Conformation to masculine norms and men’s perceived self-efficacy in osteoporosis management

Men suffer one-third of osteoporosis-related fractures globally. The gendered belief surrounding osteoporosis as a female disease and the influence of male stereotypes impact men’s self-management of osteoporosis. We aimed to explore how gendered beliefs and male stereotypes affect older men's self-efficacy to manage osteoporosis and prevent falls by examining their conformity to societal masculine norms.Men ≥ 60y at high fracture risk, recruited in Canada, completed an online survey. Conformity to masculine norms was ascertained with the Conformity to Masculine Norms Inventory (CMNI) with scores 0-66; subsequently standardized (sCMNI: mean=50, SD=10). Primary outcomes included self-efficacy for osteoporosis management (OSES), calcium intake, exercise participation (subscales of OSES), and falls efficacy (FES-I). Linear and logistic multivariate regression models were calculated to determine the associations between sCMNI and OSES and FES-I considering important co-variables. Two hundred and seven (mean age 71 (SD=7) years) participants completed the survey; all reported male sex at birth and identified as men, with an average CMNI raw score 28(8); 73% had post-secondary education, 86% identified as White, 54% had osteoporosis, 43% experienced ≥ 2 falls in the past year, and 61% had sustained a fracture. Those in the highest sCMNI tertile group tended to report other country of birth than Canada, less years since immigration and being of other race/ethnicity than White. The mean OSES was 781 (SD=209) in the lowest sCMNI tertile vs. 689 (SD=261) in the highest tertile (p=0.02). The median FES-I was 10 (IQR: 8,14) and did not differ between lowest and highest sCMNI tertile groups (p=0.52). Adjusted linear regression models demonstrated that each increase in one unit of sCMNI was significantly associated with a decrease in OSES (-3.22; 95% CI [-5.99, -0.45]) and calcium intake self-efficacy (-1.78; 95% CI [-3.41, -0.14]); there was no association with exercise self-efficacy (Table). In adjusted logistic regression models, sCMNI was not associated with FES-I (OR 1.00, 95% CI [0.96; 1.03]). A significant interaction was noted between sCMNI and the presence of depressive symptoms (p=0.01) on total OSES and calcium intake self-efficacy.We observed an association between conformity to masculine societal norms and osteoporosis management self-efficacy in men at high risk for fracture, even after adjusting for race/ethnicity, income and education. Indeed, those with highest conformity to masculine societal norms report less self-efficacy. Interventions targeting osteoporosis management in older men need to address traditional masculine norms and the presence of depressive symptoms to improve self-efficacy and, consequently, health outcomes

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