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Impact of Bone Health Education on Bone Health Practices among Postmenopausal Women in Nigeria

Abstract

Bone health is an important component of women's health, particularly after menopause when declining oestrogen levels may contribute to increased bone loss and a higher risk of osteoporosis and fractures. Postmenopausal women may face additional risk factors such as inadequate calcium and vitamin D intake, physical inactivity, low body weight, smoking, excessive alcohol consumption, prolonged use of certain medications, and limited awareness of bone health. In Nigeria, inadequate knowledge of bone health and limited access to preventive healthcare may contribute to poor practices that increase the risk of osteoporosis and other bone-related complications. Bone health education provides an opportunity to improve women's understanding of bone health, osteoporosis risk factors, nutrition, physical activity, fall prevention, appropriate screening, and healthcare-seeking. Against this background, this study investigates the impact of bone health education on bone health practices among postmenopausal women in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Promotion Model. The Health Belief Model explains how women's perceptions of their susceptibility to osteoporosis and fractures, perceived severity, perceived benefits of preventive practices, perceived barriers, and cues to action may influence their adoption of healthy bone health practices. Social Cognitive Theory emphasizes knowledge, self-efficacy, observational learning, social support, and environmental influences in developing and maintaining healthy behaviours. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in health-promoting activities. Collectively, these theoretical perspectives provide a suitable framework for explaining how bone health education may influence bone health practices among postmenopausal women in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise postmenopausal women attending selected hospitals, primary healthcare centres, women's health clinics, community health programmes, and other relevant healthcare or community settings across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, organizations, and eligible women. Bone health education will be assessed using indicators such as exposure to structured bone health education, frequency and duration of education sessions, information on osteoporosis and fracture risk, calcium-rich foods, vitamin D, safe sunlight exposure, weight-bearing and muscle-strengthening physical activity, healthy body weight, smoking avoidance, alcohol-related risk reduction, fall prevention, medication-related bone risks, bone-health screening, and appropriate healthcare-seeking. Bone health practices will be assessed using indicators such as consumption of calcium- and nutrient-rich foods, appropriate vitamin D practices, regular weight-bearing and muscle-strengthening activities, maintenance of healthy body weight, avoidance of tobacco, appropriate alcohol-related practices, fall-prevention behaviours, appropriate use of prescribed medications, and utilization of recommended bone-health screening and healthcare services. Data will be collected using structured questionnaires and appropriate bone health knowledge and practice assessment instruments. Descriptive statistics will be used to summarize participants' characteristics, exposure to bone health education, and patterns of bone health practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of bone health education on bone health practices. Where a quasi-experimental design is adopted, bone health practice scores before and after structured education may be compared, while relevant age, duration since menopause, educational, socioeconomic, health, lifestyle, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that bone health education has a significant positive impact on bone health practices among postmenopausal women in Nigeria. Women who receive structured and evidence-based bone health education are expected to demonstrate better bone health practices than women with limited exposure to bone health information. Education may improve awareness of osteoporosis risk and encourage appropriate consumption of calcium-rich foods, adequate vitamin D practices, regular weight-bearing and muscle-strengthening physical activity, healthy weight maintenance, smoking avoidance, fall prevention, and timely healthcare-seeking. Education may also help women understand that bone loss can increase after menopause and that preventive measures can contribute to maintaining bone strength and reducing fracture risk. However, financial limitations, limited access to nutritious foods and appropriate healthcare services, cultural beliefs, physical limitations, low health literacy, and inadequate availability of bone-health screening may reduce the effectiveness of education. The study therefore expects accessible, culturally appropriate, practical, and regularly reinforced bone health education to contribute significantly to improved bone health practices among postmenopausal women in Nigeria. The study is expected to contribute to the literature on bone health education, bone health practices, osteoporosis prevention, postmenopausal women's health, healthy ageing, nutrition, physical activity, fracture prevention, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, women's health clinics, healthcare providers, community health workers, development partners, and policymakers regarding strategies for improving bone health among postmenopausal women. The study will also provide evidence-based recommendations for integrating bone health education into routine women's health and primary healthcare services, strengthening osteoporosis prevention programmes, training healthcare workers in bone health counselling, improving access to bone-health screening and appropriate referral, developing culturally appropriate educational materials, and promoting sustainable bone health practices among postmenopausal women across Nigeria.

Keywords: Bone health education, bone health practices, postmenopausal women, osteoporosis prevention, bone health, fracture prevention, healthy ageing, women's health, nutrition, physical activity, Nigeria, public health.