原发性骨质疏松影响因素及健康干预研究进展
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摘要
骨质疏松症是中老年人的常见病、多发病,其导致的骨折是中老年人致残、病死的主要原因。骨质疏松己严重影响人们的健康水平,成为全球关注的公共卫生热点。骨质疏松症发展特点是"悄无声息",不易察觉。除老年、绝经、疾病和药物等危险因素外,不良的生活方式也是骨质疏松症发生的重要原因。迄今为止,尚无有效根治骨质疏松的方法,有效的健康干预是骨质疏松防治最有效最经济的手段。回顾国内外骨质疏松症流行病学和影响因素研究进展,阐述了骨质疏松的防治现状和健康干预的方法,但是目前尚没有具有地区特点、系统性的预防体系。针对本病受多种因素影响、不良因素隐性堆积导致发病的特点,研究地区人群日常生活习惯,针对性制定预防体系,应将不可控因素和可控因素结合,采取阶段性针对性控制措施及临床路径的方式,合理有效开展预防工作,以期达到节能增效的效果。
Osteoporosis is the most common bone disease in the eldely,Osteoporotic fractures are a principal cause of disability and mortality of the elderly.Osteoporosis has several threatened human health and become a global highlight of public health. Osteoporosis is a "silent"disease that is difficult to detect. Besides agedness,menopause, diseases and drugs, unhealthy lifestyles are also an important factor for osteoporosis.The effective treatment for osteoporosis is still unavailable until now, health intervention is the most effective and economic method for its prevention. The advances in epidemiology and risk factors for osteoporosis were reviewed, and emphasizes the importance of evaluation in health intervention.But at present, there is no systematic prevention system with regional characteristics.In view of the characteristics of osteoporosis caused by various factors, it is necessary to study the daily living habits of the population in the region and formulate a preventive system which combining uncontrollable factors with controllable factors and adopting stage-specific control measures and clinical pathways.The peasonable and effective preventive work need to carry out in order to achieve the effect of energy saving and efficiency increasing.
Osteoporosis is the most common bone disease in the eldely,Osteoporotic fractures are a principal cause of disability and mortality of the elderly.Osteoporosis has several threatened human health and become a global highlight of public health. Osteoporosis is a "silent"disease that is difficult to detect. Besides agedness,menopause, diseases and drugs, unhealthy lifestyles are also an important factor for osteoporosis.The effective treatment for osteoporosis is still unavailable until now, health intervention is the most effective and economic method for its prevention. The advances in epidemiology and risk factors for osteoporosis were reviewed, and emphasizes the importance of evaluation in health intervention.But at present, there is no systematic prevention system with regional characteristics.In view of the characteristics of osteoporosis caused by various factors, it is necessary to study the daily living habits of the population in the region and formulate a preventive system which combining uncontrollable factors with controllable factors and adopting stage-specific control measures and clinical pathways.The peasonable and effective preventive work need to carry out in order to achieve the effect of energy saving and efficiency increasing.
引文
[1]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松诊治指南[J].中华医学会骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[2] ADLER R A,EL-HAJJ FULEIHAN G,BAUER D C,et al.Managing osteoporosis in patients on long-term bisphosphonate treatment:report of a task force of the American society for bone and mineral reserch[J].Bone Miner Res,2016,31(1):16-35.
[3]刘柳,张巧,彭年春,等.贵阳市城区成年人骨质疏松症现状调查[J].中国骨质疏松和骨矿盐疾病杂志,2011,4(2):108-112.
[4] SI L,WINZENBERG TM,JIANG Q,et al.Projection of osteoporosis-related fractures and costs in China:2010-2050[J].Osteoporos Int,2015,26(7):1929-1937.
[5]李冲,李伟华,王亭亭,等.1088李医务人员骨质疏松流行病学研究[J].中国骨质疏松杂志,2015,21(10):1217-1220.
[6]庞丹丹,岳亚杰,徐盼盼,等.骨质疏松影响因素及筛查工具的研究进展[J].中国老年学杂志,2014,11(24):6545-6547.
[7]曲建慧.烟台市牟平区居民骨质疏松流行病学调查[J].海峡预防医学杂志,2017,23(5):44-45.
[8]赵健,郭忠琴,周丽娜,等.骨质疏松在体检人群中的流行情况及影响因素分析[J].中国卫生统计,2014,31(6):1026-1028.
[9]杨春云,邱清芳,翟学君,等.山东省胶东半岛多中心人群骨密度分析[J].中国骨质疏松杂志,2011,17(5):431-434.
[10]刘斌,董芬,任晓岚,等.甘肃省20-80岁和绝经后女性骨质疏松症患病影响因素分析[J].中国骨质疏松杂志,2018,24(5):656-663.
