Abstract
1
Pensar Enfermagem / v.30 n.Sup / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30iSup.505 / e00505
Knowledge, Self-Care and Fragility Fracture Risk: An
Exploratory Study Informing the Development of a Complex
Nursing Intervention
Tiago Silva1*, Sandra Garcêz2, Alexandre Matos 3, Tiago Nascimento4, Cristina Baixinho5, Ricardo J. O. Ferreira6,
Andreia Costa7
1 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon, Lisbon, Portugal; PhD
Student at University of Lisbon. Lisbon. Portugal; orcid.org/0009-0007-9590-5353
2 Unidade Local de Saúde de Santa Maria. Lisbon. Portugal.; orcid.org/0000-0000-0000-0000
3 Instituto Português do Sangue e da Transplantação. Lisbon. Portugal; Master’s Student at School of Nursing, University of Lisbon. Lisbon.
Portugal; orcid.org/0000-0000-0000-0000
4 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon, Lisbon, Portugal; Assistant
Professor at School of Nursing, University of Lisbon. Lisbon. Portugal; orcid.org/0000-0003-3646-9057
5 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon, Lisbon, Portugal;
Coordinating Professor at School of Nursing, University of Lisbon. Lisbon. Portugal; orcid.org/0000-0001-7417-1732
6 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon, Lisbon, Portugal;
Rheumatology Department, Unidade Local de Saúde de Coimbra. Coimbra, Portugal; Laboratório Associado TERRA, Faculdade de Medicina,
Universidade de Lisboa. Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;
orcid.org/0000-0002-2517-0247
7 Nursing Research Innovation and Development Centre of Lisbon (CIDNUR), School of Nursing, University of Lisbon, Lisbon, Portugal;
Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa. Lisbon, Portugal; Instituto de Saúde Ambiental (ISAMB),
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; orcid.org/0000-0002-2727-4402
* Corresponding author: tiagosilva@campus.esel.pt
Abstract
Introduction
Fragility fractures (FF) are a growing public health problem, with 70,700 cases recorded in Portugal in 2019.¹
These fractures are associated with a one-year mortality rate of 25%² and a major economic impact. The
management of FF risk comprises multiple interacting components, in which knowledge and the ability to
perform self-care activities are key elements.3
Objective
To explore the association between FF risk, osteoporosis knowledge and self-care, and differences across
gender and age groups.
Methods
Cross-sectional study, using a convenience sample of individuals aged 50 to 74 years, attending a Family Health
Unit, a Public Health Unit and a Blood Collection Center in Lisbon, who were fluent Portuguese speakers and
without cognitive impairments. Data collection (August-November 2025) included sociodemographic
variables and measures related to the: 10-year fracture risk estimated by FRAX (major osteoporotic fracture:
high risk ≥11%, intermediate >7 to <11%, low ≤7%; hip fracture: high ≥3%, intermediate >2 to <3%, low
≤2%); Osteoporosis Knowledge Assessment Tool (OKAT; ranging 0-20); Exercise of Self-Care Agency Scale
(ESCA; ranging 0-116). Statistical comparisons were performed using independent samples t-test or one-way
ANOVA. An Ethics Committee approved the study (CAML84/25).
Results
Our sample comprised 141 individuals (55.3% women, 61.8y (±7.2), 50.0% holding a higher education degree).
Seven women reported history of FF. 24.3% women and 11.3% men were at moderate-to-high 10-year risk of
FF. Women had a statistically higher mean OKAT score (8.9±3.4 versus 7.1±3.2; p=0.002). No statistically
significant associations were found between self-care ability score and gender, age group, OKAT score, or FF
risk category.
Conclusion
One in four women and one in ten men were at moderate-to-high risk of FF, with ~60% demonstrating very
limited osteoporosis knowledge. These findings underscore the need for developing a complex intervention
aimed at preventing FF through systematic screening and self-care promotion.
Abstract
2
Pensar Enfermagem / v.30 n.Sup / Jan-Dec 2026 / DOI: 10.71861/pensarenf.v30iSup.505 / e00505
Keywords
Osteoporotic Fracture; FRAX; Self-care; Knowledge; Complex Intervention.
References
1. Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, et al. SCOPE 2021: a new
scorecard for osteoporosis in Europe. Arch Osteoporos [Internet]. 2021 [cited 21 Out 2025]; 16(1): 1-82.
Available from: https://doi.org/10.1007/s11657-020-00871-9
2. Marques A, Lourenço Ó, Silva JAP. The burden of osteoporotic hip fractures in Portugal: costs, health
related quality of life and mortality. Osteoporos Int [Internet]. 2015 [cited 21 Out 2025]; 26(10): 2623–30.
Available from: https://doi.org/10.1007/s00198-015-3171-5
3. Adams J, Wilson N, Hurkmans E, Bakkers M, Balážová P, Baxter M, et al. 2019 EULAR points to consider
for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.
Ann Rheum Dis [Internet]. 2021 [cited 21 Out 2025]; 80(1):57–64. Available from:
https://doi.org/10.1136/annrheumdis-2020-216931
