Osteoporosis International

, Volume 30, Issue 7, pp 1395–1401 | Cite as

Factors affecting willingness to get assessed and treated for osteoporosis

  • Y. H. Roh
  • E. S. Lee
  • J. Ahn
  • H. S. Kim
  • H. S. Gong
  • K. H. Baek
  • H. Y. ChungEmail author
Original Article



Individuals with poor knowledge of osteoporosis and lower socioeconomic status, including being single and having a lower level of annual income, are less likely to be assessed or treated for osteoporosis. Individuals with particular osteoporosis risk factors such as smokers and heavy drinkers are overlooked for diagnosis. Further study is needed to identify and address the existing barriers and to promote osteoporosis management for women with these risk factors.


Despite the negative health consequences of osteoporosis and the availability of effective treatment, a pervasive and persistent prevention care gap for osteoporosis remains present throughout the world. We attempted to identify the factors affecting the willingness of patients to either undergo or avoid assessment and treatment for osteoporosis.


A nationwide online survey was conducted in 926 Korean women over age 50. The survey included questions addressing three domains: (1) clinical and socio-demographic characteristics, (2) questions concerning the reasons for undergoing or avoiding osteoporosis assessment or treatment, and (3) knowledge of osteoporosis as measured using the modified Korean version of Facts on Osteoporosis Quiz. The assessed and non-assessed participants were compared in terms of their clinical and socioeconomic statuses, reasons for undergoing or avoiding osteoporosis management, and levels of knowledge of osteoporosis.


The highest-ranked reason for undergoing osteoporosis assessment was fear of osteoporotic fracture, while the highest-ranked reason for avoiding osteoporosis assessment was not feeling a need to get tested for osteoporosis. Participants who sought assessment for osteoporosis were older and more likely to be married, and had greater knowledge of osteoporosis than those who did not seek assessment. The two groups were found to be similar in terms of tobacco use and daily alcohol use. Patients who had been diagnosed with osteoporosis but either did not initiate or discontinued osteoporosis treatment within 1 year were younger and had lower levels of annual income than those who began and continued treatment.


Individuals with poor knowledge of osteoporosis and those of lower socioeconomic status, including those who were single and had a lower level of annual income, were less likely to be assessed and treated for osteoporosis. Individuals with particular osteoporosis risk factors such as smokers and heavy drinkers are overlooked for diagnosis. Further study is needed to identify and address the existing barriers and to promote osteoporosis management for women with these risk factors.


Assessment Knowledge on osteoporosis Osteoporosis Risk factors Socio-demographic characteristics Treatment Willingness 


Compliance with ethical standards

This study obtained the ethics approval from the ethical committee of the Ewha Womans University Medical Center.

