All ETDs from UAB

Advisory Committee Chair

Connie Kohler

Advisory Committee Members

Don Lein

Julie Locher

Sarah Morgan

Scott Snyder

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


The prevalence of osteoporosis and subsequent fragility fractures will continue to rise as the American population ages. The high personal and medical costs of fragility fractures have been well documented. Taking calcium and vitamin D supplements are important strategies for lowering the risk of sustaining a fragility fracture and for improving the efficacy of prescription osteoporosis medications. The purpose of this study was to determine if patients in a home health setting in Alabama (Alacare) who are defined as high risk for a fragility fracture could be segmented via cluster analysis based on the constructs of the Osteoporosis Health Belief Subscales. We analyzed baseline data gathered as part of the parent study, Improving Osteoporosis Care in High-Risk Home Health Patients through a High-Intensity Intervention, using two-step cluster analysis. We then analyzed the groups formed in the cluster analysis using either ANOVA or independent t-tests to evaluate if group membership was related to intake of calcium supplements, vitamin D supplements, multivitamins, and dietary calcium intake. Gender and a self-reported doctor diagnosis of osteoporosis emerged as the most important influences on group membership in four different cluster analyses. The constructs of the health belief model were weak influences of cluster membership when gender and self-reported doctor diagnosis of osteoporosis were included as clustering variables. When gender and doctor diagnosis were not included as clustering variables, two measures of perceived benefit of supplements influenced group membership. Statistically significant differences for number of reported days taking calcium and vitamin D supplements were found for groups in each of the four cluster analyses with women and patients with a self-reported doctor diagnosis of osteoporosis reporting a greater number of days taking supplements. In the cluster analysis that excluded both gender and doctor diagnosis of osteoporosis, the groups had statistically significant differences for reported number of days taking a multivitamin as well. There were no differences among the groups in any of the analyses for dietary calcium intake.

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