Osteoporosis is well-known as a common illness and easily found in elderly population,[1] and osteoporotic fractures are tagged with decreased activity, reduced quality of life and excess mortality.[234] Osteoporosis could be treated by several interventions, and osteoporotic fractures could be prevented with osteoporosis treatment.[567] Several international guidelines have recommended osteoporosis treatment for elderly patients.[8910] However, the gaps between the treatment guideline and real treatment situation need to be considered, and low compliance is additionally problematic especially in asymptomatic, chronic conditions like osteoporosis.[11121314]

Among the several factors, well-knowingly associated with low compliance, lack of awareness on osteoporosis has been issued to overcome the gap between guideline and real practice.[131415] Knowledge and awareness of the health care provider could improve the level of awareness in patients with osteoporosis.[15]

Nurses can be considered as forefront healthcare providers who have widely open chances to communicate with osteoporotic patients. Nurses have a pivotal role to initiate as well as impart primary and secondary osteoporosis prevention education to patients and general populations. Thus, educating them with better knowledge as a healthcare provider might be fundamental element. However, little information is available concerning the knowledge of the nursing professionals for osteoporosis.

Recently, Facts on Osteoporosis Quiz (FOOQ) questionnaire is presented to assess knowledge of osteoporosis and it has been used in several studies due to its proven validity and reliability.[161718]

The purpose of this study is to evaluate the nurses' knowledge on osteoporosis using FOOQ questionnaire. Our study will provide an evidence to educate healthcare provider about the knowledge of osteoporosis.

In April 2017, we conducted a descriptive self-reported questionnaire survey of nurses who participated in a musculoskeletal Symposium that was held for nurses at Seongnam in South Korea.

To evaluate the knowledge of osteoporosis, all 165 registrants at the symposium were asked to answer a self-administered questionnaire, modified FOOQ before symposium.

FOOQ was based on the osteoporosis consensus conference of the National Institutes of Health (NIH) in 2000 [19] and consisted of 20 true and false questions. It has been reported to have a satisfactory validity and reliability.[19] And it has been used to assess knowledge of osteoporosis in previous studies.[161718] We modified 2 (item 10 and 15) among the 20 items, according to recent epidemiologic studies from Korean and recommendation by Korean Society for Bone and Mineral Research.[120] In modified item 10, the residual lifetime risk of osteoporotic fractures was about 60% in Korean women older than 50 years.[1] In modified item 15, the recommendation of daily calcium intake was 1,200 mg/day for the Korean population.[121]

They were assured of confidentiality and anonymity. To ensure this, the participants were not asked to provide any identifying information except the type of institution they worked in.

Demographic characteristics and scores on the FOOQ were summarized using descriptive summary measures. The design and protocol of this study were waived by the Institutional Review Board.

A total 67 of the 165 nurses completed the questionnaires (Table 1). A response rate was 40.6%.

Among 67, 88.6% was worked in the tertiary referral hospital. The mean age of respondents was 33.0 years (range, 24–58).

The majority of participants knew that there are many ways to prevent osteoporosis, osteoporosis affects both men and women, low intake of calcium and vitamin D increase the risk of osteoporosis, and high caffeine combined with low calcium intake increases the risk of osteoporosis. Ninety-seven percent of respondents were aware that bone loss speeds up after menopause and 94.0% knew that smoking increases the risk of osteoporosis.

The true statement that “lower weight women have osteoporosis more than heavy women” (item 4) was correctly identified by just 32 (47.8%) respondent.

The false statement that “walking has a great impact on bone health” (item 14) was correctly identified by only one (1.5%) respondent, with 95.5% (n=64) incorrectly identifying the statement as true. However, 80.6% (n=54) of participants knew that “high impact (weight training) exercise improves bone health” (item 2).

The false statement that “children 9 to 17 years of age get enough calcium from one glass of milk each day to prevent osteoporosis” (item 19) was correctly identified by just 22 (32.8%) respondent.

No respondent scored 100% on the quiz. The scores ranged from 8 to 16 out of a total score of 20. The mean score was 12.7±1.7, as shown in Table 1.

Our result presented the level of knowledge on osteoporosis in nurses.

Although many participants answered correctly in question about the osteoporosis, the most responders did not correctly answer in the three items as previously specified (items 4, 14 and 19), which were statements about the effect of weight, physical exercise, and calcium intake during adolescence on osteoporosis (Fig. 1).

Original FOOQ including 25 items was developed to evaluate the knowledge of osteoporosis in patients or general population. On the other hand, the modified FOOQ consisted of 20 true and false questions, based on the 2000 NIH osteoporosis consensus conference.[19]

Previous studies using FOOQ reported that most physicians, another healthcare provider rather than nurses, did not answer correctly in item 14 (“walking has a great impact on bone health”).[20]

By the 2000 NIH osteoporosis consensus conference, among exercise, only resistance and high-impact activities have been indicated to contribute to establishment of high peak bone mass.[19] Just walking is not enough to improve a bone health, and it was revealed to be promoted at an educational program for healthcare provider. Healthcare provider might pretend to underestimate the efficacy of exercise for osteoporosis in their practice, and try to administrate just medication.

The exercise field for osteoporosis was revealed to be promoted at an educational program for healthcare provider.[18]

In terms of weight effect on osteoporosis, the study conducted in Singapore presented that 46.4% of Singapore nurses answered correctly in item 4. Although we cannot directly compare the mean score, because of different survey protocol and participants, their mean score (14.6±2.6) was higher than that (12.7±1.7) of our respondents.[16]

Our study has some limitations. First, we applied FOOQ for the general population to nurses. However, there was no validated questionnaire for clinicians, and modified FOOQ seems to be sufficient because we could find items with inadequate understanding by nurses. Second, there might be selection bias of participants, because almost worded in tertiary referral hospital. It may fail to represent all nurses at each level of medical institution.

In conclusion, our study showed the level of knowledge on osteoporosis in nurses, and that the effect of physical exercise should be focused in an educational program on osteoporosis for healthcare provider.