Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Construction and validation of the Lebanese Osteoporosis Knowledge Scale among a representative sample of Lebanese women

  • 40 Accesses



Our study aimed at constructing and validating the Lebanese Osteoporosis Knowledge Scale adapted for use among Lebanese women and to assess factors associated with the poorest knowledge of osteoporosis definition, risk factors, and preventive measures. This scale showed adequate psychometric properties; higher knowledge scores were reached in women who already heard about the disease and had a formal education. As a result, the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions.


The primary objective of this study was to describe the construction of the Lebanese Osteoporosis Knowledge Scale (LOKS) and assess its psychometric properties in a representative sample of Lebanese women aged 40 years and above. Secondary objectives were to explore factors associated with this knowledge score.


A cross-sectional study carried out between March and June 2018, enrolled 560 women over the age of 40 years living in the community. This proportionate sample was randomly selected from all Lebanese governorates to cover the entire Lebanese area. A survey was developed and adapted to the Lebanese population based on preexisting scales. Personal interviews were conducted to collect data.


The items of the LOKS were distributed across seven factors with an Eigenvalue over 1 solution, outlining an overall value of 55.89% of the variance. A high Cronbach’s alpha was found for the full scale (0.725). Individuals having a university level of education (beta = 1.62; compared to illiteracy), having heard of osteoporosis (beta = 2.62), taking supplements of calcium and vitamin D compared to none (beta = 0.77), and having had Crohn’s disease (beta = 1.71) had significantly higher knowledge scores of osteoporosis; oppositely, having diabetes (beta = − 1.17), currently taking chemotherapy (beta = − 2.25), and ever having had a fracture (beta = − 0.74) were significantly correlated with lower awareness of osteoporosis.


Our findings suggest that the LOKS-19 can be used to measure knowledge of osteoporosis and help assess osteoporosis-related interventions. A better knowledge seems to be associated with more preventive measures and less risk of fracture.

This is a preview of subscription content, log in to check access.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1


  1. 1.

    Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38(2 Suppl 1):S4–S9

  2. 2.

    Kling JM, Clarke BL, Sandhu NP (2014) Osteoporosis prevention, screening, and treatment: a review. J Women's Health (Larchmt) 23(7):563–572

  3. 3.

    Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16(5):447–455

  4. 4.

    Johnell O, Kanis JA, Oden A et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42

  5. 5.

    Ballane G, Cauley JA, Luckey MM, El-Hajj FG (2017) Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28(5):1531–1542

  6. 6.

    Baddoura R, Arabi A, Haddad-Zebouni S et al (2007) Vertebral fracture risk and impact of database selection on identifying elderly Lebanese with osteoporosis. Bone 40(4):1066–1072

  7. 7.

    Green LW, Kreuter MW, Deeds SG, Partridge KB, Bartlett E (1980) Health education planning: a diagnostic approach

  8. 8.

    Lorig K, Konkol L, Gonzalez V (1987) Arthritis patient education: a review of the literature. Patient Educ Couns 10(3):207–252

  9. 9.

    Ailinger RL, Harper DC, Lasus HA (1998) Bone up on osteoporosis. Development of the Facts on Osteoporosis Quiz. Orthop Nurs 17(5):66–73

  10. 10.

    Pande KC, de Takats D, Kanis JA, Edwards V, Slade P, McCloskey EV (2000) Development of a questionnaire (OPQ) to assess patient's knowledge about osteoporosis. Maturitas 37(2):75–81

  11. 11.

    Redman BK (2003) Measurement tools in patient education. Springer Publishing Company

  12. 12.

    The Central Agency of Statistics in Lebanon website. Available from:

  13. 13.

    El Hage C, Hallit S, Akel M, Dagher E (2019) Osteoporosis awareness and health beliefs among Lebanese women aged 40 years and above. Osteoporos Int 30(4):771–786

  14. 14.

    Antunes B, Daveson B, Ramsenthaler C et al (2012) The palliative care outcome scale (POS) manual for cross-cultural adaptation and psychometric validation. Cicely Saunders Institute, London

  15. 15.

