Objective  To examine osteoporosis-related self-efficacy and self-management behavior among middle-aged and elderly residents in Shandong province and to improve evidences for osteoporosis prevention.

  Methods  Using stratified multi-stage random sampling, we conducted a questionnaire survey among 3 134 residents aged ≥ 40 years selected in 5 communities in each of 6 municipalities in Shandong province from December 2016 to March 2017.

  Results  For all the participants, the mean overall score of osteoporosis-related self-efficacy was 63.22 ± 26.49 and the self-efficacy domain scores were 29.40 ± 13.82 for physical exercise and 33.82 ± 14.64 for calcium intake, respectively. Among the participants, the number (ratio) of reporting various osteoporosis-related self-management behaviors were 287 (9.2%) for paying an attention to calcium content on food ingredient labels, 315 (10.1%) for paying an attention to vitamin D (VD) content on food ingredient labels, 935 (29.9%) for consuming food with a high content of calcium, 627 (20.1%) for consuming food with a high content of VD, 1 046 (33.4%) for persisting in healthy lifestyle, and 965 (30.9%) for having an aerobic exercise of at least 30 minutes three times or more in a week, respectively. The total score of self-efficacy increased with the level of osteoporosis-related self-management behaviors significantly among the participants (P < 0.01).

  Conclusion  Osteoporosis-related self-efficacy is at a moderate level but the self-management behavior is poor among the middle-aged and elderly residents in Shandong province, suggesting that measures should be implemented to promote osteoporosis-related self-efficacy for the development of self-management behaviors in the population.