MON-020 Identifying and Addressing Osteoporosis Knowledge Gaps in Women with Premature Ovarian Insufficiency and Early Menopause

Abstract

Premature ovarian insufficiency (POI) and early menopause (EM), menopause before ages 40 and 45 years respectively, are associated with an increased risk of osteoporosis and is a major concern for women. The aims of this study were to (i) identify knowledge gaps and behaviours regarding bone health in women with POI/EM; and (ii) co-design an osteoporosis factsheet. This mixed methods study involved: (1) quantitative survey of women, recruited from the community and hospital with a self-reported diagnosis of POI/EM, assessing demographics, medical history, factsheet information needs, calcium intake, exercise, osteoporosis knowledge (OKAT), beliefs and self-efficacy (validated scales) and (2) using the survey results, develop and refine, using semi-structured interviews, an osteoporosis factsheet. Data analysis involved descriptive statistics, logistic regression (SPSS) and thematic analysis (NViVo) of interview transcripts by 2 independent researchers. The median age of survey respondents (n=316) was 54 (IQR 47-63) years and 76% had a post school qualification. Median age of menopause was 40 (IQR 38-43) years, iatrogenic menopause occurred in 56% and osteoporosis diagnosis was reported by 19% of women. Hormone therapy use was reported by 28% of women<51 years without breast cancer. Although 80% of women reported bone density screening, most woman reported inadequate dietary calcium intake (99%) and exercise (65%). Prevalence of other osteoporosis risk factors ranged from 8% (height loss>3cm) to 31% (current/past smoker). Median OKAT score 8[IQR6-10]/19 indicated knowledge gaps regarding risk factors and treatment options. Adjusting for age and education, OKAT predicted calcium intake (OR 1.126 (CI 1.035-1.225; p=0.006) and screening (OR 1.186 (CI 1.077-1.305; p=0.001); beliefs predicted screening [OR: 1.027 (CI: 1.004-1.050), p=0.019]; and self-efficacy predicted calcium intake [OR: 1.040 (CI: 1.013-1.069), p=0.003] and exercise [OR: 1.117 (CI: 1.077-1.160), p<0.001]. All factsheet topics (risk factors, cause, screening, prevention, treatment) were considered very important/essential to include (>75% women). Initial factsheet development incorporated survey results, expert opinion and osteoporosis guidelines. Two interview rounds were conducted (n=10 for each) with 5 themes identified: content, emotional response, design, perceived usefulness and clinical considerations. The final version of the factsheet was considered acceptable and useful in relation to addressing knowledge gaps, promoting information-seeking, impacting behaviours and facilitating healthcare discussions. A co-designed factsheet is acceptable and addresses identified osteoporosis knowledge gaps in women with POI/EM. Funding: Amgen-Osteoporosis Australia-ANZBMS clinical grant