporosis Knowledge Assessment Tool. The proportion of correct responses was expressed as percentages. The mean scores obtained were also compared between different educational groups. The study result showed that the mean (standard deviation) age of the postmenopausal women was 58.8 (6) years. Although most subjects were aware of the consequences of osteoporosis, there was generalized lack of awareness with regard to risk factors and available treatment options. Overall about 60% had poor awareness about osteoporosis⁵.

MATERIAL AND METHOD:

Statement of the Problem:

Knowledge on calcium deficiency disorder among post menopausal women in selected rural community, Mangaluru with a view to provide an information booklet.

Objectives of the study:

1. To determine knowledge of postmenopausal women about calcium deficiency disorder.

2. To find the association of knowledge of postmenopausal women with selected demographic variable.

3. To prepare and provide a validated information booklet.

Hypotheses:

H₁: There will be a significant association of knowledge of postmenopausal women with selected demographic variables (age, religion, education, diet).

Research approach:

Descriptive research approach was adopted.

Research design:

Non-experimental descriptive design was used.

Research setting:

Sanurpadav rural community area, under Benjanapadav PHC, Mangaluru.

Sample:

20 postmenopausal women above 45years.

Sampling technique:

Purposive sampling technique adopted.

Description of tools

· Demographic proforma: It consists of 7 items, which includes age, religion, educational status, monthly income, type of family, type of diet and previous information regarding calcium deficiency disorder.

· Structured knowledge questionnaire regarding calcium deficiency disorder.

· The information booklet on calcium deficiency disorder

Plan of data analysis:

The obtained data was analyzed using descriptive and inferential statistics on the basis of objectives and hypothesis of the study.

· Computation of frequency and percentage distribution of demographic variables of postmenopausal women.

· Frequency and Percentage distribution of the post-menopausal women according to their knowledge scores

· Range of score, maximum score, Mean, Median and Standard Deviation, mean percentage and level of knowledge of samples.

· Fisher’s Exact test to find the association of knowledge score with selected demographic variables of postmenopausal women.

RESULT:

Section I: Description of the demographic variables of postmenopausal women

Table 1: Frequency and percentage distribution of demographic variables of postmenopausal women n=20

Demographic variables

Frequency

Percentage

1. Age (years)

a. 41-50

b. 51-60

c. Above 60

2. Religion

a. Hindu

b. Muslim

c. Christian

d. Others

3. Education Status

a. illiterate

b. Primary

c. Secondary

d. University

4. Monthly income

a. 2,500 or below

b. 2,501-5,000

c. 5,001-10,000

d. 10,001 or above

5. Type of family

a. Nuclear

b. Joint

6. Type of diet

a. Vegetarian

b. Non vegetarian

7. Previous information regarding calcium deficiency diseases

a. Yes

b. No

Section II: Description of knowledge scores on calcium deficiency disorder among postmenopausal women.

Table 2: Frequency and Percentage distribution of the post-menopausal women according to their knowledge scores n=20

Knowledge scores	Frequency	Percentage (%)
0-33% (Inadequate)	0	0
34-66% (Moderate)	11	55
67-100% (Adequate)	9	45

The data in Table 2 shows that majority (45%) of the sample had moderate knowledge, 45% had adequate knowledge and none of them (0%) had inadequate knowledge.

Table 3: Obtained range of score, maximum score, Mean, Median and Standard Deviation, mean percentage and level of knowledge of samples. n=20

Obtained range

Maximum

Score

Mean

Median

Mean% level of

Knowledge

6-10

10.35

1.13

69.00

Moderate

SD=Standard deviation

The data in Table 3 shows that the obtained range, maximum score, mean, median, standard deviation and mean percentage of knowledge questionnaire were 6-10, 13, 10.35, 10, 1.13,69.00 respectively. The mean score of the sample was 10.35±1.13. This indicates that the subjects had moderate knowledge.

Section III: Association of knowledge score on calcium deficiency disorder with the selected demographic variables.

Fisher’s Exact test was computed to determine the association of knowledge score with selected demographic variables. To test significant association, the following null hypothesis was stated.

H₀₁:There is no significant association of knowledge score with selected demographic variables of postmenopausal women.

