ABS1184-HPR IMPROVING BONE HEALTH KNOWLEDGE IN THE COMMUNITY: A QUALITY IMPROVEMENT PROJECT AND AUDIT IN THE UK

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Background: The importance of good bone health is often overlooked until someone breaks a bone. 1 in 3 women and 1 in 5 men over the age of 50 will break a bone, predominantly due to poor bone health, with an estimated 37 million fractures annually worldwide, resulting in long-term disability and reduced quality of life. The UK spend is over £4.4 billion annually on managing fragility fractures. However, investments in preventative measures and awareness campaigns remain limited. Yet, there are simple lifestyle measures that individuals can adopt throughout life to optimise their bone health. Objectives: We undertook a quality improvement project (QIP) and audit to assess what people from various groups of the community understand about bone health, and how knowledge can be improved and translated to lifestyle changes for better bone health. Methods: Design: Cross-sectional and longitudinal comparison of responses to assess the impact of bone health education. Participants: Sports Enthusiasts, Healthcare Professionals, and members of the General Public were the three groups assessed. Sports Enthusiasts included people of various sporting backgrounds from racquet sport players and footballers, to runners and cyclists. Healthcare Professionals encompassed numerous disciplines including nurses, physiotherapists, pharmacists and doctors of varying grades and specialities across primary and secondary care. The General Public included other people that did not fit in the above groups, obtained from various health pop-up events, uptake on offers of bone health information provision, or other follow-up opportunities. Research and ethics approval were not required as this was part of an NHS quality improvement project and audit. Intervention: An education package was delivered to all three groups. The bone health information was derived predominantly from educational materials developed by the International Osteoporosis Foundation (IOF) and Royal Osteoporosis Society (ROS). The package was delivered by various methods including talks to groups or individually face to face of via video link, demonstration or activity around calcium content of food, and/or reading material. The information given encompassed the lifestyle aspects of good bone health including activity/exercises, healthy balanced and varied eating with sufficient calcium, impact of smoking and excess alcohol on bone health. Myths around bone growth, repair, activities after breaking a bone were also covered. Comparator: Cross-group and within-group comparisons were made. Outcomes: Bone health knowledge between groups at baseline, change in knowledge within each group, immediately after education and around two months later. The questionnaires captured knowledge about various aspects of good bone health including calcium intake and lifestyle factors. Statistical analysis : Cross-sectional baseline comparison using ANOVA test for mean, Kruskal-Wallis ANOVA test for median and chi-square test for percentages. Within group change following education was assessed with the McNemar chi-square test. Results: We received 1,301 responses in total: 506 at baseline, 383 immediately after education, and 303 about two months after education, and 109 from the bone health specialist reference group. Table 1 describes the baseline characteristics for each participant group. There is no statistically significant difference in age, gender and ethnicity between the groups at baseline. At baseline, 96.3% of Sports Enthusiasts, 96.2% of Healthcare Professionals and 97.7% of the General Public found the education useful (with 59%, 62.9% and 67.3% finding it extremely useful, respectively). Immediately post-education, 82.0% (77.1% Sports Enthusiasts, 81.9% Healthcare Professionals, 87.0% General Public) thought they would be making lifestyle changes after receiving education. Over two months after receiving education, 70.8% (83% Sports Enthusiasts, 62.0% Healthcare Professionals, 67.3% General Public) reported that lifestyle modification had taken place. Furthermore, 22.5% Sports Enthusiasts, 32.0% Healthcare Professionals and 12.9% General Public have been able to advise others. Changes made relate to factors including exercise, smoking cessation, alcohol reduction, and dietary calcium intake adjustment. Of those who responded ‘no' to making changes, by far the greatest reason reported was that they were ‘already doing everything' leaving only between 5%, 6% and 8.9% from the three groups, respectively, who could not or did not achieve change. Table 1. Characteristics of participants Figure 1Awareness of daily calcium requirements across different groups at different time points.Figure 1 shows how reported knowledge about calcium requirement improves post-education across all three groups. There is no difference between the groups at baseline (p=0.733) and immediately after education (p=0.23), although a difference is seen between the groups two months after education (p<0.001). There was significant improvement of knowledge within each group (p<0.001). Conclusion: Current bone health knowledge is suboptimal. Providing bone health information improves knowledge and results in lifestyle changes. Regular reinforcement of bone health messages after two months may be needed for information retention. REFERENCES: [1] https://www.osteoporosis.foundation/. [2] https://theros.org.uk/. [3] https://www.worldosteoporosisday.org/resources/step-up-for-bone-health. [4] https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/how-to-build-up-exercise-for-your-bone-strength/. Acknowledgements: Thank you to the IOF for the provision of educational materials including assistance with translation of materials for equity of access to information, the ROS for provision of educational materials, UHDB Osteoporosis Team, UHDB Rheumatology team, Reem Idriss, Stella Hui, Katherine Bentley, Sophie Malik, Zara Malik, Josh Malik, and organisations in the community that we have taken an interest and engagement in the subject of bone health including We Are Padel for adopting the concept to the point of supporting bone health padel sessions and fundraising tournament, Derby City Council, Erewash Sound, Derby Arena, DCHS nurses, DCHS therapists, Littleover 125th Scouts, Haven's Under 5s, Griffe Field Primary School, Bakewell Cattle Market, Derby Homes, Derby Moor Spencer Academy, The Cottage Nursery, Abbeydale Squash and Fitness Club, Moko Physiotherapy, University of Derby, University of Nottingham, University Technical College, The Quad, Social Prescribers, Nag's Head, The Markeaton, Local Area Coordinators, UHDB A&E, Nottingham University Hospitals Rheumatology Department, Countess of Chester Hospital Rheumatology Department, Rare and Complex Bone and Mineral MDT Midland Network, Midland Bone Interest Group, British Society for Rheumatology Special Interest Group, local libraries, General Practice Task Force, UHDB Running Club, No Strings Attached Badminton, UHDB Table Tennis, and participants. Thank you to everyone who have given up their time to assist with this QIP, without which it would not be possible as the entire piece of work has been undertaken voluntarily. Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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