Influencing factors of abnormal bone mass in perimenopausal and postmenopausal women based on health ecology model: A cross-sectional study

Abstract

Background As the world's population ages, bone health has become a major public problem. The incidence of osteoporosis in women will further increase due to the decline of oestrogen after menopause. In this study, we used a health ecology model to explore the factors affecting abnormal bone mass in perimenopausal and postmenopausal women at different levels, and to provide a basis for the management and prevention of abnormal bone mass in women at this stage of life in China. Methods From October 2022 to September 2023, perimenopausal and postmenopausal women aged ≥ 40 years admitted to five recruited hospitals in China were recruited by purposive sampling method.Information on five levels of the health ecology model, including personal traits, behavioral characteristics, interpersonal network, working and living conditions, and policy environment was collected through structured questionnaires, and the data were analyzed using a structural equation model. Results Among 531 participants, 248 subjects had normal bone mass, 230 had osteopenia and 53 had osteoporosis. The results of the structural equation model showed that personal traits had the strongest direct positive effect on bone mass abnormality (β = 0.417, P < 0.05); behavioural characteristics had a direct positive effect on bone mass abnormality (β = 0.253, P < 0.05); interpersonal network had a direct negative effect on bone mass abnormality (β=-0.268, P < 0.05) and an indirect effect through personal traits; living conditions have a direct negative effect on bone mass abnormalities (β=-0.248,P < 0.05), and indirect effect through behavioural traits and interpersonal network; medical insurance can have an indirect effect on bone mass abnormalities through living conditions and interpersonal network. Conclusion Currently, the prevalence of abnormal bone mass in perimenopausal and postmenopausal women is high in China. Combined with the health ecology model, we found that personal characteristics and unhealthy behavior characteristics are risk factors for abnormal bone mass, higher social support and living conditions are protective factors for abnormal bone mass, which could indirectly affect abnormal bone mass, and medical insurance can indirectly affect abnormal bone mass. Future policy recommendations for the prevention of abnormal bone mass can be based on the factors and pathways that affect abnormal bone mass in perimenopausal and postmenopausal women identified in this study, in order to reduce the incidence of abnormal bone mass and improve the quality of life of perimenopausal and postmenopausal women.