骨质疏松的健康管理发展现状及挑战

骨质疏松是引起老年人骨质疏松性骨折的主要原因，严重影响患者的生活质量、增加经济负担。引起骨质疏松的主要原因包括骨密度下降、骨组织显微结构的破坏及骨强度减弱等。目前针对骨密度下降这一原因的主要治疗手段是使用抗骨吸收药物(如双膦酸盐类药物、降钙素)、促进骨形成药物(甲状旁腺激素)以及某些中药等，然而药物治疗效果并不理想。尽管可以通过手术进行干预，但依旧存在诸多术后并发症。近年来随着三级预防思想的树立，从一级预防的角度针对高危人群来进行骨质疏松的健康管理成为当前预防骨质疏松症及相关骨折的主流方法。本文主要从骨质疏松健康管理的来源与患者和医务人员的相互关系2个方面简要介绍骨质疏松健康管理的一些措施及其在当前发展中所遇到的挑战。此外，绝经后女性的骨质疏松症主要是由于雌激素减少导致骨密度下降，因而在预防措施上与老年性骨质疏松有所不同，予以分开阐述。进一步的发展目前需要解决我国三级诊疗体系尚不完善的现状并制定出更科学的骨质疏松评定标准以及加强患者对健康管理方案中饮食和生活习惯的依从性等。此外，从雌激素的类型、剂量、持续使用时间以及个体情况等方面改善并发展雌激素在围绝经期女性骨质疏松健康管理中的应用，最终发挥健康管理在骨质疏松症及相关骨折中的一级预防作用。 

Current status and challenges of health management for osteoporosis

Osteoporosis is the main cause of osteoporosis fracture in the elderly, which seriously affects the quality of life of patients and increases economic burden. The main causes of osteoporosis include the decrease of bone density, the destruction of bone microstructure and the decrease of bone strength. At present, the main treatment for decreased bone mineral density is to use anti-bone absorption drugs (such as bisphosphonates, calcitonin), bone formation-promoting drugs (parathyroid hormone) and some traditional Chinese medicine. However, the effect of drug treatment is not ideal. Despite surgical intervention, many complications exist. In recent years, with the establishment of the idea of three-level prevention, the health management of osteoporosis from the perspective of one-level prevention has become the mainstream method to prevent osteoporosis and related fractures. In this study, the source of osteoporosis health management and the relationship between patients and medical staff are introduced briefly, including some measures of osteoporosis health management and the challenges in the current development. In addition, the osteoporosis of postmenopausal women is mainly caused by the decrease of bone density caused by the loss of oestrogen. Thus, its preventive measures are different from those of senile osteoporosis, which should be described separately. The current situation of the three-level diagnosis and treatment system in China needs to be solved, a more scientific evaluation standard of osteoporosis should be developed, and patients' compliance with diet and living habits in the health management plan need to be strengthened. In addition, we should improve and develop the application of oestrogen in the health management of perimenopausal women's osteoporosis from the type, dose, duration and individual situation of estrogen, and finally play the primary preventive role of health management in osteoporosis and related fractures.