Race Plays a Role in the Knowledge, Attitudes, and Beliefs of Women with Osteoporosis

  • Nicole C. WrightEmail author
  • Mary E. Melton
  • Maira Sohail
  • Ivan Herbey
  • Susan Davies
  • Emily B. Levitan
  • Kenneth G. Saag
  • Natalia V. Ivankova


Using a concurrent mixed methods design, we investigated how knowledge, attitudes, values, and beliefs among women with osteoporosis can explain racial disparities in bone health. We recruited African American and White women ≥ 65 years of age with osteoporosis to participate in focus groups. We quantitatively compared scores of the “Osteoporosis & You” knowledge scale and each domain (internal, powerful others, and chance) of the Multidimensional Health Locus of Control scale by race using t tests. We qualitatively explored potential racial differences in attitudes, values, and beliefs in the domains: (1) osteoporosis and bone health concerns, (2) knowledge about osteoporosis, (3) utilization of medical services for osteoporosis, (4) facilitators of osteoporosis prevention activities, and (5) barriers to osteoporosis prevention activities. A total of 48 women (White: 36; African American: 12) enrolled in the study. White women had a mean (SD) of 7.8 (0.92), whereas African American women score a 6.6 (2.6) (p = 0.044) out of 10 on the Osteoporosis & You Scale. The powerful others domain was significantly higher among African American for both general and bone health [General Health — African American: 26.7 (5.9) vs. White: 22.3 (3.8); p = 0.01]. Qualitative thematic analysis revealed differences by race in knowledge, types of physical activity, coping with comorbidities, physician trust, religion, and patient activation. Using both quantitative and qualitative methods, our study identified racial differences in knowledge, attitudes, and beliefs in women with osteoporosis that could result in racial disparities in bone health, indicating the need to improve education and awareness about osteoporosis in African American women.


Osteoporosis Mixed-methods Disparities Epidemiology 



We would like to thank the participants of this study. This study was supported by K12 HS023009 and a pilot project from the Deep South Resource Center for Minority Aging Research.

Compliance with Ethical Standards

Conflict of Interests

NCW: Research: Amgen; Expert Witness: Pfizer; Honorarium: Columbia University Medical Center

MEM: Research: Amgen

MS: None

IH: None

SD: None

EBL: Research: Amgen; Advisory Boards: Amgen; Consultant: Novartis

KGS: research grant, consulting (Amgen, Mereo, Radius, Roche)

NVI: None


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Clinical Immunology and Rheumatology, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.School of Medicine, Department of SurgeryUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Health Behavior, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.Department of Health Services Administration, School of Health ProfessionUniversity of Alabama at BirminghamBirminghamUSA

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