原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理專家共識(shí)

原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理專家共識(shí)一、本文概述Overviewofthisarticle隨著人口老齡化的加劇和生活方式的改變，原發(fā)性骨質(zhì)疏松癥（PrimaryOsteoporosis，簡(jiǎn)稱PO）已成為全球范圍內(nèi)日益嚴(yán)重的公共衛(wèi)生問題。作為一種以骨量減少、骨組織微結(jié)構(gòu)破壞、骨脆性增加為特征的全身性骨骼疾病，PO不僅影響患者的生活質(zhì)量，還可能導(dǎo)致骨折等嚴(yán)重并發(fā)癥，甚至危及生命。因此，對(duì)PO患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理顯得尤為重要。Withtheintensificationofpopulationagingandchangesinlifestyle,primaryosteoporosis(PO)hasbecomeanincreasinglyseriouspublichealthproblemonaglobalscale.Asasystemicskeletaldiseasecharacterizedbydecreasedbonemass,destructionofbonetissuemicrostructure,andincreasedbonefragility,POnotonlyaffectsthequalityoflifeofpatients,butmayalsoleadtoseriouscomplicationssuchasfractures,andevenendangerlife.Therefore,nutritionalandexercisemanagementforPOpatientsisparticularlyimportant.營(yíng)養(yǎng)是維持骨骼健康的基礎(chǔ)，而運(yùn)動(dòng)則是增強(qiáng)骨骼強(qiáng)度、預(yù)防骨折的有效手段。然而，關(guān)于PO患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理，目前國(guó)內(nèi)外尚缺乏統(tǒng)一的標(biāo)準(zhǔn)和規(guī)范。為了提高PO患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理水平，我們組織專家團(tuán)隊(duì)，結(jié)合國(guó)內(nèi)外最新研究成果和臨床實(shí)踐，制定了本《原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理專家共識(shí)》。Nutritionisthefoundationformaintainingbonehealth,whileexerciseisaneffectivemeanstoenhancebonestrengthandpreventfractures.However,thereiscurrentlyalackofunifiedstandardsandnormsforthenutritionandexercisemanagementofPOpatientsbothdomesticallyandinternationally.InordertoimprovethenutritionandexercisemanagementlevelofPOpatients,weorganizedateamofexperts,combinedwiththelatestresearchresultsandclinicalpracticesathomeandabroad,todevelopthis"ExpertConsensusonNutritionandExerciseManagementforPrimaryOsteoporosisPatients".本共識(shí)旨在為臨床醫(yī)生、營(yíng)養(yǎng)師、康復(fù)師等相關(guān)人員提供一套科學(xué)、實(shí)用的營(yíng)養(yǎng)和運(yùn)動(dòng)管理指導(dǎo)方案，幫助PO患者改善營(yíng)養(yǎng)狀況、增強(qiáng)骨骼健康、預(yù)防骨折等并發(fā)癥。我們也希望通過(guò)本共識(shí)的推廣，促進(jìn)PO患者營(yíng)養(yǎng)和運(yùn)動(dòng)管理的規(guī)范化、標(biāo)準(zhǔn)化，為PO的防治工作貢獻(xiàn)力量。Thisconsensusaimstoprovideascientificandpracticalnutritionandexercisemanagementguidanceplanforclinicaldoctors,nutritionists,rehabilitationprofessionals,andotherrelatedpersonnel,helpingPOpatientsimprovetheirnutritionalstatus,enhancebonehealth,andpreventcomplicationssuchasfractures.WealsohopetopromotethestandardizationandnormalizationofnutritionandexercisemanagementforPOpatientsthroughthepromotionofthisconsensus,andcontributetothepreventionandtreatmentofPO.