绝经后骨质疏松高危人群的健康管理干预

An intervention programme of healthcare management on women with high-risk of postmenopausal osteoporosis

目的评价健康管理干预绝经后骨质疏松高危人群的有效作用。方法为期1年的随机对照研究,对象为240名绝经后骨量减少妇女,随机分为两组,干预组(Ⅰ组)和对照组(Ⅱ组),每组120人。Ⅰ组干预内容包括,每季度进行1次(30min～1h)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30min～2h,每周8h以上),有氧运动(每天30min～1h,每周3-5次),每天补充元素钙600mg和维生素D125IU。B组为对照组,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)变化,分别于干预前,干预6个月和12个月时测量腰椎(1-4)、髋部总量、股骨颈、Wards区、粗隆的骨密度。结果 195名患者1年后得到随访,干预组健康知、信、行自身比较优秀率明显提高;骨量变化:干预组与对照组比较,腰椎骨量变化有显著性提高(0.890±0.142g/cm^2/0.855±0.138g/cm^2,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)均有统计学差异。结论经1年以教育和生活方式调整等为目的的健康管理干预,绝经后骨质疏松高危人群的相关危险因素和生活方式得到了有效地改善。

Objective To evaluate the effects of an intervention programme of healthcare management,targeted to high-risk osteoporosis subjects.Methods Randomized controlled trial with one-year follow-up,carried out in The Center of Research for Metabolic Bone Disease of Nanjing.A total of 240 postmenopausal osteopenia women were enrolled. The subjects were randomized to either the intervention group(Ⅰ,n = 120) or the control group(Ⅱ,n = 120). GroupⅠ: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 (30min～1 h),and some printed material was delivered.The message included healthy and balanced diet,exposure to sunlight(30min^2h/d,and more than 8h/w),and respect to physical fitness(30min～1h/d,and more than 3～5 times/w),and supplement calcium 600mg and VitD 125IU daily.GroupⅡ: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,195 subjects completed the follow-up.The levels of KAP in the intervention group increased significantly.There were significant differences between groups:BMD on lumbar spine(0.890±0.142g/cm^2/0.855±0.138g/cm^2,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) .Conclusion A prevention programme of 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.