The bone health in Sannio rural area: An analysis of free screening

Purpose: Significant gaps persist in osteoporosis prevention and management within rural regions, including limited knowledge, poor access to screening, and inconsistent clinical follow-up. This study investigates risk factors, awareness, personal experiences, and preferences for osteoporosis care among residents of a rural area, with the aim of supporting the development of targeted public health programs. Methods: A mobile screening project was carried out across the rural Sannio area, excluding the city of Benevento. Adults were invited to participate in a three-phase assessment: (1) free calcaneal quantitative ultrasound (QUS), (2) semi-structured interviews with medical history collection and calculation of the Fracture Risk Assessment Tool (FRAX) score, and (3) blood and urine tests to assess calcium–phosphorus metabolism. Collected data included diagnoses, risk factors, previous management, and knowledge regarding osteoporosis. Quantitative analyses were performed, including linear and logistic regression, to identify variables associated with prevention awareness and satisfaction with the National Health System. Results: A total of 726 individuals completed the survey. The mean age was 59 years, with a strong female predominance (693 women, 33 men). Overall, 89% had previously undergone osteoporosis screening, and 58.54% reported a diagnosis of osteoporosis. QUS screening identified osteopenia secondary to hypothyroidism in 6% of participants. Among those with a history of gynecological or oncological ablative procedures, 80% were not receiving adequate osteoporosis prophylaxis. Eighteen percent of osteopenia cases were associated with inflammatory bowel disease or celiac disease. Almost all individuals with osteoporosis (90%) underwent screening after a minor fracture. Satisfaction with the initiative was high, with an average 10-year FRAX fracture risk of 14% (±9.7). Conclusion: Three principal themes emerged from qualitative interviews: concerns regarding the adequacy of care in rural settings, a desire for locally accessible and tailored services, and interest in a structured osteoporosis prevention program. These insights may guide future public health initiatives in underserved rural areas.