Knowledge, Beliefs and Preventive Practices Regarding Osteoporosis: A Cross-Sectional Study in Community Pharmacies in Tunis

<b>Background/Objectives</b>: Osteoporosis represents a major yet underdiagnosed public health concern in developing countries, including Tunisia. Limited awareness, delayed diagnosis, and suboptimal adoption of preventive strategies contribute to increased risk of fragility fractures in aging populations. This study aimed to assess post-pandemic knowledge, attitudes, and preventive practices regarding osteoporosis in the Tunisian general population. <b>Methods</b>: A cross-sectional survey was conducted between February and April 2024 in six randomly selected community pharmacies in Tunis. Adults ≥ 40 years old completed a validated 31-item questionnaire assessing socio-demographic factors, osteoporosis knowledge, risk factors, screening practices, and preventive behaviors. A total of 160 fully completed questionnaires were analyzed using SPSS v22. <b>Results</b>: Only 60.6% of respondents reported awareness of osteoporosis. Knowledge levels were significantly higher in men (8.37 vs. 7.40; <i>p</i> = 0.043), urban residents (8.22 vs. 7.21; <i>p</i> = 0.036), participants with higher education (8.73 vs. 7.00; <i>p</i> < 0.001), those with a family history (8.58 vs. 7.49; <i>p</i> = 0.033), and individuals already diagnosed (9.19 vs. 7.63; <i>p</i> = 0.025). Screening rates were low: only 11.3% had ever undergone DXA testing, despite 18.8% reporting prior fractures. Preventive behaviors were inadequate: 80% did not supplement calcium, 88.1% did not use vitamin D, and 58.8% did not engage in <30 min of daily activity. Osteoporosis was reported by 13.1% of participants and 95.2% of diagnosed cases received treatment, predominantly bisphosphonates (75%). Comorbidities were significantly associated with osteoporosis (24.5% vs. 7.5%; <i>p</i> = 0.003). <b>Conclusions</b>: This study reveals suboptimal awareness, limited access to screening, and insufficient preventive behaviors regarding osteoporosis in Tunisia. Targeted educational initiatives, expansion of DXA availability, adoption of national osteoporosis guidelines, and multidisciplinary stakeholder involvement are critical to improve early detection, prevention, and management in the aging Tunisian population. Furthermore, promoting balanced nutrition that includes calcium- and vitamin D-rich foods, along with appropriate dietary supplementation when needed, is an essential preventive strategy to support optimal bone health and reduce osteoporosis risk in the general population.