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Effect of Community-Based Bone Health Screening on Osteoporosis Risk Detection among Older Adults in Nigeria

Abstract

Osteoporosis remains an important public health concern among older adults in Nigeria because age-related reduction in bone strength can increase the risk of fractures, disability, reduced mobility, loss of independence, and diminished quality of life. Older adults may be particularly vulnerable to poor bone health because of advancing age, inadequate dietary intake of calcium and vitamin D, physical inactivity, previous fractures, chronic health conditions, prolonged use of certain medications, and other lifestyle and biological factors. Osteoporosis often develops without noticeable symptoms until a fracture occurs, making early risk identification an important component of preventive healthcare for older adults. Delayed detection of osteoporosis risk may increase the likelihood of preventable fractures, hospitalization, long-term disability, and increased healthcare expenditure. Community-based bone health screening provides an opportunity to identify older adults at increased risk of osteoporosis through accessible health assessments conducted within communities, primary healthcare centres, outreach programmes, elderly health initiatives, and mobile health services. Early identification may facilitate nutritional counselling, physical activity interventions, fall prevention, clinical assessment, bone mineral density evaluation where available, and appropriate referral and treatment. However, inadequate awareness, limited screening facilities, shortage of trained healthcare personnel, financial barriers, geographical inaccessibility, and weak referral and follow-up systems may limit the effectiveness of community-based bone health screening programmes in Nigeria. Against this background, this study investigates the effect of community-based bone health screening on osteoporosis risk detection among older adults in Nigeria. The study will be anchored on the Health Belief Model, the International Classification of Functioning, Disability and Health (ICF) Framework, and the Health Systems Framework. The Health Belief Model explains how older adults' perceptions of susceptibility to osteoporosis, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in bone health screening. The ICF Framework emphasizes the interaction between health conditions, body functions, activities, participation, environmental factors, and personal factors in understanding healthy ageing and functional independence. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective osteoporosis screening and geriatric healthcare programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based bone health screening may influence osteoporosis risk detection among older adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 60 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible older adults. Community-based bone health screening will be measured using indicators such as availability of screening services, screening coverage, frequency of screening activities, accessibility of screening locations, osteoporosis risk assessment, assessment of previous fractures, nutritional assessment, physical activity assessment, bone mineral density screening where available, availability of trained healthcare personnel, screening equipment, and referral arrangements. Osteoporosis risk detection will be assessed using indicators such as identification of individuals at increased risk of osteoporosis, low bone density findings where screening equipment is available, history of fragility fractures, presence of recognized osteoporosis risk factors, newly identified high-risk cases, referrals for confirmatory assessment, and linkage to appropriate preventive or therapeutic interventions. Data will be collected using structured questionnaires, community screening registers, bone health assessment records, healthcare facility records, referral registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, bone health findings, and patterns of osteoporosis risk detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based bone health screening on osteoporosis risk detection. Where appropriate, osteoporosis risk detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based bone health screening has a significant positive effect on osteoporosis risk detection among older adults in Nigeria. Older adults who participate in community-based bone health screening are expected to have a higher likelihood of having previously unrecognized osteoporosis risk factors identified than older adults without access to such services. Systematic assessment of fracture history, nutritional status, physical activity, relevant health conditions, and bone density where available may facilitate early identification of individuals at increased risk of osteoporosis. Early detection may provide opportunities for nutritional counselling, appropriate calcium and vitamin D interventions, physical activity and strengthening exercises, fall prevention measures, clinical assessment, treatment, and continued monitoring. Bringing bone health screening services closer to older adults may also reduce geographical and financial barriers and improve awareness of healthy ageing and fracture prevention. Conversely, inadequate screening coverage, limited diagnostic capacity, shortage of trained healthcare personnel, low awareness, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of community-based bone health screening. The study therefore expects accessible and well-organized community-based bone health screening to contribute significantly to improved detection and prevention of osteoporosis risk among older adults in Nigeria. The study is expected to contribute to the literature on community-based bone health screening, osteoporosis risk detection, older adult health, bone health, healthy ageing, fracture prevention, geriatric healthcare, preventive medicine, community health services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, geriatric healthcare providers, physiotherapists, nutritionists, community health workers, older adult health programmes, development partners, and policymakers regarding strategies for improving bone health among older adults. The study will also provide evidence-based recommendations for expanding community-based bone health screening programmes, improving access to osteoporosis risk assessment and appropriate bone density evaluation, strengthening healthcare worker training, increasing awareness of osteoporosis and fracture prevention, promoting appropriate nutrition and physical activity among older adults, strengthening referral and follow-up systems, improving access to preventive and therapeutic interventions, and supporting healthy ageing among older adults across Nigeria.

Keywords: Community-based bone health screening, osteoporosis risk detection, older adults, osteoporosis, bone health, fracture prevention, healthy ageing, geriatric healthcare, preventive healthcare, community health services, Nigeria, public health.