Conflicts of interest



  1. 1.
    Wade SW, Strader C, Fitzpatrick LA, Anthony MS, O'Malley CD (2014) Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos 9:182CrossRefGoogle Scholar
  2. 2.
    Cummings SR, Black DM, Rubin SM (1989) Lifetime risks of hip, Colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med 149:2445–2448CrossRefGoogle Scholar
  3. 3.
    Haentjens P, Autier P, Collins J, Velkeniers B, Vanderschueren D, Boonen S (2003) Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis. J Bone Joint Surg Am 85-A:1936–1943CrossRefGoogle Scholar
  4. 4.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRefGoogle Scholar
  5. 5.
    Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA, Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S, Joyce C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA (2003) The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 14:895–904CrossRefGoogle Scholar
  6. 6.
    Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228CrossRefGoogle Scholar
  7. 7.
    Cranney A, Wells G, Willan A, Griffith L, Zytaruk N, Robinson V, Black D, Adachi J, Shea B, Tugwell P, Guyatt G, Osteoporosis Methodology G, The Osteoporosis Research Advisory G (2002) Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 23:508–516CrossRefGoogle Scholar
  8. 8.
    Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, Kleerekoper M, Luckey MM, McClung MR, Pollack RP, Petak SM (2010) American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis: executive summary of recommendations. Endocr Pract 16:1016–1019CrossRefGoogle Scholar
  9. 9.
    Tarantino U, Iolascon G, Cianferotti L, Masi L, Marcucci G, Giusti F, Marini F, Parri S, Feola M, Rao C, Piccirilli E, Zanetti EB, Cittadini N, Alvaro R, Moretti A, Calafiore D, Toro G, Gimigliano F, Resmini G, Brandi ML (2017) Clinical guidelines for the prevention and treatment of osteoporosis: summary statements and recommendations from the Italian Society for Orthopaedics and Traumatology. J Orthop Traumatol 18:3–36CrossRefGoogle Scholar
  10. 10.
    Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of P (2008) Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med 149:404–415CrossRefGoogle Scholar
  11. 11.
    Gillespie CW, Morin PE (2017) Trends and disparities in osteoporosis screening among women in the United States, 2008-2014. Am J Med 130:306–316CrossRefGoogle Scholar
  12. 12.
    Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH (2009) Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am 91:2376–2380CrossRefGoogle Scholar
  13. 13.
    Port L, Center J, Briffa NK, Nguyen T, Cumming R, Eisman J (2003) Osteoporotic fracture: missed opportunity for intervention. Osteoporos Int 14:780–784CrossRefGoogle Scholar
  14. 14.
    Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11CrossRefGoogle Scholar
  15. 15.
    Nayak S, Roberts MS, Greenspan SL (2009) Factors associated with diagnosis and treatment of osteoporosis in older adults. Osteoporos Int 20:1963–1967CrossRefGoogle Scholar
  16. 16.
    Nelson RE, Nebeker JR, Sauer BC, LaFleur J (2012) Factors associated with screening or treatment initiation among male United States veterans at risk for osteoporosis fracture. Bone 50:983–988CrossRefGoogle Scholar
  17. 17.
    Meadows ES, Mitchell BD, Bolge SC, Johnston JA, Col NF (2012) Factors associated with treatment of women with osteoporosis or osteopenia from a national survey. BMC Womens Health 12:1CrossRefGoogle Scholar
  18. 18.
    Jeon YJ, Kim JW, Park JS (2014) Factors associated with the treatment of osteoporosis in Korean postmenopausal women. Women Health 54:48–60CrossRefGoogle Scholar
  19. 19.
    Galesic M, Bosnjak M (2009) Effects of questionnaire length on participation and indicators of response quality in a web survey. Public Opin Q 73:349–360CrossRefGoogle Scholar
  20. 20.
    Ailinger RL, Lasus H, Braun MA (2003) Revision of the facts on osteoporosis quiz. Nurs Res 52:198–201CrossRefGoogle Scholar
  21. 21.
    Park C, Ha YC, Jang S, Jang S, Yoon HK, Lee YK (2011) The incidence and residual lifetime risk of osteoporosis-related fractures in Korea. J Bone Miner Metab 29:744–751CrossRefGoogle Scholar
  22. 22.
    Park C-H, Lee Y-K, Koo K-H (2017) Knowledge on osteoporosis among nurses. J Bone Metab 24:111–115CrossRefGoogle Scholar
  23. 23.
    Baek JH, Lee YK, Hong SW, Ha YC, Koo KH (2013) Knowledge on osteoporosis in guardians of hip fracture patients. J Bone Miner Metab 31:481–484CrossRefGoogle Scholar
  24. 24.
    Yoon BH, Baek JH, Lee YK, Ha YC, Koo KH (2014) Knowledge on osteoporosis of prescriber according to level of medical institute. Yonsei Med J 55:1058–1062CrossRefGoogle Scholar
  25. 25.
    Solomon DH, Brookhart MA, Gandhi TK, Karson A, Gharib S, Orav EJ, Shaykevich S, Licari A, Cabral D, Bates DW (2004) Adherence with osteoporosis practice guidelines: a multilevel analysis of patient, physician, and practice setting characteristics. Am J Med 117:919–924CrossRefGoogle Scholar
  26. 26.
    Morris CA, Cheng H, Cabral D, Solomon DH (2004) Predictors of screening and treatment of osteoporosis: a structured review of the literature. Endocrinologist 14:70–75CrossRefGoogle Scholar
  27. 27.
    Demeter S, Leslie WD, Lix L, MacWilliam L, Finlayson GS, Reed M (2007) The effect of socioeconomic status on bone density testing in a public health-care system. Osteoporos Int 18:153–158CrossRefGoogle Scholar
  28. 28.
    Wilson RK, Tomlinson G, Stas V, Ridout R, Mahomed N, Gross A, Cheung AM (2011) Male and non-English-speaking patients with fracture have poorer knowledge of osteoporosis. J Bone Joint Surg Am 93:766–774CrossRefGoogle Scholar
  29. 29.
    Shaw C, Brittain K, Tansey R, Williams K (2008) How people decide to seek health care: a qualitative study. Int J Nurs Stud 45:1516–1524CrossRefGoogle Scholar
  30. 30.
    Meadows LM, Mrkonjic LA, Lagendyk LE, Petersen KM (2004) After the fall: women’s views of fractures in relation to bone health at midlife. Women Health 39:47–62CrossRefGoogle Scholar
  31. 31.
    Kadakia RJ, Tsahakis JM, Issar NM, Archer KR, Jahangir AA, Sethi MK, Obremskey WT, Mir HR (2013) Health literacy in an orthopedic trauma patient population: a cross-sectional survey of patient comprehension. J Orthop Trauma 27:467–471CrossRefGoogle Scholar
  32. 32.
    Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, Sparkes L, Hawkins M, Osborne RH (2015) Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Public Health 15:678CrossRefGoogle Scholar
  33. 33.
    Kang HG, Kwon KH, Lee IW, Jung B, Park EC, Jang SI (2013) Biochemically-verified smoking rate trends and factors associated with inaccurate self-reporting of smoking habits in Korean women. Asian Pac J Cancer Prev 14:6807–6812CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Y. H. Roh
    • 1
  • E. S. Lee
    • 2
  • J. Ahn
    • 3
  • H. S. Kim
    • 4
  • H. S. Gong
    • 5
  • K. H. Baek
    • 6
  • H. Y. Chung
    • 7
    Email author
  1. 1.Department of Orthopaedic Surgery, Ewha Womans University Medical Center, College of MedicineEwha Womans UniversitySeoulSouth Korea
  2. 2.Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, College of MedicineSoonchunhyang UniversitySeoulSouth Korea
  3. 3.Division of Endocrinology and Metabolism, Department of Internal MedicineKorea Medical InstituteSeoulSouth Korea
  4. 4.Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, College of MedicineSoonchunhyang UniversitySeoulSouth Korea
  5. 5.Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, College of MedicineSeoul National UniversitySeoulSouth Korea
  6. 6.Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea
  7. 7.Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, School of MedicineKyung Hee UniversitySeoulSouth Korea

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