Sex differences in osteoporosis self-efficacy among community-residing older adults presenting for DXA

  • S. L. SolimeoEmail author
  • V.-T. T. Nguyen
  • S. W. Edmonds
  • Y. Lou
  • D. W. Roblin
  • K. G. Saag
  • P. Cram
  • F. D. Wolinsky
Original Article



The Osteoporosis Self Efficacy Scale was determined to equivalently measure calcium and exercise beliefs in both sexes. Despite data illustrating men’s and women’s similar self-efficacy, gender differences in clinical predictors of self-efficacy imply that efforts to improve care must account for more than self-efficacy.


To understand the extent to which the Osteoporosis Self Efficacy (OSE) Scale is reliable for both men and women. A secondary objective was to evaluate sex differences in OSE.


For this cross-sectional study, we analyzed data collected as part of the Patient Activation after DXA Result Notification (PAADRN) pragmatic trial which enrolled 7749 community-residing adults aged 50 and older reporting for bone densitometry. We used univariable methods, item analysis, exploratory and confirmatory factor analyses, and linear regression to evaluate sex differences in OSE responses and measurement.


In this sample, the confirmatory factor analysis model for OSE both overall and within groups indicated a poor fit. The sex differences in the measurement model, however, were minor and reflected configural invariance (i.e., constructs were measuring the same things in both men and women), confirming that the OSE was measuring the same constructs in men and women. Men overall had higher exercise self-efficacy and women higher calcium self-efficacy. Overall, education, hip fracture, and self-reported health status predicted exercise self-efficacy whereas prior DXA, self-reported osteoporosis, and history of pharmacotherapy use did not. Predictors of calcium self-efficacy differed by gender.


The OSE can be used to measure calcium and exercise self-efficacy in all older adults. However, gender differences in clinical predictors of self-efficacy and the lack of an association of prior DXA with self-efficacy imply that interventions to improve self-efficacy may be insufficient to drive significant improvement in rates of osteoporosis evaluation and treatment.

Trial registration

Patient Activation after DXA Result Notification (PAADRN), NCT01507662,


Calcium  Exercise Gender Fracture  Prevention 



We thank Rebecca Burmeister, MPH (UI), Mollie Giller, MPH (UI), April Miller RT (UI), CBDT, Amna Rizvi-Toner, BA, BS (UI), Kara Wessels, BA (UI), Brandi Robinson (KP), Akeba Mitchell (KP), Aimee Khamar (KP), and Roslin Nelson (KP) and all of the staff at the Iowa Social Science Research Center for recruiting and interviewing all study participants. All except Ms. Miller were compensated from grant funds for their time. We also thank Ryan Outman, MS (UAB), for coordinating and facilitating recruitment of study participants. Finally, we thank the 7749 patients who participated in PAADRN.


This work was supported by the National Institute on Aging at the United States (U.S.) National Institutes of Health (R01 AG033035 to PC and FDW). SL Solimeo receives support from the Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Department of Veterans Affairs, Iowa City VA Health Care System, Iowa City, IA (Award no. CIN 13-412), and a VA HSR&D Career Development Award (Award no. CDA 13-272).

Compliance with ethical standards

Conflicts of interest

SL Solimeo, VT Nguyen, SW Edmonds, Y Lou, DW Roblin, P Cram, and FD Wolinsky have no conflicts to report. KG Saag has received grants from Amgen, Eli Lilly, and Merck and has served as a paid consultant to Amgen, Eli Lilly, and Merck unrelated to this project.


The US Department of Health and Human Services, National Institutes of Health’s National Institute on Aging had no role in the analysis or interpretation of data or the decision to report these data in a peer-reviewed journal. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of Internal Medicine, College of MedicineUniversity of Iowa CarverIowa CityUSA
  2. 2.Department of Veterans Affairs, CADREIowa City VA HCSIowa CityUSA
  3. 3.Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityUSA
  4. 4.College of NursingUniversity of IowaIowa CityUSA
  5. 5.Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityUSA
  6. 6.Kaiser PermanenteRockvilleUSA
  7. 7.Division of Clinical Immunology and Rheumatology, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  8. 8.Department of MedicineUniversity of TorontoTorontoCanada
  9. 9.Division of General Internal Medicine and GeriatricsMt. Sinai/UHN HospitalsTorontoCanada
  10. 10.Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityUSA

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