Introduction

Osteoporosis (OP) is a skeletal disease, characterized by structural deterioration of bone tissue and low bone mass leading to bone fragility and increased susceptibility to fractures (1). It is one of the major public health problems and its influence on the risk of fragility fracture; may significantly affect life expectancy and quality of life. It can be prevented with appropriate lifestyle and sometimes medication; and in patients with OP, treatment may involve lifestyle changes, preventive measures against falls and appropriate medications. Health care providers need to determine the population’s awareness and knowledge of OP to plan effective education programs (2).There are several studies about awareness and knowledge of OP in different countries and various populations, but to our knowledge there are no studies among medical students (3,4). In most studies, there is a significant relationship between knowledge and educational level; increased knowledge of OP was correlated with a higher level of education and there are different results for the sources of knowledge about OP (5-7). The aim of this study is to evaluate the knowledge of OP and the sources of information about the disease among English preparatory, first and second year’s medical students; and the effect of the medical training on their awareness about the OP.

Results

Two hundred twenty seven students (mean age=19.88 ± 1.36 years) were asked if they knew OP. The majority of the students (94.7%, n=215) reported that they were familiar with OP. These participants were divided to 3 groups according to their educational status. There was no significant difference between the groups regarding the question about the familiarity with OP. (p=0.06). The same questionnaire was applied to all of the groups. 94.4% (n=203) of the subjects thought that OP was a serious health problem, 87.4% (n=188) believed that OP was a preventable disease. There was no significant difference between the groups about these questions (respectively p=0.517, p=0.108) (Table 1). For the question about the population in which OP is seen, participants in group 2 and group 3 gave more correct answers (women, man and children) than group 1 (p=0.035) (Table 1). The sources of knowledge about OP are summarized in table 1. There was a significant difference between the groups for reporting the menopause (p=0.001), older age (p=0.004), estrogen deficiency (p=0.001) and the drugs (p=0.002) as the causes of OP. The difference between the groups is shown in fig. 1.The answers of the students about the diagnostic methods of OP are shown in table 1. There was a significant difference between the groups for reporting the clinical findings (p=0.001) and conventional radiography (p=0.007) as diagnostic methods. The difference between the groups is shown in fig. 2. The treatment options of OP were reported as one or more of the following: medical treatment (86%), exercise (65.6%), exposure to sunshine (51.6%) and others (19.5%). There was a significant difference between the groups regarding the treatment options (medical treatment p=0.001, exercises p=0.008, exposure to sunshine p=0.015, others p=0.021) (Table 1).With regard to sources of knowledge, 63.7% of students reported television, 57.2% newspapers, 43.3% health professionals, 22.8% friends and 28.8% others as the main sources of knowledge. For reporting the health professionals as source of information there was a significant difference between the groups (p=0.001) (Table 1). The difference between the groups is shown in fig. 3.

Discussion

There are few studies about awareness and knowledge of OP among college students, but to the best our knowledge there is no study among medical students (8-11). University students represent a better-educated section of the society and especially medical students, who will work for public health, have the potential to become role models for the society. In the present study, the knowledge of OP and the sources of information about disease among EP, first and second year’s medical students; and the effect of the medical training on their awareness about the OP have been revealed. EP does not have any medical lecture. At the first and second years of the faculty of medicine there are lectures about bone structure and bone metabolism, but not about OP. So this study was carried out among the medical students who have not been educated about OP yet.Different results between 54% and 96% are reported among the general public in community-based studies about the awareness and knowledge (2,3,4,5). In two different studies among college students these percentages were between 84% and 90% (8,9,10). On the other hand, in the study among Asian and Asian-American college students, only 11% of students had answered 75% of OP fact questions correctly (9). In the current study it was found that 94.5% of medical students had known OP.In the study among college women by Kasper et al (10), the students had believed that OP is less serious than other common causes of morbidity and mortality in women, such as heart disease and breast cancer. Nguyen et al (9) reported that 38% of college students had attributed OP to fate, chance or luck and 42% had said menopause was a natural occurrence for which pharmacologic treatment should not be administered. In our study most of the participants (94.4%) thought that OP is a serious health problem.Although OP has long been considered a special problem for women, it is also an important clinical issue for men. Idiopathic OP occurs in children or young adults of both sexes. Riberio et al (15) concluded that it was a common misconception that OP was a disease limited to women. In a study by Cummings and Mellton (16), only 59% of women had realized that men also experience loss of bone density as they age. Similarly, in our study approximately half of the students (54.4%) believed that OP is seen only in women. Although 25.1% of students knew that OP is seen in both sex and children, the proportion was quite low. But in detail, correct answer proportion was higher in upper class students.The National Institutes of Health (NIH) has released predictors of low bone mass (17). In recent studies specifically inadequate dietary calcium-vitamin D intake, menopause, menstrual irregularities, family history and lack of exercise were defined by the participants as the more prevalent risk factors (2,3,4,5,6,7,8,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18). In present study, the more probable causes of OP were inadequate dietary calcium and vitamin D intake, following by older age, menopause, inadequate exposure to sunshine and estrogen deficiency. Genetics, drugs, fracture history and others as the causes of OP, were the least important. Increased knowledge about the causes of OP (especially menopause, older age, estrogen deficiency, drugs) was significantly different between the groups. Currently, dual X-ray absorptiometry (DXA) is one of the most widely used techniques for bone mineral density measurement in the evaluation of OP (19). In this study, according to all groups DXA was the most common diagnostic method for OP. It seems that their knowledge about DXA is not related to medical education. Reporting clinical findings and conventional radiography as diagnostic modalities for OP was more frequent in first and second year medical students when compare with EP students.There are many studies which have different results about the sources of OP knowledge. Garton et al (20) found that most women had heard about OP (84%) usually from women’s magazines or friends; family practitioners and hospital doctors were the least important source of information about this subject. Conversely, in two different studies it was reported that participants had been informed by their doctors (5,6,7,8,9,10,11,12,13,14). In another study, 55% of women had reported television as the main source of knowledge (2). In our study, more than half of the students reported television as the main source of OP knowledge, followed by newspapers, health professionals and friends. This can be explained by the popularity of television among young adults. Continuous long term health promotion strategies directed toward both physicians and the general population, appear to increase awareness about OP in women and/or in the medical community (21). Therefore health education messages given via television should be designed carefully. For the first and second year’s students, health professionals also play an important role as sources of knowledge about OP. These findings are probably due to increasing communication between the health professionals and medical students with the beginning of medical education. Previous reports indicated that there is positive correlation between OP knowledge and educational level (2,3,4,5,3,4,5,6). Although educational levels of students in our study were not so different, there were significant differences between the groups regarding the causes of OP, the population in which OP is seen, diagnostic methods and treatment options. On the other hand the participants have a quite good amount of knowledge about OP and the main source of this knowledge seems to be television and newspapers. Broadcast matters such as television and newspaper may play an important role to increase the public and medical students’ awareness of OP. So the content and frequency of the tasks about OP in the broadcast matters should be appropriately designed.