Table 4: Association of knowledge score on calcium deficiency disorder with the selected demographic variables. n=20

Demographic Variables

≤median

(10)

>median

(10)

pValue

Table Value

Inference

Age

· 45-50yrs

· 51- 60yrs

· Total

0.46

>0.05

not significant

Religion

· Hindu

· Muslim

· Total

0.71

>0.05

not significant

Education status

· Illiterate

· Primary

· Total

0.60

>0.05

not significant

Monthly income

· <2,500

· 2,501-5,000

· Total

0.28

>0.05

not significant

Type of family

· Nuclear

· Joint

· Total

0.28

>0.05

not significant

Type of diet

· Non vegetarian

· Total

0.28

>0.05

not significant

Previous information regarding calcium deficiency diseases

Yes

Total

0.55

>0.05

not significant

The data present in the table 4 shows that there is no significance association of knowledge score with age(p=0.46), religion (p=0.71), educational status (p=0.60), monthly income (p=0.08), type of family (p=0.28), type of diet (p=0.28), previous information regarding calcium deficiency diseases (p=0.55) at 0.05 level of significance.

DISCUSSION:

Majority (55%) of the sample had moderate knowledge, 45% had adequate knowledge and none of them (0%) had inadequate knowledge. The obtained range, maximum score, mean, median, standard deviation and mean percentage of knowledge questionnaire were 6-10, 13, 10.35, 10, 1.13,69.00 respectively. The mean score of the sample was 10.35±1.13. This indicates that the subjects had moderate knowledge. The finding of the present study is supported by a study done, to assess the level of knowledge of osteoporosis among postmenopausal women. The study result showed that the mean (standard deviation) age of the postmenopausal women was 58.8 (6) years. Although most subjects were aware of the consequences of osteoporosis, there was generalized lack of awareness with regard to risk factors and available treatment options. Over all about 60% had poor awareness about osteoporosis⁵. There is no significant association between knowledge score of postmenopausal women with the selected demographic variables, like age (p=0.46), religion (p=0.71), educational status (p=0.60), monthly income (p=0.08), type of family (p=0.28), type of diet (p=0.28), previous information regarding calcium deficiency diseases (p=0.55) at 0.05 level of significance. The findings of the present study was supported by a cross-sectional study was conducted to investigate the association between knowledge, beliefs, and practices regarding osteoporosis and bone health. The study result showed Women (76.57%) scored significantly higher in general knowledge regarding osteoporosis compared to men (70.14%) (p< 0.05). The score of knowledge regarding prevention of osteoporosis was similar between both sexes (p > 0.05)⁸. There was no significant differences in knowledge regarding osteoporosis based on demographic characteristic like age, sex, marital status, nature of job, monthly income, education, number of life time pregnancy. Beliefs regarding osteoporosis were associated with age, sex, education level, and parity. Comparison between sexes showed that women perceived significantly higher susceptibility to osteoporosis (60.37%) compared to men (56.59%) (p = 0.011). Among women, those with 1 to 3 lifetime pregnancies had significantly higher health motivation compared to others (p = 0.021)^6.

CONCLUSION:

Calcium and vitamin D are two important micronutrients for maintaining proper bone health. They play a key role in preventing as well as treating different clinical conditions with excessive bone loss. They are considered to be essential for increasing peak bone mass and for minimizing age-related bone loss to reduce the risk of osteoporosis and low-trauma fractures.

LIMITATION OF THE STUDY:

Some of the post-menopausal women were not answering to the questions in the questionnaire, so investigator need to search for other post-menopausal women.

RECOMMENDATIONS:

1. The study can be replicated on the larger samples for the generalization of finding.

2. A planned teaching program for nurses on knowledge of calcium deficiency disorder can be organised.

REFERENCES:

1. Beto J. The Role of Calcium in Human Aging. Clinical nutrition research. 2015;4:1-8

2. Facts and Statistics / International Osteoporosis Foundation. [Available from: https://www. iofbonehealth.org> facts- statistics]

3. The role of calcium in peri and post-menopausal women: Position statement of the North American Menopause Society. 2016; 13: 862-877.

4. Dalal P, Agarwal M. Post Menopausal Syndrome. Indian Journal of Psychiatry. July 2015; 57(2): 222-232.

5. Senthilraja M, Cherian K, Jebasingh F, et al. Osteoporosis knowledge and beliefs among Postmenopausal Women: A cross sectional study from a teaching hospital in South India. Journal of Family Medicine And Primary Care, Apr 2019; 8(4):1374-1378.

6. Chan C, Subramaniam S, Clin K, Nirwana S, et al. Knowledge, belief, dietary and lifestyle practice related to bone health among middle aged and elderly Chinese in Klang valley, Malaysia. International Journal of Environment Research and Public Health. May 2019. 16(10):77-87

Received on 13.01.2020 Modified on 07.02.2020

Asian J. Nursing Education and Research. 2020; 10(2):185-188.

DOI: 10.5958/2349-2996.2020.00040.3