Knowledge, Self-Care and Fragility Fracture Risk: An Exploratory Study Informing the Development of a Complex Nursing Intervention
Published 2026-04-08
Keywords
- Osteoporotic Fracture; FRAX; Self-care; Knowledge; Complex Intervention
How to Cite
Copyright (c) 2026 Tiago Silva, Sandra Garcêz, Alexandre Matos, Tiago Nascimento, Cristina Baixinho, Ricardo J. O. Ferreira, Andreia Costa
This work is licensed under a Creative Commons Attribution 4.0 International License.
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.