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ORCID ID

Thean Hui Ru: 0009-0005-4704-4742

Nurul Aimi Ab Kadir: 0009-0006-3539-2640

Fatin Izzaty Mohd Shahrin: 0009-0009-4950-2267

Abstract

Background: The Malaysian Chinese population records the highest national prevalence of osteoporotic hip fractures. This study investigated the relationships between osteoporosis knowledge, health beliefs, and calcium intake among Malaysian Chinese adults.

Methods: A cross-sectional study was conducted among 205 Malaysian Chinese adults in Kampar, Perak, using the adapted Osteoporosis Prevention and Awareness Tool (OPAAT), Osteoporosis Health Belief Scale (OHBS), and a 30-item Food Frequency Questionnaire (FFQ).

Results: Participants demonstrated low osteoporosis knowledge (6.84 ± 2.92), with low perceived susceptibility (14.87 ± 5.00), moderate perceived seriousness (17.81 ± 5.20), and barriers to calcium intake (15.61 ± 4.15), and high perceived benefits (22.73 ± 3.75) and health motivation (21.26 ± 3.84). The mean daily calcium intake was 530 ± 353.2 mg/day, with only 12% of participants achieving adequate intake. Knowledge of osteoporosis was significantly correlated with almost all health belief domains. Several statistically significant correlations were observed among the OHBS domains, and calcium intake was correlated with age (r = 0.181), osteoporosis knowledge (r = 0.141), perceived benefits (r = 0.177), perceived barriers (r = −0.240), and health motivation (r = 0.176).

Conclusion: Strategies that improve osteoporosis awareness, strengthen health motivation, and reduce practical dietary barriers may support healthier calcium-intake behaviors among Malaysian Chinese adults.