二、營(yíng)養(yǎng)管理Nutritionmanagement原發(fā)性骨質(zhì)疏松癥的營(yíng)養(yǎng)管理對(duì)于疾病的防治至關(guān)重要。營(yíng)養(yǎng)素的攝入與骨骼健康密切相關(guān)，因此，合理的飲食結(jié)構(gòu)和營(yíng)養(yǎng)補(bǔ)充是預(yù)防和治療骨質(zhì)疏松癥的重要手段。Thenutritionalmanagementofprimaryosteoporosisiscrucialforthepreventionandtreatmentofthedisease.Theintakeofnutrientsiscloselyrelatedtobonehealth,therefore,areasonabledietarystructureandnutritionalsupplementationareimportantmeansofpreventingandtreatingosteoporosis.鈣的攝入：鈣是構(gòu)成骨骼的主要成分，對(duì)于維持骨密度和預(yù)防骨折具有重要作用。建議原發(fā)性骨質(zhì)疏松癥患者每日攝入1000-1200mg的鈣，可通過(guò)食物或補(bǔ)充劑形式攝入。富含鈣的食物包括牛奶、奶制品、豆制品、深綠色葉菜等。Calciumintake:Calciumisthemaincomponentofbonesandplaysanimportantroleinmaintainingbonedensityandpreventingfractures.Itisrecommendedthatpatientswithprimaryosteoporosisconsume1000-1200mgofcalciumdaily,whichcanbeconsumedthroughfoodorsupplements.Foodsrichincalciumincludemilk,dairyproducts,soyproducts,darkgreenleafyvegetables,etc.維生素D的補(bǔ)充：維生素D有助于鈣的吸收和利用，對(duì)于維持骨骼健康至關(guān)重要。建議原發(fā)性骨質(zhì)疏松癥患者每日攝入400-800IU的維生素D。除了陽(yáng)光照射，食物中的維生素D來(lái)源包括魚肝油、蛋黃、奶制品等。VitaminDsupplementation:VitaminDhelpswiththeabsorptionandutilizationofcalcium,whichiscrucialformaintainingbonehealth.Itisrecommendedthatpatientswithprimaryosteoporosisconsume400-800IUofvitaminDdaily.Inadditiontosunlightexposure,thesourcesofvitaminDinfoodincludefishliveroil,eggyolks,dairyproducts,etc.蛋白質(zhì)的攝入：適量的蛋白質(zhì)攝入有助于維持肌肉和骨骼的健康。然而，過(guò)高的蛋白質(zhì)攝入可能增加鈣的流失，因此建議原發(fā)性骨質(zhì)疏松癥患者適量攝入優(yōu)質(zhì)蛋白質(zhì)，如魚、瘦肉、豆類等。Proteinintake:Moderateproteinintakehelpsmaintainmuscleandbonehealth.However,excessiveproteinintakemayincreasecalciumloss,soitisrecommendedthatpatientswithprimaryosteoporosisconsumehigh-qualityproteininmoderation,suchasfish,leanmeat,beans,etc.其他營(yíng)養(yǎng)素的補(bǔ)充：除了鈣和維生素D，其他營(yíng)養(yǎng)素如磷、鎂、鋅、銅等也對(duì)骨骼健康有重要作用。建議原發(fā)性骨質(zhì)疏松癥患者保持均衡飲食，攝入各種營(yíng)養(yǎng)素。Supplementingwithothernutrients:InadditiontocalciumandvitaminD,othernutrientssuchasphosphorus,magnesium,zinc,copper,etc.alsoplayanimportantroleinbonehealth.Itisrecommendedthatpatientswithprimaryosteoporosismaintainabalanceddietandconsumevariousnutrients.在營(yíng)養(yǎng)管理的過(guò)程中，個(gè)性化飲食計(jì)劃和營(yíng)養(yǎng)補(bǔ)充方案應(yīng)根據(jù)患者的具體情況進(jìn)行調(diào)整。對(duì)于存在營(yíng)養(yǎng)不良或特殊飲食需求的患者，應(yīng)在專業(yè)醫(yī)師或營(yíng)養(yǎng)師的指導(dǎo)下進(jìn)行營(yíng)養(yǎng)管理。營(yíng)養(yǎng)教育與宣傳也是提高患者自我管理能力的重要手段，有助于促進(jìn)患者的康復(fù)和生活質(zhì)量的提高。