Abstract: Objective To investigate the prevalence of osteoporosis among the rural elderly population in southern Sichuan and to analyze its potential influencing factors, thereby providing an evidentiary basis for the prevention and management of osteoporosis in this demographic. Methods A multi-stage stratified sampling method was employed from January to December 2023 to recruit elderly individuals from rural areas in southern Sichuan region as study participants. Health literacy regarding osteoporosis was assessed using the osteoporosis knowledge assessment questionnaire (OKAQ) and the osteoporosis knowledge test (OKT). Bone mineral density was measured using a radial ultrasonic bone densitometer. Serum 25-hydroxyvitamin D[25(OH)D]concentrations were determined via chemiluminescence immunoassay. Multivariate logistic regression analysis was conducted to analyze the potential influencing factors for osteoporosis among the rural elderly. Results A total of 582 individuals were enrolled, comprising 259 males and 323 females, with a mean age of (68.6±5.8) years. The prevalence of osteoporosis in this cohort was 25.60% (149/582). The mean scores for osteoporosis-related knowledge, attitude, and practice were (12.36±3.33), (24.08±5.45), and (28.15±6.19), respectively. The mean serum 25(OH)D concentration was (33.87 ± 14.49) ng/mL;335 participants (57.56%) exhibited normal vitamin D levels, while 247 (42.44%) were deficient. The multivariate logistic regression analysis identified several risk factors for osteoporosis: age ≥70 years (OR=16.793), a history of fractures (OR=5.308), lack of regular outdoor activity (OR=2.540), serum vitamin D deficiency (OR=24.674), absence of regular calcium supplementation (OR=3.360), low osteoporosis-related knowledge scores (OR=6.473), and low osteoporosis prevention and management practice scores (OR=2.448). Conversely, a BMI<18.5 kg/m² (OR=0.015) and a BMI of 18.5 to<24.0 kg/m² (OR=0.214) were identified as protective factors (all P<0.05). Conclusion The prevalence of osteoporosis is high among the elderly population in rural southern Sichuan. The prevention of osteoporosis may be enhanced by improving health literacy, maintaining an optimal body mass index (BMI), increasing outdoor physical activity, and ensuring adequate calcium supplementation.

Key words: Osteoporosis, Health literacy, Bone mineral density, Vitamin D, Southern Sichuan, Elderly population