Osteoprotective Knowledge in a Multiethnic Epilepsy Population

John O. Elliott, MPH; Brenda F. Seals, PhD, MPH; Mercedes P. Jacobson, MD


J Neurosci Nurs. 2008;40(1):14-24. 

In This Article

Osteoporosis Knowledge

Osteoporosis knowledge scores are not significantly associated with calcium intake or minutes of weight-bearing exercise (Terrio & Auld, 2002). Overall, level of education seemed to be the best predictor of knowledge scores (Terrio & Auld). Race and culture are important factors for predicting differences in knowledge and behavior for numerous health issues, although these differences have been less emphasized in osteoporosis-related knowledge and preventive behaviors (Larkey, Day, Houtkooper, & Renger, 2003). Less than 10% of African American and Hispanic women took in adequate daily calcium, and only 13% took calcium supplements; they also perceived osteoporosis to be less of a threat than breast cancer, heart disease, diabetes, and Alzheimer disease (Geller & Derman, 2001).

In older men (> 65 years of age), 71% failed an osteoporosis knowledge test. Only one-third engaged in twice-weekly weight-bearing exercise, and a meager 1.4% reported getting 1,500 mg of calcium daily (Sedlak, Doheny, & Estok, 2000). This is of concern when the rate of fracture-related mortality, 1 year after a hip fracture, is double in men compared to women (Olszynski et al., 2004). Males on AEDs have been found to have a 1.8% annual loss of bone- mineral density, yielding a 2.5-fold increased prevalence of bone loss at the hip when compared to the healthy U.S. male population (Andress et al., 2002).

Studies of osteoporosis educational programs in various populations have shown significant increases in specific knowledge related to exercise and calcium intake (Chan, Kwong, Zang, & Wan, 2007; Sedlak, Doheny, Estok, & Zeller, 2005; Sedlak, Doheny, & Jones, 1998). Programs including content on (1) identification of osteoporosis risk factors, (2) identification of potential consequences of osteoporosis, and (3) strategies to prevent osteoporosis, including exercise and maintenance of daily calcium requirements, have been effective in increasing knowledge for groups of health professionals (Piaseu, Belza, & Mitchell, 2001; Ziccardi, Sedlak, & Doheny, 2004) and men (Tung & Lee, 2006).

Currently, osteoporosis knowledge has not been investigated in people with epilepsy. As part of a larger study, we found exercise knowledge related to osteoporosis to be a predictor of increased adoption of preventative behaviors such as dietary calcium intake and physical exercise (Elliott, Seals, & Jacobson, 2007). It would be beneficial for nurses and other health educators to understand similarities and differences in calcium and exercise knowledge among males and females, as well as various age groups, ethnicities, and education levels. The U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (n.d.) recommends that epidemiology, demographics, behavior, culture, and attitude be considered when taking steps to improve the usability of health information. They also recommend that materials and messages reflect the age, social and cultural diversity, language, and literacy skills of the intended users. In the case of osteoprotective behaviors, such as diet and exercise, culturally adapted messages and materials have a greater impact (Kreuter et al., 2005). By looking at specific knowledge deficiencies by ethnicity, more effective patient education could be developed and provided to people with epilepsy who are at risk for accelerated bone loss due to use of AEDs. This potential for improvement is especially important in light of previous research that has found that non-Caucasians get less dietary calcium (Geller & Derman, 2001), take calcium supplements less frequently (Wei, Jackson, & Herbers, 2003), exercise less frequently (Geller & Derman), and are screened three times less for osteoporosis (Mudano et al., 2003) than Caucasians.