Intheprocessofnutritionalmanagement,personalizeddietaryplansandnutritionalsupplementationplansshouldbeadjustedaccordingtothespecificsituationofpatients.Forpatientswithmalnutritionorspecialdietaryneeds,nutritionalmanagementshouldbecarriedoutundertheguidanceofprofessionalphysiciansornutritionists.Nutritioneducationandpromotionarealsoimportantmeanstoimprovepatients'self-managementabilities,whichcanhelppromotetheirrecoveryandimprovetheirqualityoflife.三、運(yùn)動(dòng)管理Sportsmanagement對(duì)于原發(fā)性骨質(zhì)疏松癥患者，運(yùn)動(dòng)管理是一項(xiàng)至關(guān)重要的干預(yù)措施。運(yùn)動(dòng)不僅能提高骨骼肌的力量和耐力，還能促進(jìn)骨骼健康，提高骨密度，減少骨折風(fēng)險(xiǎn)。Forpatientswithprimaryosteoporosis,exercisemanagementisacrucialinterventionmeasure.Exercisecannotonlyimprovethestrengthandenduranceofskeletalmuscles,butalsopromotebonehealth,increasebonedensity,andreducetheriskoffractures.骨質(zhì)疏松癥患者應(yīng)選擇低沖擊性、負(fù)重性的運(yùn)動(dòng)，如散步、慢跑、游泳、瑜伽和太極等。這些運(yùn)動(dòng)能夠增強(qiáng)骨骼和肌肉的力量，提高身體的協(xié)調(diào)性，減少跌倒的風(fēng)險(xiǎn)。同時(shí)，對(duì)于骨折風(fēng)險(xiǎn)較高的患者，應(yīng)避免進(jìn)行高沖擊性的運(yùn)動(dòng)，如跳躍、籃球等。Patientswithosteoporosisshouldchooselowimpact,weight-bearingexercisessuchaswalking,jogging,swimming,yoga,andTaiChi.Theseexercisescanenhancethestrengthofbonesandmuscles,improvebodycoordination,andreducetheriskoffalls.Meanwhile,forpatientswithahigherriskoffractures,high-impactexercisessuchasjumpingandbasketballshouldbeavoided.運(yùn)動(dòng)強(qiáng)度應(yīng)根據(jù)患者的身體狀況和耐受能力進(jìn)行調(diào)整。一般來(lái)說(shuō)，中等強(qiáng)度的運(yùn)動(dòng)（如快走、慢跑）對(duì)患者最為適宜。運(yùn)動(dòng)頻率建議每周至少進(jìn)行3-5次，每次持續(xù)30-60分鐘。對(duì)于剛開始運(yùn)動(dòng)的患者，可以從低強(qiáng)度、短時(shí)間開始，逐漸增加運(yùn)動(dòng)強(qiáng)度和時(shí)間。Theintensityofexerciseshouldbeadjustedaccordingtothepatient'sphysicalconditionandtolerance.Generallyspeaking,moderateintensityexercise(suchasbriskwalkingandjogging)ismostsuitableforpatients.Itisrecommendedtoexerciseatleast3-5timesaweekfor30-60minuteseachtime.Forpatientswhohavejuststartedexercising,theintensityanddurationofexercisecanbegraduallyincreasedfromlowintensityandshortduration.在運(yùn)動(dòng)過(guò)程中，患者應(yīng)保持身體平衡，避免跌倒和受傷。同時(shí)，骨質(zhì)疏松癥患者容易出現(xiàn)骨折，因此在運(yùn)動(dòng)前應(yīng)做好熱身活動(dòng)，穿著合適的運(yùn)動(dòng)鞋，選擇平整、安全的運(yùn)動(dòng)場(chǎng)地?；颊哌€應(yīng)在運(yùn)動(dòng)過(guò)程中保持適當(dāng)?shù)乃趾蜖I(yíng)養(yǎng)攝入，以維持身體的正常功能。Duringexercise,patientsshouldmaintainbodybalanceandavoidfallsandinjuries.Atthesametime,patientswithosteoporosisarepronetofractures,sowarm-upactivitiesshouldbedonebeforeexercise,appropriatesportsshoesshouldbeworn,andaflatandsafesportsfieldshouldbechosen.Patientsshouldalsomaintainappropriatewaterandnutrientintakeduringexercisetomaintainnormalbodyfunction.