1- Needs assessment of the community which supports the importance of the hypothetical health promotion program.
A- Osteoporosis is divided into two groups:
- Primary osteoporosis:
It is caused by excessive bone loss through aging, menopause, and negative effects of lifestyle factors like smoking, alcohol, diet and lack of physical activity.
- Secondary osteoporosis:
It is caused by different types of diseases like: hypogonadism (low estrogen production), tyreotoxicose, hyperparotidism, anorexia, rheumatoid arthritis, malabsorptive conditions (coeliac disease etc.) and other illnesses which lead to low physical motion. Usage of some medicaments like glucocorticoids may cause osteoporosis.
Osteoporosis does not include other pathological circumstances which lead to low BMD, for example, rickets, hyperparatyroid bone sickness, osteomalacia and renal osteodystrophy. Many different factors play a role during childhood and adolescence; these can be differentiated into susceptible and non- susceptible factors. All of them lead to lower BMD, and most will also be risk factors for fractures. The outcome of osteoporosis is mostly estimated through number of fractures. The strongest risk factors like age and gender are not changeable. However, one European study demonstrates that lifestyle can explain half of hip fractures.
B- None changeable influences
- Strong evidence:
a- Gender: females have nearly 100 percent increased risk for hip fracture compared to men. Between 60-80 years old people; females loose almost double bone mass density than males.
b- Age: By men it’s a continual loss, but women will have an amplified reduction after menopause.
c- Earlier fractures: Low energy fractures in wrist, column, and hip or upper arm.
d- Body height: Tall women have an increased risk for osteoporosis and fractures.
- Moderate evidence:
a- Early menopause and short fertile period: Early menopause is defined when onset is before 45 years. The risk for osteoporosis is three times larger compared to normal onset of menopause (mean 51 years old in 2003 among Swedish women).
b- Ethnicity: Caucasians have higher risk for fractures compared to Asiatic and Afro-American females. Caucasians have a lower BMD than Afro-Americans, but not compared to Asiatic women.
c- Heredity: For example hip fracture by mother is associated with an increased risk.
C- Changeable influences
- Strong evidence:
a- Physical inactivity: Low physical activity and especially disappearance of no dynamic muscle strength training increases the risk of fractures.
b- Glucocorticoid treatment: Contribute to osteoporosis when continually usage lasts over 3 months and dosage is minimum 5 mg daily.
c- Diet: Low intake of Calcium and vitamin D rich food decreases bone formation and raises bone resorption. Vitamin D sources are mainly fat fish, fish oil and vitamin D added dairy products. The role of Vitamin K, C and A is discussed but not yet...