[11]张珍珍,李李,沈莹,等.皖北地区围绝经期女性骨质疏松影响因素调查及健康教育[J].中国全科医学,2013,11(11):1745-1746.
[12]张恒林,谢文凯,羊才丰,等.儋州农村地区老年人群骨质疏松症的患病率及其危险因素分析[J].中国骨质疏松杂志,2017,23(6):812-817.
[13]刘凤英,郭子宏,冯晴,等.云南省多民族老年人骨质疏松性骨折和驼背的分析[J].中国骨质疏松杂志,2002,8(3):237-241.
[14]杨通宇,陈新春,刘照时,等.少数民族地区农村女性骨质疏松患病及影响因素分析[J].中国公共卫生,2016,32(3):266-269.
[15] SANO M,INUOE S,HOSOI T,et al. Association of estrogen receptor dinucleotide repeat polymorphism with osteoporosis[J].Biochem Biophys Res Commun,1995,217(1):378-83.
[16]陈宗玮,彭维杰,周颖,等.雌激素受体α基因TA重复序列多态性与南昌市绝经后妇女骨密度的相关性研究[J].南昌大学学报(医学版),2012; 52(5):1-4.
[17]秦正积,杨坚波,庄勋,等.无锡市居民骨质疏松影响因素分析[J].中国公共卫生,2015,31(5):545-549.
[18]欧阳钢,唐曦,葛伟,等.维生素D对骨质疏松相关性因素—肠钙吸收影响的研究进展[J].中国老年学杂志,2013,33(7):1707-1709.
[19] HANNAN N T. Effect of dietary Protein on bone loss in elderly man and women:the Framingham osteoporosis study[J].Bone Miner Res,2000,15(5):2504-2512.
[20]赵春燕.个体化营养健康教育对中老年骨质疏松患者知信行及骨密度的影响[D].唐山:华北理工大学,2016.
[21]李煜,上官昌跃,马洪林,等.老年男性骨质疏松症的影响因素研究[J].中国现代医学杂志,2017,27(7):99-102.
[22]李煜,李洁颖,马洪林,等.锦州地区绝经后妇女骨质疏松症的影响因素研究[J].现代预防医学,2016,43(18):3327-3331.
[23]柯务.体重指数与男性骨质疏松关系的研究素研究[J].中国现代医生,2013,51(21):25-26.
[24]李冲,李伟华,王亭亭,等.1088例医务人员骨质疏松流行病学研究[J].中国骨质疏松杂志,2015,21(10):1217-1220.
[25] KEMMLER W,H BERLE L,VON STENGEL S. Effects of exercise on fracture reduction in older adults:a systematic review and meta-analysis[J].Osteoporos Int,2013,24(7):1937-1950.
[26]徐紫君,崔颖超,吕诚,等.骨质疏松患者健康行为干预模型和理论[J].上海交通大学学报(医学版),2017,37(1):118-133.
[27]周建烈,刘忠厚.补充钙和维生素D防治骨质疏松症的全球临床指南进展[J].中国骨质疏松杂志,2017,23(3):371-377.
[28]代洪宾,胡靖.骨质疏松性骨折外科治疗进展[J].社区医学杂志,2010,16(7):529-532.
[29]王晓光,孙运德.骨质疏松药物治疗研究进展[J].中国医药,2012,7(5):652-654.
[30]邹双伟,王大伟,何英敏,等.绝经期妇女骨质疏松症治疗依从性调查分析及干预对策[J].中国妇幼保健,2011,26(33):5211-5212.
[31]李军,祝勇刚,薛宝宝等.老年骨折患者对骨质疏松知识认知程度及健康教育需求调查分析[J].解放军预防医学杂志,2017,35(8):986-988.
[32]张锐,张邢伟,冯国和,等.骨质疏松症健康教育效果评价的研究进展[J].护理学杂志,2014,29(24):80-82.
[33]邓珍良,周笑珍.健康教育对老年性骨质疏松病人辅助治疗的效果观察[J].全科护理,2009,12(64):3207-3208.
[34]陈玉燕,林桂娥.护理干预在老年人骨质疏松患者中的应用[J].护理实践与研究,2017,14(4):49-50.
[35] MOYER V A. Vitamin D and calcium supplementation to prevent fractures in adults:U.S. Preventive Services Task Force recommendation statement[J].Ann Intern Med,2013,158(9):691-696.
[36] G USZKO P,LORENC R S,KARCZMAREWICZ E,et al. Polish guidelines for the diagnosis and management of osteoporosis:a review[J].Pol Arch Med Wewn,2014,124(5):255-263.
[37] HOLICK M F,BINKLEY N C,BISHOFF FERRARI H A,et al. Evaluation,treatment and prevention of vitamin D deficiency:an endocrine society clinical practice guideline[J].Clin Endocrinol Metab,2011,96(7):1911-1930.