References

  1. Yap SY, Aziz Y, Asma’ A, Yusof HM. Ethnic variation in osteoporosis risk factors: dietary calcium, vitamin D intake and body mass index (BMI). Food Res. 2019;3:741–8.
  2. LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022;33:2049–102.
  3. Cheung CL, Ang SB, Chadha M, Chow ESL, Chung YS, Hew FL, et al. An updated hip fracture projection in Asia: the Asian federation of osteoporosis societies study. Osteoporos Sarcopenia. 2018;4:16–21.
  4. Lee JK, Khir ASM. The incidence of hip fracture in Malaysians above 50 years of age: variation in different ethnic groups. APLAR J Rheumatol. 2007;10:300–5.
  5. Subramaniam S, Chan CY, Soelaiman IN, Mohamed N, Muhammad N, Ahmad F, et al. Prevalence and predictors of osteoporosis among the Chinese population in Klang Valley, Malaysia. Appl Sci. 2019;9:1820.
  6. Kaur M. Prevalence and associated risk factors of osteoporosis in post-menopausal women in North India. Mal J Nutr. 2013;19:285–92.
  7. Khan YH, Sarriff A, Khan AH, Mallhi TH. Knowledge, Attitude and Practice (KAP) survey of osteoporosis among students of a tertiary institution in Malaysia. Trop J Pharm Res. 2014;13:155–62.
  8. Zamzuri M, Hamirudin AH, Zainudin N, Sidek S, Rahman NAA. Trend in dietary calcium intake among elderly in Kuantan, Pahang. Int J Allied Health Sci. 2019;3:884–93.
  9. National Coordinating Committee on Food and Nutrition. Recommended nutrient intakes for Malaysia: a report of the technical working group on nutritional guidelines. Kuala Lumpur: Putrajaya, 2017.
  10. Chiang WL, Jamal MHA. The osteoporosis knowledge, belief and calcium intake behaviour among students in a medical sciences university. Int J Public Health Res. 2020;10:1195–208.
  11. Hodges JK, Cao S, Cladis DP, Weaver CM. Lactose intolerance and bone health: the challenge of ensuring adequate calcium intake. Nutrients. 2019;11:718.
  12. Falchetti A, Cavati G, Valenti R, Mingiano C, Cosso R, Gennari L, et al. The effects of vegetarian diets on bone health: a literature review. Front Endocrinol. 2022;13:899375.
  13. Elgzar WT, Nahari MH, Sayed SH, Ibrahim HA. Determinant of osteoporosis preventive behaviors among perimenopausal women: a cross-sectional study to explore the role of knowledge and health beliefs. Nutrients. 2023;15:3052.
  14. Yeap SS, Thambiah SC, Samsudin IN, Appannah G, Zainuddin N, Ismuddin SM, et al. Different reference ranges affect the prevalence of osteoporosis and osteopenia in an urban adult Malaysian population. Osteoporos Sarcopenia. 2020;6:168–72.
  15. Toh LS, Lai PSM, Wu DBC, Wong KT, Low BY, Anderson C. The development and validation of the osteoporosis prevention and awareness tool (OPAAT) in Malaysia. PLoS ONE. 2015;10:e0124553.
  16. Chan CY, Subramaniam S, Chin KY, Ima-Nirwana S, Muhammad N, Fairus A, et al. Knowledge, beliefs, dietary, and lifestyle practices related to bone health among middle-aged and elderly Chinese in Klang Valley, Malaysia. Int J Environ Res Public Health. 2019;16:1787.
  17. Kim TH, Lee YS, Byun DW, Jang S, Jeon DS, Lee HH. Evaluation of the osteoporosis health belief scale in Korean women. J Bone Metab. 2013;20:25–30.
  18. Chan CY, Subramaniam S, Chin KY, Ima-Nirwana S, Muhammad N, Fairus A, et al. Effect of a screening and education programme on knowledge, beliefs, and practices regarding osteoporosis among Malaysians. Int J Environ Res Public Health. 2022;19:6072.
  19. Cheou NY. Osteoporosis knowledge, health beliefs and calcium intake among UTAR students [undergraduate thesis]. Kampar: Universiti Tunku Abdul Rahman; 2021.
  20. Shahar S, Safii NS, Manaf ZA, Haron H. Atlas Makanan: Saiz Pertukaran & Porsi. 3rd ed. Kuala Lumpur: MDC Publishers, 2015.
  21. Leng LS, Ali A, Yusof H. Knowledge, attitude and practices towards osteoporosis prevention among adults in Kuala Lumpur, Malaysia. Malays J Nutr. 2017;23:279–90.
  22. Al-Muraikhi H, Said H, Selim N, Chehab MAH. The knowledge of osteoporosis risk factors and preventive practices among women of reproductive age in the state of Qatar: a cross-sectional survey. Int J Community Med Public Health. 2017;4:522-7.
  23. Mortada EM, EI Seifi OS, Abdo NM. Knowledge, health beliefs and osteoporosis preventive behaviour among women of reproductive age in Egypt. Malays J Med Health Sci. 2020;16:9–16.
  24. Chan CY, Subramaniam S, Chin KY, Ima-Nirwana S, Muhammad N, Fairus A, et al. Levels of knowledge, beliefs, and practices regarding osteoporosis and the associations with bone mineral density among populations more than 40 years old in Malaysia. Int J Environ Res Public Health. 2019;16:4115.
  25. des Bordes J, Prasad S, Pratt G, Suarez-Almazor ME, Lopez-Olivo MA. Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies. Plos One. 2020;15:e0227765.
  26. Endicott RD. Knowledge, health beliefs, and self-efficacy regarding osteoporosis in perimenopausal women. J Osteoporos. 2013;2013:853531.
  27. Ramli N, Rahman NAA, Haque M. Knowledge, attitude, and practice regarding osteoporosis among allied health sciences students in a public university in Malaysia. Erciyes Medical J. 2018;40:210–7.
  28. Nayak S, Roberts MS, Chang CCH, Greenspan SL. Health beliefs about osteoporosis and osteoporosis screening in older women and men. Health Educ J. 2010;69:267–76.
  29. Demirtaş-Madran HA. Accepting restrictions and compliance with recommended preventive behaviors for COVID-19: a discussion based on the key approaches and current research on fear appeals. Front Psychol. 2021;12:558437.
  30. Lucero KS, Chen P. What do reinforcement and confidence have to do with it? a systematic pathway analysis of knowledge, competence, confidence, and intention to change. J Eur CME. 2020;9:1834759.
  31. Blom V, Drake E, Kallings LV, Ekblom MM, Nooijen CFJ. The effects on self-efficacy, motivation and perceived barriers of an intervention targeting physical activity and sedentary behaviours in office workers: a cluster randomized control trial. BMC Public Health. 2021;21:1048.
  32. Inoue K, Sakamaki K, Komukai S, Ito Y, Goto A, Shinozaki T. Methodological tutorial series for epidemiological studies: confounder selection and sensitivity analyses to unmeasured confounding from epidemiological and statistical perspectives. J Epidemiol. 2025;35:3-10.
  33. Feeney T, Hartwig FP, Davies NM. How to use directed acyclic graphs: guide for clinical researchers. BMJ. 2025;388:e078226.
  34. Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, et al. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol. 2012;41:871–86.

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