Evaluation of Osteoporosis Awareness Among Post-Menopausal Women

This research proposal aims to evaluate the levels of osteoporosis awareness among post-menopausal women and explore their understanding of how diet and exercise influence osteoporosis. The research will identify associations between awareness and demographic characteristics and lifestyle factors. The goal is to enhance awareness and improve osteoporosis management among post-menopausal women.

Running head: RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
RESEARCH PROPOSAL: EVALUATION OF OSTEOPOROSIS AWARENESS
AMONG POST-MENOPAUSAL WOMEN
Name of the Student:
Name of the University:
Author note:

1RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Table of Contents
Introduction..........................................................................................................................2
Research Aims and Objectives............................................................................................9
Research Questions..............................................................................................................9
Research Methodology......................................................................................................10
Conclusion.........................................................................................................................12
References..........................................................................................................................13
Appendices........................................................................................................................18
Appendix 1: Proposed Costing (As designed by the Author)........................................18
Appendix 2: Proposed Timeframe (As designed by the Author)..................................18

2RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Introduction
As researched by Black and Rosen (2016), osteoporosis is a chronic disease condition
characterized by the emergence of fragility in the skeletal system. In accordance to the World
Health Organization, an individual is deemed to be diagnosed with osteoporosis if he or she is in
possession of a bone mass which is greater than 2.5 standard deviations below the recommended
meal values in adults (Zamaniet al. 2018).
As examined Zhang et al. (2016), type-2 osteoporosis is alternatively known as age-
associated or senile osteoporosis. With increasing age, hindrances in the equilibrium between
osteoblastic-associated bone modeling and osteoclastic-associated bone resorption processes are
observed. This results in simultaneous losses of rigid cortical and spongy trabecular bones.
According to Eastell et al. (2016), type 1 osteoporosis is also known as postmenopausal
osteoporosis. Such gender-associated chronic pathologies occurs due to reductions of estrogen.
Estrogen has been known to exert protective effects on osteoblasts responsible for bone
modelling
Hence, the following research proposal will outline the rationale and methodologies
underlying the evaluation of awareness among post-menopausal women concerning the role of
diet and physical activity in influencing osteoporosis symptoms and prevalence.
In accordance to the International Osteoporosis Foundation, osteoporosis affects a total of
200 million of the global population. Of this, 30% of the population at risk is distributed across
women in the post-menopausal stage, in Europe and United States. Lack of adequate treatment
will result in an increased susceptibility of vertebral and hip fractures in an estimated 40% of

3RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
such women (Cianferottiet al. 2015). Further, as per the National Health Service, osteoporosis
affects almost 3 million of the population of the United Kingdom, of which post-menopausal
women have been estimated to be a high risk group (Van der Veldeet al. 2017). Further,
according to the National Institute of Health and Clinical Excellence, lack of adequate awareness
and osteoporosis management further accounts for an alarming 75, 000 femoral fracture cases in
the United Kingdom and 12% women residing in additional European countries (Compston
2017). According to World Health Organization as well as the International Osteoporosis
Foundation, indicates three to four fold increase in susceptibilities of osteoporosis-associated
fractures in women worldwide. Osteoporosis affects 3.5 million in the United Kingdom, of
which, 21.8% comprise of women (Edwards 2017).
Hence the increased susceptibilities of osteoporosis and future possibilities of fractures
across women comprise the underlying background for the proposed research.
Authors Andreopoulou and Bockman (2015) researched that the of the key effects post
the menopausal stage in women is the reduction in estrogen, which has been documented to exert
protective effects on osteoblasts. These are osteoids responsible with the functions of bone
modeling, comprising of acquisition of serum calcium for the purpose of bone growth,
structuring and repair from minor fractures.
Hence, as researched by Eastwell and Szulc (2017), post menopause results in increased
activation of osteoclastic activity. This results in dissolution of bone calcium to counteract low
serum calcium levels. Menopause further results in loss of osteoblastic processes which results
in loss of cortical as well as trabecular bone among post-menopausal women. Hence, the above
chronic bone pathologies results in reduced bone mass, bone density, bone strength and bone

4RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
porosity, resulting in an increased risk of the acquisition of fractures among women in the post-
menopausal stage.
Recent research has also examined lack of awareness among post-menopausal concerning
osteoporosis. A survey conducted by Janiszweskaet al. (2016), among 292 osteoporotic women,
in the age group of 51 to 83 years, reported low levels of knowledge and awareness concerning
the assessment, treatment and underlying factors of risk underlying osteoporosis, even among
subjects undergoing examinations of bone densitometry. The study however, noted the presence
of increased osteoporotic knowledge and awareness among post-menopausal women with levels
of education. Increased knowledge was also noted in women residing in urbanized areas and in
possession of comfortable socioeconomic standards.
Similarly, an additional survey was undertaken by the Lewieckiet al. (2019) for the
evaluation of perceptions associated with risk of fractures couple with barriers concerning
diagnosing and treatment of osteoporosis among a total of 1012 women in the post-menopausal
stage. The authors obtained results indicating that only 45% women were aware of the
osteoporotic risk factors of fractures while 42% had underwent no form of osteoporotic
screening. Further, as observed by in the disease trends indicated by the disease trends reported
by the World Health Organization, the National Health Service and International Osteoporosis
Foundation, osteoporosis contributes to a total of 3.5 million cases and 75, 000 fractures in the
United Kingdom, of which, 21.8% include women in the post-menopausal stage.
Authors Park et al. (2017), identified the positive association between education
dissemination on the importance of diet and exercise and improvements in self-management of
osteoporosis. The collective contributions of dietary calcium and Vitamin D intake, coupled with
adequate exercise is notable in the prevention and management of osteoporosis – the levels of

5RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
which have been found to be low among post-menopausal women, due to prevalence of lack of
awareness. Hence, this rationale and importance of this research lies in the identification of
associations between dietary and exercise factors on osteoporosis awareness among women,
which may further pave the way for future health promotional activities aimed at enhancing
awareness among post-menopausal women.
Hence, the need of the hour is to generate sufficient levels of awareness among post-
menopausal women concerning the various risk factors and endocrinal pathophysiologies
associated with osteoporosis along with the treatment procedures. This can be utilized for the
purpose of ensuring positive health outcomes. However, as researched in the cross sectional
study by Langer et al. (2016), evaluation of existing levels of awareness among the high risk
group of post-menopausal women is of utmost importance. Hence, the endrocrinal associated
osteoporotic pathologies and high fracture susceptibility coupled with the need for identification
of the factors associated with osteoporotic awareness among post-menopausal women form the
underlying rationale of this research.
In a comparative study Authors Miyakoshi et al. (2017), researched that one of the
primary negative health consequences associated with osteoporosis, is the high prevalence of
fractures pertaining to the hips, thighs and vertebrae as a result of injuries, falls and poor bone
density. As reviewed by Pisaniet al. (2016), fractures associated with osteoporosis cause
hindrances to the mobility of the patient resulting in increased dependency and an inability to
perform daily life activities. Such consequences further result in self-perceptions of being a
burden. This is accompanied by a disinterest towards social engagement due to the associated
physical inabilities and deformities.

6RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Hence, evaluating the existing levels of awareness considering osteoporosis among post-
menopausal women, as stated in this research proposal, will pave the way for identification of
barriers which may serve as factors underlying an absence of or delayed assessment, diagnosis
and treatment. Identification of such factors will allow future health professionals to redirect
increased treatment and health promotional activities towards osteoporotic management among
post-menopausal women resulting in avoidance of the detrimental social and emotional
consequences (Sabesanet al. 2015).
Women belonging in the post-menopausal group pose to be a high risk group with
considerable vulnerabilities, comprising of a total of over 21.8% of the patients undergoing
osteoporotic associated fractures of the hip or vertebrae (Diaz-Perez et al. 2017). The Clinical
Guideline for the Prevention and Treatment of Osteoporosis published by the National
Osteoporosis Guideline Group (NOGG) in the year 2017, provides key recommendations,
guidelines and strategies for the assessment, treatment and lifestyle modifications of osteoporosis
(McCloskey et al. 2017).Similarly, the National Institute for Health and Clinical Excellence
(NICE)outlines primary treatment guidelines and medical interventions for the prevention of
fractures associated with osteoporosis in post-menopausal women. However, there still lies a
lack of considerable importance attached to the need for a multidisciplinary approach to
osteoporotic management. The pathologies outlining osteoporosis can be associated with a
multiple specialty model, encompassing geriatrics, endocrinology, orthopaedics, rheumatology,
obstetrics, metabolic medicine, gynaecology and general practice. Despite the theoretical
recognition of the same, existing medical curriculum associated with these specialties, is devoid
of training which would cover osteoporosis management (Gudmundssonet al. 2019). Likewise,
despite the prevalence of the NICE primary care guidelines, there is insufficient healthcare

7RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
policy information and guidelines for women who have not undergone complete treatment or are
in possession of osteoporosis as a comorbidity. Such lack of sufficient training and education
may be associated with the lack of awareness of the severity associated with osteoporosis in
post-menopausal women (Harvey et al. 2017). Hence, the following research proposal on
evaluation of osteoporosis awareness among post-menopausal can be beneficial in the legal
context since it may pave the way for identifications of barriers to treatment and possibilities of
improvement. This can further result in improved evidence based research, training and practice
of multidisciplinary health interventions for management of osteoporosis (Javaid and Mitchel;
2019).
The exploratory study conducted by Baba, Khan and Ali (2017), post-menopausal
women with a high risk of osteoporosis associated fractures lack awareness concerning the need
for screening. Lack of awareness was also observed concerning the possibilities of regaining or
mitigation their bone-related physiological issues with adequate dietary, lifestyle and assessment
procedures. Further, as researched by Flais et al. (2017), post-menopausal women with
osteoporotic symptoms have reported a lack of communication concerning the need for
osteoporosis screening. Timely screening coupled with physical activity and dietary
interventions have been implicated to mitigate the debilitating lifestyle effects of osteoporosis,
along with the susceptibility of fractures (Baccaroet al. 2015). Hence, the proposed research will
pose to be beneficial in the context of health. Not only will the proposed research reveal levels of
disease awareness among post-menopausal women, but will also result in key insights on the
possible contributors of participant demographics or additional factors. Such factors may act as
facilitators or barriers directed towards osteoporotic treatments. Such research results will further

8RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
prove to be advantageous by encouraging procedures with which existing osteoporosis health
interventions may be amended (Kaniset al. 2019).
Research Aims and Objectives
The aim of this research is to evaluate the levels of disease among post-menopausal
women by exploring their understanding of how diet and exercise influences osteoporosis.
Hence, the objectives of the research will include:
 To identify the level of osteoporosis awareness among post-menopausal women.
 To identify the presence of associations between levels of osteoporosis awareness and
demographic characteristics of the participants.
 To identify the presence of associations between levels of osteoporosis awareness and
lifestyle factors such as physical activity and diet among post-menopausal women.
 To explore the role of diet and physical activity in influencing osteoporosis among post
menopausal women.
Research Questions
1. What is the level of osteoporosis awareness among post-menopausal women concerning
the role of diet and physical activity as influencers of osteoporotic symptoms and
awareness?
2. What is the association between osteoporosis awareness and demographic characteristics
among post-menopausal women?
3. What is the association between osteoporosis awareness and lifestyle factors such as
physical activity and diet among post-menopausal women?

9RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Research Methodology – Primary Research
A primary research will be conducted which will involve collection of original data from
human subjects. The sample size will comprise of women in the post menopausal age (45 to 60
years of age). The sample size for the primary research will be recruited hence, using purposive
sampling methods and from the locality or the local community health center. For the purpose of
osteoporosis awareness evaluation along with assessment of demographic characteristics, diet
and exercise among post-menopausal women, a qualitative research will be undertaken, which
will involve face to face interviews using a questionnaire. The interview questions on
osteoporosis awareness will be adopted from a valid and ethically approved questionnaire, that is
the one used in the analytical and descriptive study by Alharthiet al. (2017). The role of diet as
well as awareness will be assessed using dietary recalls. Physical activity levels will be assessed
using the Global Physical Activity Questionnaire formulated by the World Health Organization
(Chu et al. 2015).
For the following proposed research, a primary research was favored since this form of
methodology and data collections allows improved data control over data interpretation where
researchers can evaluate data considering their requirements instead of relying on interpretations
made my other authors. Primary data is advantageous since it allows collection of relatively
recent and accurate data where authors can choose participants based exactly on their desired
study scenario or participant characteristics (that is, post-menopausal women, after the ages of 40
years) (McCusker and Gunaydin 2015)
Qualitative methods such as interviews were selected for the study due to their ability to
obtain in depth, subjective information on the emotions, needs, opinions and preferences of
participants, which may be otherwise absent in quantitative data relying completely on

10RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
quantifiable and limited objective information (Rahman, 2017). Interviews with open ended
questions are advantageous since they enhance participant comfort and expression of
information, resulting in improved data collection quality(Edley and Litosseliti2018). As
researched by Couper, Antoun and Mavletova (2017), questionnaire data collection methods are
beneficial since these allow cost effective collection of measurable and interpretable data in a
short amount of time.
Hence, a primary research comprising of usage of interviews is justified since it will
provide an in-depth, accurate and participant-centered insight on the actual levels of awareness
concerning osteoporosis among post-menopausal women. A primary research will also reveal
how participant demographic characteristics and habits of diet and exercise may contribute to the
awareness, treatment and management of the same (McCusker and Gunaydin, 2015)
As researched by Rocca-Serraet al. (2016), one of the primary limitations associated with
primary research is the associated financial and time constraints. This is due to the direct
involvement of the research to design and perform every aspect of the research by himself or
herself. Hence, to address these limitations, a proposed timeframe will be designed by the
researcher to aid in appropriate time management and utilization. Likewise, the researcher must
address the accurate requirement of funding which can be obtained from notable academic
institutions (Cherney et al. 2015).
As researched by Alonso and Moscoso (2017), interview usage of data collection is often
susceptibility to obtaining incorrect results, due to social desirability resulting in participants
giving dishonest responses. Likewise, participants often drift off and provide responses
inconclusive to the topic. Hence, as observed by Peters and Halcomb (2015), the researcher must
establish a rapport with the participant to prevent bias. The research must patiently directing the

11RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
participant to speak in relation to the research question. Researchers must also exercise ethical
responsibilities of not exercising personal bias while interviewing participants (Wolgemuth et al.
2015).
Likewise, authors Pasicket al. (2016), examined that interview questionnaire responses
may also project the limitation of social desirability, in response to which, the researcher must
engage in gentle persuasion by encouraging the subject to answer as honestly as possible,
coupled with additional provision of financial resources to the participants if required.
Conclusion
Hence, it can be concluded that, the evaluation of the awareness concerning osteoporosis
among post-menopausal women will prove to be beneficial. A primary research method will be
adopted which will incorporate qualitative data collection using interviews and questionnaires.
Such methodologies will prove to be beneficial in terms of research currency and accuracy,
along with presenting limitations in the form of financial and time constraints coupled with
possible bias. Researchers must aim to establish participant rapport, adhere to research ethics and
formulate a research structure to remove such limitations.

12RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
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15RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
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18RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Appendices
Appendix 1: Proposed Costing (As designed by the Author)
Description Cost (£)
Incentives for Participants 20 per person, hence, 2000 for an estimated
total of 100 participants
Questionnaires (Osteoporosis Awareness, Food
Frequency Questionnaire, Global Physical
Activity Questionnaire)
25 for each questionnaire, hence, 75 for three
questionnaires - to be distributed online
Incentives for Volunteers involved in Data
Collection and Information
20 per volunteer, hence, 100 for an estimated
total of 5 volunteers
Software resources for Data Analysis
Interpretation
132
Total: £2307
Appendix 2: Proposed Timeframe (As designed by the Author)
Tasks 1st to 3rd
week
4th to 10th
week
11th to
13th
week
14th to
17th
week
18th to
21st week
22nd to
23rd
week
24th
week
Topic
selection 

19RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Collection of
Secondary
Research
Sources
 
Research
framework
creation
 
Collection of
Primary Data  
Data
interpretation
and Analysis
 
Data
findings  
Conclusion

Draft
Formation  

20RESEARCH PROPOSAL: POST-MENOPAUSAL OSTEOPOROSIS
Complete
work
submission
