The osteoporosis knowledge, belief and calcium intake behaviour among students in a medical sciences university

  • Wan Ling Chiang


Objective: This study determines the association between osteoporosis knowledge, health belief and calcium intake behaviour among students in a medical sciences university.Methods: This study was conducted using cross sectional design. Malaysian students, aged 18 to 40 were selected using stratified randomisation method. The osteoporosis knowledge, health belief and calcium intake behaviour of participants were obtained through a validated questionnaire.Results: The response rate of the study was 93.0% (n=333). More than 80% of participants had been exposed to information related to osteoporosis knowledge and calcium-rich foods. The mean score of osteoporosis knowledge test (OKT)= 50.46.48, perceived susceptibility= 14.2±4.02, perceived seriousness= 20.4±4.67, perceived benefits of calcium= 23.1±3.94, perceived barriers to calcium= 14.4±3.99 and health motivation= 21.6±3.79. Only 37.8% of participants consumed adequate dairy products. There were significant correlations between OKT and perceived benefits of calcium (r=0.127, p=0.020), perceived barriers to calcium (r=-0.208, p<0.001) and health motivation (r=0.173, p=0.002). Perceived seriousness to osteoporosis, health motivation and OKT significantly predicted intake of dairy products (p<0.001). Discussion: The osteoporosis knowledge was moderate, health belief was moderate and consumption of dairy products was low. The osteoporosis knowledge and health belief were correlated but not the behaviour of dairy products consumption.Conclusion: Young adults had moderate osteoporosis knowledge and consumption of dairy products was low. Future educational programme should focus on osteoporosis knowledge, health belief as well as determining factors that influence behaviour of consumption of dairy products.Keywords: Osteoporosis knowledge - Osteoporosis health belief - Consumption of dairy products - Young adults


World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group [Internet]. Technical Report Series 843. Geneva: WHO; 1994 [Cited 2017 November 14]. Available from:

Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int [Internet]. 2006 [Cited 2017 November 15];17(11): 897-902. Available from:

Lim PS, Ong FB, Adeeb N, Seri SS, Noor-Aini MY, Shamsuddin K, Hapizah N, Mohamed AL, Mokhtar A, Wan HW. Bone health in urban midlife Malaysian women: risk factors and prevention. Osteoporos Int [Internet]. 2005 [Cited 2017 November 14];16(12): 2069–2079. Available from:

Kim J, Lee E, Kim S, Lee TJ. Economic burden of osteoporotic fracture of the elderly in South Korea: A national survey. Value in Health Regional Issues [Internet]. 2015 [Cited 2019 March 18];9C(2016): 36–41. Available from:

Lee JK, Khir ASM. The incidence of hip fracture in Malaysians above 50 years of age: variation in different ethnic groups. APLAR J Rheumatol [Internet]. 2007 [Cited 2017 November 8];10: 300-305. Available from:

National Coordinating Committee on Food and Nutrition. Recommended nutrient intakes for Malaysia, a report of the technical working group on nutritional guidelines [Internet]. Putrajaya: Ministry of Health; 2017 [Cited 2017 November 6]. Available from:

Institute for Public Health. National Health and Morbidity Survey 2014: Malaysian Adult Nutrition Survey (MANS) Vol. II: Survey findings [Internet]. Kuala Lumpur: National Institutes of Health, Ministry of Health; 2014 [Cited 2017 November 15]. Available from:

Chan SP, Scott BB, Sen SS. An Asian viewpoint on the use of vitamin D and calcium in osteoporosis treatment: physician and patient attitudes and beliefs. BMC Musculoskelet Disorder [Internet]. 2010 [Cited 2017 October 24];11: 248. Available from:

MyHEALTH. Malaysian food pyramid [Internet]. Putrajaya: Health Online Unit, Ministry of Health Malaysia; 2017 [Cited 2018 January 16]. Available from:

Gendler PE, Coviak CP, Martin JT, Kim KK, Dankers JK, Barclay JM, Sanchez TA. Revision of the osteoporosis knowledge test: Reliability and validity. West J Nurs Res [Internet]. 2015 [Cited 2017 November 15];37: 1623‑43. Available from:

Nguyen VH, Wang Z. Osteoporosis knowledge of students in relevant healthcare academic programs. J Osteoporos [Internet]. 2012 [Cited 2019 January 7];2012: 383412. Available from:

Sharifi N, Majlessi F. Self-empowerment of female students in prevention of osteoporosis. Global Journal of Health Science [Internet]. 2016 [Cited 2019 January 15];9(2): 7-14. Available from:

