Health Literacy and Patient Education in Osteoporosis Strategies to Improve Treatment Adherence and Fracture Prevention

Abstract

Background: Osteoporosis remains a major public health issue because poor treatment adherence and weak fracture-prevention behavior increase the risk of avoidable fractures, disability, and reduced quality of life. Limited health literacy, inadequate knowledge, low self-efficacy, and insufficient support often prevent patients from maintaining long-term osteoporosis care.

Purpose: This study examined the effect of health-literacy–tailored osteoporosis patient education on treatment adherence and fracture-prevention behavior. It also tested the mediating roles of osteoporosis knowledge and osteoporosis self-efficacy and the moderating role of social support.

Methods: A quantitative cross-sectional design was used. Data were collected from 513 osteoporosis patients through a structured questionnaire. The study targeted osteoporosis patients receiving osteoporosis education, counseling, treatment, or fracture-prevention services at Mother Theresa University Hospital Center, University Hospital of Trauma, and Pegasus Med Clinic in Tirana, Albania. The data were analyzed using Partial Least Squares Structural Equation Modeling to assess the measurement model, structural model, mediation effects, and moderation effects.

Findings: The findings showed that health-literacy–tailored osteoporosis patient education had a significant positive effect on treatment adherence and fracture-prevention behavior. It also strongly improved osteoporosis knowledge and osteoporosis self-efficacy. Both osteoporosis knowledge and self-efficacy significantly mediated the relationship between patient education and adherence outcomes, with self-efficacy showing the stronger mediating effect. Social support significantly strengthened the effects of patient education on knowledge and self-efficacy, but it did not significantly moderate the direct relationship between education and adherence behavior.

Conclusion: The study concluded that osteoporosis education should be literacy-sensitive, patient-centered, and confidence-oriented. Improving knowledge and self-efficacy through clear education may enhance treatment adherence and fracture-prevention behavior among osteoporosis patients.