對(duì)于骨質(zhì)疏松癥患者，運(yùn)動(dòng)與藥物治療應(yīng)相互結(jié)合，以達(dá)到最佳的治療效果。在運(yùn)動(dòng)管理的患者應(yīng)根據(jù)醫(yī)生的建議，按時(shí)服用抗骨質(zhì)疏松藥物，如鈣劑、維生素D等。通過(guò)運(yùn)動(dòng)與藥物的結(jié)合，可以更好地改善骨骼健康狀況，降低骨折風(fēng)險(xiǎn)。Forpatientswithosteoporosis,exerciseandmedicationshouldbecombinedtoachievethebesttreatmenteffect.Patientsinexercisemanagementshouldtakeantiosteoporosisdrugs,suchascalciumsupplementsandvitaminD,ontimeaccordingtothedoctor'sadvice.Thecombinationofexerciseandmedicationcanbetterimprovebonehealthandreducetheriskoffractures.對(duì)于原發(fā)性骨質(zhì)疏松癥患者來(lái)說(shuō)，合理的運(yùn)動(dòng)管理是提高骨骼健康、減少骨折風(fēng)險(xiǎn)的重要手段?；颊邞?yīng)根據(jù)自身情況選擇合適的運(yùn)動(dòng)類型、強(qiáng)度和頻率，并在運(yùn)動(dòng)過(guò)程中注意安全事項(xiàng)和藥物治療的配合。通過(guò)科學(xué)的運(yùn)動(dòng)管理，我們可以幫助患者更好地管理疾病，提高生活質(zhì)量。Forpatientswithprimaryosteoporosis,reasonableexercisemanagementisanimportantmeanstoimprovebonehealthandreducetheriskoffractures.Patientsshouldchoosetheappropriatetype,intensity,andfrequencyofexercisebasedontheirownsituation,andpayattentiontosafetyprecautionsandmedicationtreatmentduringtheexerciseprocess.Throughscientificexercisemanagement,wecanhelppatientsbettermanagetheirillnessesandimprovetheirqualityoflife.四、綜合管理和建議Comprehensivemanagementandrecommendations對(duì)于原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理，我們強(qiáng)調(diào)綜合性和個(gè)體化原則?；颊邞?yīng)根據(jù)自身情況，結(jié)合醫(yī)生的建議，制定合適的營(yíng)養(yǎng)與運(yùn)動(dòng)計(jì)劃。營(yíng)養(yǎng)方面，患者應(yīng)保持均衡飲食，增加鈣、磷、維生素D等骨健康相關(guān)營(yíng)養(yǎng)素的攝入。適當(dāng)攝入優(yōu)質(zhì)蛋白質(zhì)，如瘦肉、魚、蛋、奶等，有助于增強(qiáng)肌肉力量，改善身體功能。運(yùn)動(dòng)方面，患者應(yīng)根據(jù)自身情況選擇適合的運(yùn)動(dòng)方式，如散步、慢跑、游泳、瑜伽等，以增強(qiáng)肌肉力量、提高骨密度、改善身體協(xié)調(diào)性。運(yùn)動(dòng)過(guò)程中，患者應(yīng)注意安全，避免受傷。Forthenutritionandexercisemanagementofpatientswithprimaryosteoporosis,weemphasizetheprinciplesofcomprehensivenessandindividualization.Patientsshoulddevelopappropriatenutritionandexerciseplansbasedontheirownsituationandincombinationwiththedoctor'sadvice.Intermsofnutrition,patientsshouldmaintainabalanceddietandincreasetheintakeofbonehealth-relatednutrientssuchascalcium,phosphorus,andvitaminD.Moderateintakeofhigh-qualityprotein,suchasleanmeat,fish,eggs,milk,etc.,canhelpenhancemusclestrengthandimprovebodyfunction.Intermsofexercise,patientsshouldchoosesuitableexercisemethodsbasedontheirownsituation,suchaswalking,jogging,swimming,yoga,etc.,toenhancemusclestrength,improvebonedensity,andimprovebodycoordination.Duringexercise,patientsshouldpayattentiontosafetyandavoidinjury.