Building Better Bones for a Better You: Osteoporosis Prevention for Adolescent Girls

Saturday, 7 November 2015

Joanna Christina M. Trice, MSN, BSN, RN, PHN
Nursing Program, Vanguard University of Southern California, Costa Mesa, CA, USA


Introduction and Background

Osteoporosis is a serious bone disease occurring with the loss of bone mass and weakening of bone tissue. According to Healthy People 2020, there are approximately 5.3 million Americans aged 50 years and older with osteoporosis. Although this disease affects both men and women, it is much more common in women. Individuals with osteoporosis often experience bone fragility leading to bone fracture, particularly of the hip, spine, and wrist. Bone fractures are the most serious health complications of osteoporosis as they are associated with severe pain, loss of stature, limited mobility, and even death. Healthy People 2020, estimates 50% of all women will experience a bone fracture resulting from osteoporosis during their lifetime. Medical expenses associated with osteoporosis related fractures are extremely costly. The National Osteoporosis Foundation, projects by 2025 osteoporosis will cause nearly three million bone fractures at a cost of $25.3 billion annually.

Problem Statement

Osteoporosis was commonly thought to be a disease of older adulthood. However, osteoporosis truly begins in childhood and adolescence. By the age of 18, females achieve peak bone mass, which contributes to bone strength. Therefore, it is best to begin osteoporosis prevention during childhood and adolescence to build bone mass and promote life long bone health. However, gaps in knowledge about osteoporosis and methods of prevention are present, particularly among adolescent girls. Providing osteoporosis prevention education to this population is essential to reduce the risk of osteoporosis development later in life. 

Purpose and Goal

The purpose of this thesis project was to design and present an educational session about osteoporosis prevention directed towards adolescent girls. The goal of this thesis project was to bring awareness of osteoporosis and to stimulate motivation for a health promotion change.

Theoretical Framework

The theoretical framework for this thesis project was based on Albert Bandura’s social-cognitive learning theory. Bandura’s theory involves four basic steps for social-cognitive learning. First, the observer watches the behavior modeled by another person. Second, the observer recalls the behavior. Third, the observer has to mimic the behavior correctly. Lastly, the observer is motivated to learn and carry out the behavior. Bandura’s social-cognitive learning theory provided the basis for this thesis project to optimize learning, comprehension, and motivation.


This thesis project consisted of a 40-minute educational session directed towards adolescent girls. The sample of participants included eight adolescent girls (n = 8) between the ages of 12 to 15 years old, who were involved in a girls club. The educational session provided an extensive overview of osteoporosis, risk factors, associated health complications, and methods of prevention. Dietary modification through adequate consumption of calcium and vitamin D and participation in weight-bearing exercise were the primary methods of osteoporosis prevention discussed. Due to the unique learning needs of adolescent girls, learning activities that were age-appropriate, hands-on, interactive, and relevant were incorporated into this educational session. These learning activities included meal planning, reading nutrition labels, re-demonstrating weight-bearing exercise, and creating a calcium-rich snack. Data collection instruments included a demographic questionnaire, pretest, and posttest. The demographic questionnaire consisted of seven questions regarding age, grade, previous osteoporosis prevention patient education, milk intake, daily exercise, and personal exercise preference. The pretest and posttest consisted of the same nine questions having to do with essential osteoporosis related facts, calcium, vitamin D, weight-bearing exercise, personal perception of osteoporosis prevention importance, and motivation to prevent osteoporosis. Participants were asked to complete the pretest and demographic questionnaire prior to the start of the educational session. Once the educational session concluded the participants were asked to complete the posttest. Results from each participant’s pretest and posttest were compared to determine changes in knowledge of osteoporosis, personal perception of osteoporosis prevention importance, and motivation to prevent osteoporosis. Data from the demographic questionnaire, pretest, and posttest were analyzed using descriptive statistics, a paired t-test, and IBM SPSS version 21 software.


Analysis of the demographic questionnaires revealed 75% of participants were not educated about osteoporosis prevention by their physician. The majority of participants (62.5%) drank one to two glasses of milk per day. Only 25% of participants exercised on a daily basis. In one day, most participants exercised for 30 minutes (37.5%) or 1 hour (37.5%). Interestingly, participant 2 responded with “not at all” in regards to frequency of exercise and “I don’t exercise” in regards to duration of exercise. Additionally, participant 2 did not provide any response when asked about personal exercise preference.

Analysis of the pretests and posttests revealed 100% of participants knew osteoporosis is a bone disease. Knowledge of the best time to begin osteoporosis prevention increased from 87.5% at pretest to 100% at posttest. Knowledge of the recommended daily calcium and vitamin D intake levels increased from 0% at pretest to 100% at posttest. Knowledge of calcium-rich food increased from 50% at pretest to 100% at posttest (p < 0.04). Knowledge of exercise best suited for osteoporosis prevention increased from 37.5% at pretest to 100% at posttest. Knowledge related to frequency of performing osteoporosis prevention exercises during the week increased from 75% at pretest to 100% at posttest. At pretest, only 62.5% of participants deemed preventing osteoporosis now as very important. In contrast, at posttest 100% of participants deemed preventing osteoporosis now as very important. Moreover, at posttest each participant’s motivation to begin osteoporosis prevention was either increased or reinforced.


The data confirms achievement of this thesis project’s goal. Participants were made aware of osteoporosis and motivation for a health promotion change was stimulated. Therefore, this educational session and the means in which the education was delivered were successful.

Recommendations and Implications

In the future, educators, community health nurses, and school nurses may utilize the foundations of this educational session as a guideline to deliver effective osteoporosis prevention education to adolescent girls. Additionally, foundations of this educational session may be incorporated into standard health and nutrition curriculum for adolescents in middle school and high school.

It is concerning that the majority of participants were not educated about osteoporosis prevention by their physician. Future nursing research is still warranted to determine existing barriers preventing the delivery of osteoporosis prevention education to adolescent girls by physicians. Additionally, other methods of delivering effective education (e.g. interactive websites, smart phone applications) must be studied to determine best practices for teaching adolescent girls. Lastly, future longitudinal research studies must be conducted to determine if motivation to perform osteoporosis prevention methods is still sustained at various intervals (i.e. weeks, months, and years) after the educational session has ended.


Limitations of this thesis project involved the small sample of participants utilized, as this sample may not be representative of most adolescent girls. Participants in this thesis project were part of a girls club. These participants may have been more motivated and educated, which may have skewed the data collected. Future research that replicates this thesis project but utilizes a much larger sample is warranted so that a more diverse population is represented.