    Beaton D, Bombardier C, Guillemin F, Ferraz MB (2002) Recommendations for the cross-cultural adaptation of health status measures. New York: American Academy of Orthopaedic Surgeons:1–9

  16. 16.

    Gemalmaz A, Oge A (2008) Knowledge and awareness about osteoporosis and its related factors among rural Turkish women. Clin Rheumatol 27(6):723–728

  17. 17.

    Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25(24):3186–3191

  18. 18.

    Al-Bannay H, Jarus T, Jongbloed L, Yazigi M, Dean E (2013) Culture as a variable in health research: perspectives and caveats. Health Promot Int 29(3):549–557

  19. 19.

    Weidmer B. Issues and guidelines for translation in cross-cultural research. Paper presented at: Proceedings of the American Statistical Association, Section on Survey Research Methods1994.

  20. 20.

    Maneesriwongul W, Dixon JK (2004) Instrument translation process: a methods review. J Adv Nurs 48(2):175–186

  21. 21.

    Nejjari C, El Fakir S, Bendahhou K et al (2014) Translation and validation of European organization for research and treatment of cancer quality of life questionnaire-C30 into Moroccan version for cancer patients in Morocco. BMC research notes 7(1):228

  22. 22.

    Flesch R (1948) A new readability yardstick. J Appl Psychol 32(3):221

  23. 23.

    Anastasi A (1954) Psychological testing

  24. 24.

    Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL (2018) Best practices for developing and validating scales for health, social, and behavioral research: a primer. Front Public Health;6

  25. 25.

    Kanis JA, Cooper C, Rizzoli R et al (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30(1):3–44

  26. 26.

    Saw S, Hong C, Lee J, et al. Awareness and health beliefs of women towards osteoporosis. Osteoporosis Int 2003;14(7):595–601

  27. 27.

    Magnus JH, Joakimsen RM, Berntsen GK, Tollan A, Søgaard AJ. What do norwegian women and men know about osteoporosis? Osteoporosis Int. 1996;6(1):31–36

  28. 28.

    Panday K, Gona A, Humphrey MB (2014) Medication-induced osteoporosis: screening and treatment strategies. Ther Adv Musculoskelet Dis 6(5):185–202

  29. 29.

    Giangregorio L, Thabane L, Cranney A, Adili A. Osteoporosis knowledge among individuals with recent fragility fracture. Orthopedic nursing. 2010;29(2):99

  30. 30.

    Marsh HW, Hau K-T, Wen Z (2004) In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler's (1999) findings. Struct Equ Model 11(3):320–341

  31. 31.

    Oh EG, Yoo JY, Lee JE, Hyun SS, Ko IS, Chu SH (2014) Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial. Res Nurs Health 37(4):292–301

  32. 32.

    Park KS, Yoo JI, Kim HY, Jang S, Park Y, Ha YC (2017) Education and exercise program improves osteoporosis knowledge and changes calcium and vitamin D dietary intake in community dwelling elderly. BMC Public Health 17(1):966

  33. 33.

    Kanis JA, Cooper C, Rizzoli R et al (2019) Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 104(3):235–238

Download references

Author information

Correspondence to S. Hallit or C. El Hage.

Ethics declarations

Conflicts of interest


Ethics statement

In accordance with the Regulatory Research Protocol of the Hospital, the Institutional Review Board of the Holy Spirit University of Kaslik (USEK) approved this study protocol based on the fact that participants’ autonomy and confidentiality have been respected and since it was an observational study, no harm will be caused to them. The purpose and requirement of the study were explained to each woman and they all signed written informed consent.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.



Table 5 Lebanese Osteoporosis Knowledge Scale

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hallit, S., El Hage, C., Hajj, A. et al. Construction and validation of the Lebanese Osteoporosis Knowledge Scale among a representative sample of Lebanese women. Osteoporos Int 31, 379–389 (2020).

Download citation


  • Knowledge
  • Lebanon
  • Osteoporosis
  • Scale
  • Women