title: Mediating effects on health-related quality of life in adults with osteoporosis: a structural equation modeling.
abstract: Participants with physical limitation and high degree of pain had poor mental and physical health-related quality of life. In addition, the more support and exercise that the participants had, the more likely they were to report better health-related quality of life.
  
  
  BACKGROUND
  Osteoporosis is a public health threat worldwide. The aim of this study is to examine the effects of individual demographics, disease characteristics, and social support on health-related quality of life (HrQoL) of adults with osteoporosis. Most psychosocial studies focused on the relationships but not the specific construct of social support on HrQoL.
  
  
  METHODS
  In a correlational design, face-to-face, structured interviews were employed to collect information. Study questionnaires included a demographic sheet, the modified Social Support Inventory, and the Short-Form 36 scales on a convenience sample of 161 individuals recruited from four outpatient centers. Using the structural equation modeling approach, all relationships among factors, mediators, and HrQoL were analyzed.
  
  
  RESULTS
  The mean duration of osteoporosis was longer than 5 years. Participants who exercised more than three times per week had greater HrQoL than individuals who exercised less frequently. Participants with physical limitation and high degree of pain had poor mental and physical HrQoL. The more support that the participants perceived, the more likely they were to report better HrQoL. The best fitted structural equation modeling (SEM) model included individual demographics and physical function, and social support as significant predictors on HrQoL, with informational support and physical function acting as mediators in those relationships. Moreover, this structural model explained 35, 42, and 40 % of the variance on activity of daily living (ADL), physical, and mental health-related quality of life.
  
  
  CONCLUSIONS
  The more informational support that individuals have, the more likely they were to report better HrQoL. Individuals with osteoporosis who have lower pain and more exercise are considered having better HrQoL. Further longitudinal research will help clarify the direction of these relationships.
authors.affiliation: Department of Nursing, I-Shou University, No. 8, Yida Rd, Yanchao district, Kaohsiung, 82445, Taiwan, chiung.huang@gmail.com.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Huang
authors.forename: L-C
authors.initials: LC
authors.lastname: Liao
authors.forename: K-M
authors.initials: KM
authors.lastname: Tong
authors.forename: H-L
authors.initials: HL
authors.lastname: Lai
authors.forename: W-K
authors.initials: WK
authors.lastname: Chen
authors.forename: C-I
authors.initials: CI
authors.lastname: Chen
authors.forename: C-Y
authors.initials: CY
authors.lastname: Lu
authors.forename: F-J
authors.initials: FJ
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010024:Osteoporosis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D011594:Psychometrics; D011788:Quality of Life; D012944:Social Support; D012959:Socioeconomic Factors