{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T23:24:14Z","timestamp":1781306654007,"version":"3.54.1"},"reference-count":49,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Scholars in HeAlth Research Program"},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Office of Dietary Supplements of the National Institutes of Health","award":["D43 TW009118"],"award-info":[{"award-number":["D43 TW009118"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,21]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Osteoporosis represents a growing public health concern in the Middle East and North Africa (MENA) region, where ageing populations and limited healthcare access contribute to high fracture rates and poor treatment adherence. Despite the existence of clinical practice guidelines, these often lack integration of stakeholder perspectives such as those of patients, healthcare providers, insurers and systems. Understanding knowledge, attitudes and practices (KAP) related to osteoporosis is essential to inform inclusive, culturally relevant strategies for prevention and management. This systematic review aims to evaluate the knowledge, attitudes (preferences) and practices (behaviours) of key stakeholders, including adults aged 50 years and older and healthcare providers, regarding the prevention, diagnosis and treatment of osteoporosis in the MENA region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines, we conducted comprehensive searches of MEDLINE and Embase for studies published from January 1994 to January 2025. Two reviewers independently screened titles, abstracts and full texts in duplicate. Title\/abstract and full-text screening were completed by September 2025. Data extraction will begin in October 2025 and will be performed in duplicate using piloted standardised forms. Risk of bias assessment and data synthesis will follow, using validated design-specific tools and a narrative approach guided by the Synthesis Without Meta-analysis framework. The review was initiated in June 2025, and completion of analysis and manuscript preparation is anticipated in June 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This review synthesises data from publicly available literature and does not involve primary data collection with human participants; therefore, ethics approval is not required. Findings will be disseminated through peer-reviewed publications, conference presentations and deposition of study materials on the Open Science Framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trail registration number<\/jats:title>\n                    <jats:p>\n                      This protocol is registered on the\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/b5h49\">Open Science Framework<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105603","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:51:43Z","timestamp":1763628703000},"page":"e105603","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Knowledge, attitudes, and practices on osteoporosis prevention and treatment strategies in the MENA region: a systematic review protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3635-8141","authenticated-orcid":false,"given":"Youssef","family":"Makarem","sequence":"first","affiliation":[{"name":"Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bshara","family":"Sleem","sequence":"additional","affiliation":[{"name":"Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene Toufic","family":"Chakhtoura","sequence":"additional","affiliation":[{"name":"Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-3291","authenticated-orcid":false,"given":"Ola","family":"El Zein","sequence":"additional","affiliation":[{"name":"Clinical Research Institute, American University of Beirut Faculty of Medicine, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2076-5858","authenticated-orcid":false,"given":"Ghada","family":"El-Hajj Fuleihan","sequence":"additional","affiliation":[{"name":"Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025112000504654000_15.11.e105603.1","doi-asserted-by":"publisher","DOI":"10.1080\/13561820.2021.1973975"},{"key":"2025112000504654000_15.11.e105603.2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.35680\/2372-0247.1561","article-title":"Perceptions of the healthcare system among stakeholders","volume":"8","author":"Markee","year":"2021","journal-title":"Patient Exp J"},{"key":"2025112000504654000_15.11.e105603.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"2025112000504654000_15.11.e105603.4","unstructured":"Developing nice guidelines: the manual. 2015. 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