除了營(yíng)養(yǎng)和運(yùn)動(dòng)管理，患者還應(yīng)定期接受醫(yī)生的評(píng)估和指導(dǎo)，及時(shí)調(diào)整治療方案。對(duì)于骨密度明顯下降或骨折風(fēng)險(xiǎn)較高的患者，可考慮使用藥物治療，如鈣劑、維生素D、雙膦酸鹽等?；颊哌€應(yīng)保持良好的生活習(xí)慣，如戒煙限酒、保持充足的睡眠等，以維護(hù)身體健康。Inadditiontonutritionandexercisemanagement,patientsshouldalsoreceiveregularevaluationsandguidancefromdoctors,andadjusttreatmentplansinatimelymanner.Forpatientswithsignificantlydecreasedbonedensityorahigherriskoffractures,medicationsuchascalciumsupplements,vitaminD,andbisphosphonatesmaybeconsideredfortreatment.Patientsshouldalsomaintaingoodlifestylehabits,suchasquittingsmokingandlimitingalcoholconsumption,maintainingsufficientsleep,etc.,tomaintaintheirphysicalhealth.原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理是一個(gè)綜合性的過(guò)程，需要患者、醫(yī)生和社會(huì)的共同努力。通過(guò)制定合理的營(yíng)養(yǎng)計(jì)劃、選擇適合的運(yùn)動(dòng)方式、接受醫(yī)生的評(píng)估和指導(dǎo)，患者可以有效改善骨健康狀況，提高生活質(zhì)量。社會(huì)也應(yīng)加強(qiáng)對(duì)骨質(zhì)疏松癥的認(rèn)識(shí)和宣傳，提高公眾的健康意識(shí)，共同促進(jìn)骨質(zhì)疏松癥防治工作的開展。Thenutritionandexercisemanagementofpatientswithprimaryosteoporosisisacomprehensiveprocessthatrequiresjointeffortsfrompatients,doctors,andsociety.Bydevelopingareasonablenutritionplan,selectingsuitableexercisemethods,andreceivingevaluationandguidancefromdoctors,patientscaneffectivelyimprovetheirbonehealthandqualityoflife.Societyshouldalsostrengthenitsawarenessandpromotionofosteoporosis,raisepublichealthawareness,andjointlypromotethepreventionandtreatmentofosteoporosis.五、結(jié)論Conclusion《原發(fā)性骨質(zhì)疏松癥患者的營(yíng)養(yǎng)和運(yùn)動(dòng)管理專家共識(shí)》強(qiáng)調(diào)了營(yíng)養(yǎng)與運(yùn)動(dòng)在原發(fā)性骨質(zhì)疏松癥治療中的重要作用。對(duì)于患者來(lái)說(shuō)，合理的營(yíng)養(yǎng)攝入和適度的運(yùn)動(dòng)鍛煉是預(yù)防和治療骨質(zhì)疏松癥的重要手段。通過(guò)改善飲食結(jié)構(gòu)，增加鈣、磷、維生素D等關(guān)鍵營(yíng)養(yǎng)素的攝入，以及進(jìn)行適量的負(fù)重運(yùn)動(dòng)和抗阻運(yùn)動(dòng)，可以有效地提高骨密度，增強(qiáng)骨骼的強(qiáng)度和韌性，從而降低骨折的風(fēng)險(xiǎn)。TheExpertConsensusonNutritionandExerciseManagementforPatientswithPrimaryOsteoporosisemphasizestheimportantroleofnutritionandexerciseinthetreatmentofprimaryosteoporosis.Forpatients,reasonablenutrientintakeandmoderateexerciseareimportantmeansofpreventingandtreatingosteoporosis.Byimprovingdietarystructure,increasingtheintakeofkeynutrientssuchascalcium,phosphorus,andvitaminD,aswellasengaginginmoderateweight-bearingandresistanceexercises,bonedensitycanbeeffect