[38] TAKACS I,BENKO I,TOLDY E,et al. Hungarian consensus regarding the role of vitamin D in the prevention and treatment of diseases[J].Orv Hetil,2012,153(Suppl):5-26.
[39]熊艳文,康劲松,李长振.绝经妇女骨质疏松症保健干预的状况分析[J],中国妇幼保健,2013,28(35):5835-5836.
[40]AILINGER R L,BRAUN MA. Revision of the facts on osteoporosis quiz[J]. Nurs Res,2008,52(3):198-201.
[41]王卓群,杨静.我国老年人跌倒的危险因素及预防措施[J].中国社区医师,2006,22(312):46-47.
[42]COLEMAN C I,LIMONE B,SOBIERAJ D M,et al. Dosing frequency and medication adherence in chronic disease[J]. Manag Care Pharm,2012,18(7):527-539.
[43]刘海容,王亮,曹敏,等.建立骨质疏松俱乐部为平台的健康教育新模式[J].中国骨质疏松杂志,2010,16(4):279-281.
[44]王亮,马远征,刘海容,等.骨质疏松健康教育新模式探讨[J].中华老年多器官疾病杂志,2011,10(5):393-396.
[45]罗展鹏,马远征,王亮,等.基于数字化平台的持续化骨质疏松健康管理对生活习惯、药物依从性的长期影响[J].中国骨质疏松杂志,2017,23(3):337-340.
[2] ADLER R A,EL-HAJJ FULEIHAN G,BAUER D C,et al.Managing osteoporosis in patients on long-term bisphosphonate treatment:report of a task force of the American society for bone and mineral reserch[J].Bone Miner Res,2016,31(1):16-35.
[3]刘柳,张巧,彭年春,等.贵阳市城区成年人骨质疏松症现状调查[J].中国骨质疏松和骨矿盐疾病杂志,2011,4(2):108-112.
[4] SI L,WINZENBERG TM,JIANG Q,et al.Projection of osteoporosis-related fractures and costs in China:2010-2050[J].Osteoporos Int,2015,26(7):1929-1937.
[5]李冲,李伟华,王亭亭,等.1088李医务人员骨质疏松流行病学研究[J].中国骨质疏松杂志,2015,21(10):1217-1220.
[6]庞丹丹,岳亚杰,徐盼盼,等.骨质疏松影响因素及筛查工具的研究进展[J].中国老年学杂志,2014,11(24):6545-6547.
[7]曲建慧.烟台市牟平区居民骨质疏松流行病学调查[J].海峡预防医学杂志,2017,23(5):44-45.
[8]赵健,郭忠琴,周丽娜,等.骨质疏松在体检人群中的流行情况及影响因素分析[J].中国卫生统计,2014,31(6):1026-1028.
[9]杨春云,邱清芳,翟学君,等.山东省胶东半岛多中心人群骨密度分析[J].中国骨质疏松杂志,2011,17(5):431-434.
[10]刘斌,董芬,任晓岚,等.甘肃省20-80岁和绝经后女性骨质疏松症患病影响因素分析[J].中国骨质疏松杂志,2018,24(5):656-663.
[11]张珍珍,李李,沈莹,等.皖北地区围绝经期女性骨质疏松影响因素调查及健康教育[J].中国全科医学,2013,11(11):1745-1746.
[12]张恒林,谢文凯,羊才丰,等.儋州农村地区老年人群骨质疏松症的患病率及其危险因素分析[J].中国骨质疏松杂志,2017,23(6):812-817.
[13]刘凤英,郭子宏,冯晴,等.云南省多民族老年人骨质疏松性骨折和驼背的分析[J].中国骨质疏松杂志,2002,8(3):237-241.
[14]杨通宇,陈新春,刘照时,等.少数民族地区农村女性骨质疏松患病及影响因素分析[J].中国公共卫生,2016,32(3):266-269.
[15] SANO M,INUOE S,HOSOI T,et al. Association of estrogen receptor dinucleotide repeat polymorphism with osteoporosis[J].Biochem Biophys Res Commun,1995,217(1):378-83.
[16]陈宗玮,彭维杰,周颖,等.雌激素受体α基因TA重复序列多态性与南昌市绝经后妇女骨密度的相关性研究[J].南昌大学学报(医学版),2012; 52(5):1-4.
[17]秦正积,杨坚波,庄勋,等.无锡市居民骨质疏松影响因素分析[J].中国公共卫生,2015,31(5):545-549.
[18]欧阳钢,唐曦,葛伟,等.维生素D对骨质疏松相关性因素—肠钙吸收影响的研究进展[J].中国老年学杂志,2013,33(7):1707-1709.