Kim KK, Horan ML, Gendler P, Patel MK. Development and evaluation of the osteoporosis health belief scale. Research in Nursing & Health [Internet]. 1991 [Cited 2017 November 18];14(2): 155–163. Available from:

Sham F, Shdaifat E, Majid N, Khairudin F, Zainol N, Majid S. Knowledge and perception of calcium intake among students in University Technology MARA, International Journal of Public Health Research [Internet]. 2013 [Cited 2017 November 6];3(2): 370-375. Available from:

Edmonds E, Turner LW, Usdan SL. Osteoporosis knowledge, beliefs, and calcium intake of college students: Utilization of the health belief model. Open J Prev Med [Internet]. 2012 [Cited 2017 November 20];2(1): 27-34. Available from:

Kasper MJ, Garber M, Walsdorf K. Young women's knowledge and beliefs about osteoporosis: Results from a cross-sectional survey of college females. American Journal of Health Education [Internet]. 2007 [Cited 2018 December 20];38(4): 186-193. Available from:

Elnaem M H, Jamshed SQ, Elkalmi RM, Baharuddin MF, Johari MA, Abdul Aziz NA, Ahmad Sabri SF, Ismail NA. Osteoporosis knowledge among future healthcare practitioners: Findings from a Malaysian public university. J Pharm Bioallied Sci [Internet]. 2017 [Cited 2018 December 16];9(2): 115–120. Available from: file:///E:/MSc/Articles/New%20folder%20(2)/Elnaem%202017.pdf

Folasire OF, Eyitayo VA. Calcium knowledge and consumption pattern of calcium-rich foods among female university students in south-west Nigeria. Journal of Food and Nutrition Research [Internet]. 2017 [Cited 2019 January 15];5(5): 347-353. Available from:

Hazavehei SM, Taghdisi MH, Saidi M. Application of the health belief model for osteoporosis prevention among middle school girl students, Garmsar, Iran. Education for Health [Internet]. 2007 [Cited 2017 November 15];20: 1. Available from:

Laslett LL, McNeil JD, Lynch J. Patient education – the forgotten link in managing osteoporosis. Australian Family Physician [Internet]. 2004 [Cited 2018 December 16];33(3): 121-124. Available from:

Drozdzowska B, Pluskiewicz W, Skiba M. Knowledge about osteoporosis in a cohort of Polish females: the influence of age, level of education and personal experiences. Osteoporos Int [Internet]. 2004 [Cited 2018 December 16];15:645–648. Available from:

Marcinow ML, Randall Simpson JA, Whiting SJ, Jung ME, Buchholz AC. Young adults’ perceptions of calcium intake and health: A qualitative study. Health Educ. Behav [Internet]. 2017 [Cited 2019 January 7];44: 898–906. Available from:

Cadarette SM, Beaton DE, Hawker GA. Osteoporosis health belief scale: minor changes were required after telephone administration among women. Journal of Clinical Epidemiology [Internet]. 2004 [Cited 2017 November 19];57(2): 154–166. Available from:

Doheny MO, Sedlak CA, Estok PJ, Zeller R. Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older. Orthopaedic Nursing [Internet]. 2007 [Cited 2017 November 19];26(4): 243–250. Available from:

Endicott RD. Knowledge, health beliefs, and self-efficacy regarding osteoporosis in perimenopausal women. Journal of Osteoporosis [Internet]. 2013 [2019 January 14];2013: 853531. Available from:

Tastan S, Ayhan H, Unver V, Demiralp M, Iyigun E. Osteoporosis-related risk factors and health beliefs of women who are first-degree relatives of Turkish nursing students. International Journal of Caring Sciences [Internet]. 2017 [Cited 2019 January 7];10(2): 1021-1030. Available from:

Ford MA, Bass M, Zhao Y, Bai JB, Zhao Y. Osteoporosis knowledge, self-efficacy, and beliefs among college students in the USA and China. J Osteoporos [Internet]. 2011 [Cited 2017 October 25];2011(1): 729219. Available from:

De Silva REE, Haniffa MR, Gunathillaka KDK, Atukorala I, Fernando EDPS, Perera WLSP. A descriptive study of knowledge, beliefs and practices regarding osteoporosis among female medical school entrants in Sri Lanka. Asia Pacific Family Medicine [Internet]. 2014 [Cited 2017 November 20];13(1): 15. Available from:

Vahidafagh M. Relationships between osteoporosis health belief, self-efficacy and knowledge, calcium intake and physical activity with bone health status among undergraduates at Universiti Putra Malaysia [Internet]. Universiti Putra Malaysia; 2012 [Cited 2017 November 20]. Available from: