Abstract
This study assessed the knowledge, attitude, and practices (KAP) regarding osteoporosis and hip fracture among older adults in Ningxia, China, to inform better prevention and management strategies through patient education and lifestyle changes. This cross-sectional study surveyed older adults at Ningxia Hui Autonomous Region People’s Hospital (Sep 2022–Nov 2023) using a convenience sampling method, collecting demographic data and assessing KAP scores. Structural equation modeling (SEM) analyzed relationships between KAP and demographics. The analysis included 522 (99.4%) valid questionnaires. The mean knowledge, attitude, and practice scores were 22.66 ± 4.29 (/30, 75.53%), the mean attitude score was 43.13 ± 4.54 (/60, 71.88%), and the mean practice score was 57.15 ± 10.24 (/80, 71.44%), indicating sufficient knowledge, positive attitude, and proactive practice. In the SEM, knowledge was associated with income (β = 1.01, P < 0.001), frequency of fall prevention (β=-0.55, P < 0.001), residence (β = 0.97, P = 0.030), and falls in the past year (β = 0.76, P = 0.017). Attitude was associated with knowledge (β = 0.21, P < 0.001) and alcohol (β=-1.26, P < 0.001). Practice was associated with attitude (β = 1.09, P < 0.001), frequency of fall prevention (β=-1.86, P < 0.001), and use of anti-osteoporosis drugs (β = 2.63, P < 0.001). Older adults in Ningxia demonstrated generally good KAP toward osteoporosis and hip fracture; however, targeted educational interventions addressing specific knowledge gaps may help further improve preventive practices and support behavior change.
Similar content being viewed by others
Data availability
All data generated or analyzed during this study are included in this article and supplementary information files.
References
Camacho, P. M. et al. American association of clinical Endocrinologists/American college of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal Osteoporosis-2020 update. Endocr. Pract. 26, 1–46 (2020).
Watts, N. B. et al. Osteoporosis in men: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 97, 1802–1822 (2012).
LeBoff, M. S. et al. The clinician’s guide to prevention and treatment of osteoporosis. Osteoporos. Int. 33, 2049–2102 (2022).
Looker, A. C., Isfahani, S., Fan, N. & Shepherd, B. Trends in osteoporosis and low bone mass in older US adults, 2005–2006 through 2013–2014. Osteoporos. Int. 28, 1979–1988 (2017).
Wright, N. C., Saag, K. G., Dawson-Hughes, B., Khosla, S. & Siris, E. S. The impact of the new National bone health alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA. Osteoporos. Int. 28, 1225–1232 (2017).
Ensrud, K. E. et al. Implications of expanding indications for drug treatment to prevent fracture in older men in united states: cross sectional and longitudinal analysis of prospective cohort study. BMJ 349, g4120 (2014).
Salari, N. et al. Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis. J. Orthop. Surg. Res. 16, 669 (2021).
Zheng, M. et al. Differences in the prevalence and risk factors of osteoporosis in Chinese urban and rural regions: a cross-sectional study. BMC Musculoskelet. Disord. 24, 46 (2023).
Eastell, R. et al. Pharmacological management of osteoporosis in postmenopausal women: an endocrine Society* clinical practice guideline. J. Clin. Endocrinol. Metab. 104, 1595–1622 (2019).
Adler, R. A. Osteoporosis in men: a review. Bone Res. 2, 14001 (2014).
Gennari, L. & Bilezikian, J. P. New and developing pharmacotherapy for osteoporosis in men. Expert Opin. Pharmacother. 19, 253–264 (2018).
Florschutz, A. V., Langford, J. R., Haidukewych, G. J. & Koval, K. J. Femoral neck fractures: current management. J. Orthop. Trauma. 29, 121–129 (2015).
Sheehan, S. E., Shyu, J. Y., Weaver, M. J., Sodickson, A. D. & Khurana, B. Proximal femoral fractures: what the orthopedic surgeon wants to know. Radiographics 35, 1563–1584 (2015).
Sheng, B., Li, X., Nussler, A. K. & Zhu, S. The relationship between healthy lifestyles and bone health: A narrative review. Med. (Baltim). 100, e24684 (2021).
Andrade, C., Menon, V., Ameen, S. & Kumar Praharaj, S. Designing and conducting Knowledge, Attitude, and practice surveys in psychiatry: practical guidance. Indian J. Psychol. Med. 42, 478–481 (2020).
World Health Organization. Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice surveys. http://whqlibdoc.who.int/publications/2008/9789241596176_eng.pdf. Accessed November 22, 20222008.
Nohra, J., Sacre, Y., Abdel-Nour, A. & Mannan, H. Evaluation of Knowledge, Attitudes, and Practices Related to Osteoporosis and Correlates of Perceived High Risk among People Living in Two Main Districts of Lebanon. J Osteoporos. 2022, 1188482. (2022).
Khan, Y. H., Sharriff, A., Khan, A. H., Mallhi, T. H. & Knowledge Attitude and practice (KAP) survey of osteoporosis among students of a tertiary institution in Malaysia. Trop. J. Pharm. Res. 13, 155–162 (2014).
Tay, C. L., Ng, W. L., Beh, H. C., Lim, W. C. & Hussin, N. Screening and management of osteoporosis: a survey of knowledge, attitude and practice among primary care physicians in Malaysia. Arch. Osteoporos. 17, 72 (2022).
Chan, C. Y. 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 16, (2019).
Ahmed, S. et al. Assessing the knowledge, attitude and practice of osteoporosis among Pakistani women: A National social-media based survey. PLoS One. 18, e0288057 (2023).
Al-Hemyari, S. S., Jairoun, A. A., Jairoun, M. A., Metwali, Z. & Maumoun, N. Assessment of knowledge, attitude and practice (KAP) of osteoporosis and its predictors among university students: cross sectional study. UAE J Adv. Pharm. Educ. Res. 8, 43–48 (2018).
Alani, Q. et al. Knowledge, Attitude, and practices towards osteoporosis among adults in the united Arab Emirates (UAE) in 2023. Cureus 16, e56084 (2024).
Xu, P., Zhao, N. & Wang, J. Knowledge, attitude, and practice toward osteoporosis among patients with chronic kidney disease in Zhejiang. Med. (Baltim). 103, e38153 (2024).
Wu, Y. et al. Attitudes, and practices of patients with knee osteoarthritis regarding osteoporosis and its prevention: A Cross-Sectional study in China. Int. J. Gen. Med. 17, 3699–3709 (2024).
Ran, J., Yang, X., Li, S. & Peng, W. A. Systematic review of research Tools, research status and improvement measures for osteoporosis awareness in Chinese and international. Int. J. Gen. Med. 18, 801–813 (2025).
Chandran, M. et al. Development of the Asia Pacific consortium on osteoporosis (APCO) framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region. Osteoporos. Int. 32, 1249–1275 (2021).
Cheng, X. et al. Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density. Quant. Imaging Med. Surg. 10, 2066–2077 (2020).
Xie, Y. M. et al. [Clinical practice guideline for postmenopausal osteoporosis with traditional Chinese medicine]. Zhongguo Zhong Yao Za Zhi. 46, 5992–5998 (2021).
Svendsen, M. T. et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large National population-based survey among Danish adults. BMC Public. Health. 20, 565 (2020).
Clemens, K. K. et al. Hip fractures in older adults in Ontario, Canada-Monthly Variation, Insights, and implications. Can. Geriatr. J. 22, 148–164 (2019).
Azevedo, D. C. et al. G. Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study. Adv. Rheumatol. 64, 8 (2024).
Beran, T. N. & Violato, C. Structural equation modeling in medical research: a primer. BMC Res. Notes. 3, 267 (2010).
Fan, Y., Chen, J. & Shirkey, G. Applications of structural equation modeling (SEM) in ecological studies: an updated review. Ecol. Process. 5, 19 (2016).
Kline, R. B. Principles and Practice of Structural Equation Modeling (Fifth Edition) (The Guilford Press, 2023).
Bergen, N. & Labonte, R. Everything is Perfect, and we have no problems: detecting and limiting social desirability bias in qualitative research. Qual. Health Res. 30, 783–792 (2020).
Latkin, C. A., Edwards, C., Davey-Rothwell, M. A. & Tobin, K. E. The relationship between social desirability bias and self-reports of health, substance use, and social network factors among urban substance users in Baltimore, Maryland. Addict. Behav. 73, 133–136 (2017).
Funding
This study was supported by the Ningxia Hui Autonomous Region’s Key R&D Program for Foreign Scientific and Technological Cooperation Projects (2022BFH02010).
Author information
Authors and Affiliations
Contributions
Feng Ma, Zhaofu Wang, Xiaohai Luo, Ning Wu, and Xiaolin Ma carried out the studies, participated in collecting data, and drafted the manuscript. Feng Ma, Yanjun Hu, and Bin Yu performed the statistical analysis and participated in its design. Feng Ma and Zhaofu Wang participated in the acquisition, analysis, or interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
This work has been carried out in accordance with the Declaration of Helsinki (2000) of the World Medical Association. This study was approved by the Medical Ethics Committee of Ningxia Hui Autonomous Region People’s Hospital ([2021]-ZDYF-020), and all participants provided written informed consent.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Ma, F., Wang, Z., Luo, X. et al. Knowledge, attitude, and practice of osteoporosis and hip fracture in older Chinese adults. Sci Rep (2026). https://doi.org/10.1038/s41598-026-35046-y
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-35046-y