[19] HANNAN N T. Effect of dietary Protein on bone loss in elderly man and women:the Framingham osteoporosis study[J].Bone Miner Res,2000,15(5):2504-2512.
[20]赵春燕.个体化营养健康教育对中老年骨质疏松患者知信行及骨密度的影响[D].唐山:华北理工大学,2016.
[21]李煜,上官昌跃,马洪林,等.老年男性骨质疏松症的影响因素研究[J].中国现代医学杂志,2017,27(7):99-102.
[22]李煜,李洁颖,马洪林,等.锦州地区绝经后妇女骨质疏松症的影响因素研究[J].现代预防医学,2016,43(18):3327-3331.
[23]柯务.体重指数与男性骨质疏松关系的研究素研究[J].中国现代医生,2013,51(21):25-26.
[24]李冲,李伟华,王亭亭,等.1088例医务人员骨质疏松流行病学研究[J].中国骨质疏松杂志,2015,21(10):1217-1220.
[25] KEMMLER W,H BERLE L,VON STENGEL S. Effects of exercise on fracture reduction in older adults:a systematic review and meta-analysis[J].Osteoporos Int,2013,24(7):1937-1950.
[26]徐紫君,崔颖超,吕诚,等.骨质疏松患者健康行为干预模型和理论[J].上海交通大学学报(医学版),2017,37(1):118-133.
[27]周建烈,刘忠厚.补充钙和维生素D防治骨质疏松症的全球临床指南进展[J].中国骨质疏松杂志,2017,23(3):371-377.
[28]代洪宾,胡靖.骨质疏松性骨折外科治疗进展[J].社区医学杂志,2010,16(7):529-532.
[29]王晓光,孙运德.骨质疏松药物治疗研究进展[J].中国医药,2012,7(5):652-654.
[30]邹双伟,王大伟,何英敏,等.绝经期妇女骨质疏松症治疗依从性调查分析及干预对策[J].中国妇幼保健,2011,26(33):5211-5212.
[31]李军,祝勇刚,薛宝宝等.老年骨折患者对骨质疏松知识认知程度及健康教育需求调查分析[J].解放军预防医学杂志,2017,35(8):986-988.
[32]张锐,张邢伟,冯国和,等.骨质疏松症健康教育效果评价的研究进展[J].护理学杂志,2014,29(24):80-82.
[33]邓珍良,周笑珍.健康教育对老年性骨质疏松病人辅助治疗的效果观察[J].全科护理,2009,12(64):3207-3208.
[34]陈玉燕,林桂娥.护理干预在老年人骨质疏松患者中的应用[J].护理实践与研究,2017,14(4):49-50.
[35] MOYER V A. Vitamin D and calcium supplementation to prevent fractures in adults:U.S. Preventive Services Task Force recommendation statement[J].Ann Intern Med,2013,158(9):691-696.
[36] G USZKO P,LORENC R S,KARCZMAREWICZ E,et al. Polish guidelines for the diagnosis and management of osteoporosis:a review[J].Pol Arch Med Wewn,2014,124(5):255-263.
[37] HOLICK M F,BINKLEY N C,BISHOFF FERRARI H A,et al. Evaluation,treatment and prevention of vitamin D deficiency:an endocrine society clinical practice guideline[J].Clin Endocrinol Metab,2011,96(7):1911-1930.
[38] TAKACS I,BENKO I,TOLDY E,et al. Hungarian consensus regarding the role of vitamin D in the prevention and treatment of diseases[J].Orv Hetil,2012,153(Suppl):5-26.
[39]熊艳文,康劲松,李长振.绝经妇女骨质疏松症保健干预的状况分析[J],中国妇幼保健,2013,28(35):5835-5836.
[40]AILINGER R L,BRAUN MA. Revision of the facts on osteoporosis quiz[J]. Nurs Res,2008,52(3):198-201.
[41]王卓群,杨静.我国老年人跌倒的危险因素及预防措施[J].中国社区医师,2006,22(312):46-47.
[42]COLEMAN C I,LIMONE B,SOBIERAJ D M,et al. Dosing frequency and medication adherence in chronic disease[J]. Manag Care Pharm,2012,18(7):527-539.
[43]刘海容,王亮,曹敏,等.建立骨质疏松俱乐部为平台的健康教育新模式[J].中国骨质疏松杂志,2010,16(4):279-281.
[44]王亮,马远征,刘海容,等.骨质疏松健康教育新模式探讨[J].中华老年多器官疾病杂志,2011,10(5):393-396.
[45]罗展鹏,马远征,王亮,等.基于数字化平台的持续化骨质疏松健康管理对生活习惯、药物依从性的长期影响[J].中国骨质疏松杂志,2017,23(3):337-340.