摘要目的 探讨健康管理对绝经后骨质疏松及其高危人群干预的作用.方法 300例绝经后妇女经知情同意为观察对象,其中240例为骨最减少,另60例为骨质疏松患者,240例骨量减少患者随机分为两组,骨茸减少管理组(A组)和骨量减少对照组(B组),每组120例.60例骨质疏松患者为骨质疏松管理组(C组).为期1年的随机对照和自身对比研究,A组和C组干预内容包括,每季度进行1次(30 min～1 h)的健康知识讲座、健康问题咨询和健康教育资料发放;生活方式调整包括平衡饮食,日晒(每天30 min～2 h,每周8 h以上),有氧运动(每天30 min～1 h,每周3～5次),每天补充元素钙600 mg和维生素D 125 IU.B组为骨量减少对照组,饮食、运动及生活方式无特殊要求.所有对象每月随访一次,监测内容为信息采集与健康知识知晓率、健康信念持有率、健康行为形成率(健康知信行)指导,分别于干预前和12个月时测量腰椎、髋部总量、股骨颈、Words区、粗隆的骨密度.结果 229例患者1年后得到随访,A组和C组健康知、信、行自身比较优秀率明显提高.骨量变化:A组与B组比较,腰椎骨量变化有显著性提高(0.890±0.142)s/cm2,(0.855±0.138)s/cm2,P=0.0459,腰椎骨量变化值(0.025±0.069/-0.003±0.095,P=0.0016)和髋部骨量变化值(0.015±0.105/-0.004±0.096,P=0.0217)差异均有统计学意义;C组患者健康管理前后自身比较,腰椎和髋部骨量变化差异无统计学意义.结论 以教育和生活方式调整等为目的 的健康管理干预1年,绝经后骨质疏松高危人群的相关危险因素得到了有效的改善,但已患有骨质疏松的患者管理前后骨量未见明显变化.

abstractsObjective To evaluate the effects of an intervention programme of healthcare management, targeted to high-risk osteoporosis subjects and osteoporosis women. Methods Randomized controlled trial with one-year follow-up, carried out in the study. A total of 240 postmenopausal osteopenia women and 60 osteoporosis women were enrolled. The 240 postmenopausal osteopenia subjects were randomized to either the intervention group (A, n = 120) or the control group (B, n = 120), and 60 osteoporosis women were the intervention group (C, n =60). Group A and C: Education program performed once a season for the intervention group, at baseline, the intervention group was given general information about lifestyle and osteoporosis risk. This was done either individually or in one group session (30 min to 1 h), and some printed material was delivered. The message included healthy and balanced diet, exposure to sunlight (30m-2h/d, and more than 8h/w), and respect to physical fitness (30m-1h/d, and more than 3-5 times/w), and supplement calcium 600mg and VitD 125IU daily. Group B: non-intervention controls. Follow- up meetings with doctor were conducted monthly there after. Primary outcomes were anthropometry and changes in levels of health knowledge, health attitude and health practice (KAP). The secondary outcomes were changes in Bone mineral density (BMD). During one year of intervention, BMD was measured by DXA on lumbar spine and proximal femur at pre-intervention, 6 months and 12months after intervention. Results After one year, 229 subjects completed the follow-up. The levels of KAP in the intervention groups (A and C) increased significantly. There were significant differences between group A and group B: BMD on lumbar spine (0.890±0.142) g/cm2, (0.855±0.138)g/cm2, P =0.0459, and the changes of BMD on lumbar spine (0.025±0.069/-0.003±0.095, P = 0.0016) and total hip (0.015 ±0.105/-0.004±0.096, P = 0.0217). In the group C, intervention with healthcare management resulted in no significant improvements in BMD both on lumbar spine and total hip. Conclusion Healthcare management with a focus on health education and health lifestyle counseling followed by structured follow-up meetings can favorably influence several risk factors for osteoporosis and quality of life in high-risk osteoporosis subjects for at least one year. But for osteoporosis women, there was no significant difference of BMD both on lumbar spine and total hip compares pre-intervention after one year.