久坐行为与身体活动对骨质疏松影响的研究进展

摘要/Abstract

摘要：

骨质疏松症引发脆性骨折、慢性疼痛和失能，已成为全球重大公共卫生负担之一。久坐行为时间延长和身体活动水平下降，是骨质疏松症发病及病情进展的关键可逆危险因素。本文系统梳理骨质疏松症在骨折风险、身体疼痛、日常活动受限以及心理社会负担等多维度健康影响，分析久坐行为和身体活动对其发病与进展的影响，并以能力-机会-动机-行为模型归纳出骨质疏松症患者久坐行为三大关键因素，包括能力、机会和动机。旨在为今后制定科学、有效、针对骨质疏松症患者久坐并增加身体活动的干预策略提供参考。

关键词: 骨质疏松症, 久坐行为, 身体活动, 行为改变轮, 影响因素, 综述

Abstract:

Osteoporosis，which causes fragility fractures，chronic pain，and disability，has become one of the major public health burdens worldwide. Prolonged sedentary time and declining physical activity levels are key modifiable risk factors for both the incidence and progression of osteoporosis. This article provides a systematic review and analysis of the multidimensional health impacts of osteoporosis，encompassing fracture risk，somatic pain，limitations in activities of daily living，and psychosocial sequelae. It also examines how sedentary behavior and physical activity influence its onset and progression. Guided by the capability-opportunity-motivation-behaviour（COM-B） model，we identify three overarching determinants of sedentary behavior in osteoporosis patients，including capability，opportunity and motivation. Intended to provide reference for the development of scientific，effective and targeted interventions that reduce sedentary time and increase physical activity in osteoporosis patients in the future.

Key words: Osteoporosis, Sedentary behavior, Physical activity, Behavior change wheel, Influencing factors, Review

中图分类号:

R181.3+7

刘艺, 董正惠, 张衬欣, 张莉萍, 马娴. 久坐行为与身体活动对骨质疏松影响的研究进展. [J]职业与健康, 2026, 42(19): 2727-2731.

LIU Yi, DONG Zhenghui, ZHANG Chenxin, ZHANG Liping, MA Xian. Research progress on the effects of sedentary behavior and physical activity on osteoporosis. [J]OCCUPATION AND HEALTH, 2026, 42(19): 2727-2731.

参考文献 48

[1]	KANIS J A, MELTON L J, CHRISTIANSEN C, et al. The diagnosis of osteoporosis[J]. J Bone Miner Res, 1994, 9(8):1137-1141. DOI URL
[2]	SALARI N, GHASEMI H, MOHAMMADI L, et al. The global prevalence of osteoporosis in the world:A comprehensive systematic review and meta-analysis[J]. J Orthop Surg Res, 2021, 16(1):609. DOI
[3]	朱洁云, 高敏, 宋秋韵, 等. 中国老年人骨质疏松患病率的Meta分析[J]. 中国全科医学, 2022, 25(3):346-353.
[4]	WILSON S, SHARP C A, DAVIE M W J. Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture:A systematic review[J]. Osteoporos Int, 2012, 23(12):2749-2768. DOI URL
[5]	国际骨质疏松基金会. 骨质疏松症欧洲记分卡:英国分册-英国骨质疏松症的流行病学、负担和治疗情况[EB/OL].(2021)[2025-06-30].https://www.osteoporosis.foundation/sites/iofbonehealth/files/scope-2021/UK%20report.pdf.
[6]	LEWIECKI E M, ORTENDAHL J D, VANDERPUYE O J, et al. Healthcare policy changes in osteoporosis can improve outcomes and reduce costs in the United States[J]. J Bone Miner Res Plus, 2019, 3(9):e10192.
[7]	曲艺, 吴晶. 骨质疏松髋部骨折患者医疗资源使用与医疗费用研究[J]. 中国卫生统计, 2016, 33(3):430-432.
[8]	TREMBLAY M S, AUBERT S, BARNES J D, et al. Sedentary behavior research network(SBRN)-terminology consensus project prd outcome[J]. Int J Behav Nutr Phys Act, 2017, 14(1):75-91. DOI URL
[9]	徐帅, 刘静, 徐道明, 等. 久坐行为诱发肌骨系统疾病及运动干预调控机制[J]. 中华骨质疏松和骨矿盐疾病杂志, 2022, 15(2):211-217.
[10]	BULL F C, AL-ANSARI S S, BIDDLE S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour[J]. Br J Sports Med, 2020, 54(24):1451-1462. DOI URL
[11]	PINHEIRO M B, OLIVEIRA J, BAUMAN A, et al. Evidence on physical activity and osteoporosis prevention for people aged 65+ years:A systematic review to inform the WHO guidelines on physical activity and sedentary behaviour[J]. Int J Behav Nutr Phys Act, 2020, 17(1):150. DOI
[12]	蓝永生, 张殿禹, 蒋艳杰. 健步走活动指数与老年骨质疏松的相关性[J]. 中国老年学杂志, 2018, 38(15):3697-3698.
[13]	HARVEY N C W, MCCLOSKEY E V, MITCHELL P J, et al. Mind the(treatment) gap:A global perspective on current and future strategies for prevention of fragility fractures[J]. Osteoporos Int, 2017, 28(5):1507-1529. DOI URL
[14]	MICHIE S, VAN STRALEN M M, WEST R. The behaviour change wheel:A new method for characterising and designing behaviour change interventions[J]. Implement Sci, 2011, 6(1):42. DOI URL
[15]	VAN OOSTWAARD M. Osteoporosis and the nature of fragility fracture:an overview[M].//Fragility fracture nursing: Holistic Care and Management of the Orthogeriatric Patient. Cham:Springer,2018:1-13.
[16]	DYER S M, CROTTY M, FAIRHALL N, et al. A critical review of the long-term disability outcomes following hip fracture[J]. BMC Geriatr, 2016, 16(1):158. DOI URL
[17]	WU C Y, TSAI C F, HSU Y H, et al. Exploring mortality risk factors and specific causes of death within 30 days after hip fracture hospitalization[J]. Sci Rep, 2024, 14(1):27544. DOI
[18]	HOLVIK K, ELLINGSEN C L, SOLBAKKEN S M, et al. Cause-specific excess mortality after hip fracture:The norwegian epidemiologic osteoporosis Studies(NOREPOS)[J]. BMC Geriatr, 2023, 23(1):201. DOI
[19]	HERNLUND E, SVEDBOM A, IVERGÅRD M, et al. Osteoporosis in the european union:Medical management,epidemiology and economic burden:A report prepared in collaboration with the international osteoporosis foundation(IOF) and the european federation of pharmaceutical industry associations(EFPIA)[J]. Arch Osteoporos, 2013, 8(1):136. DOI URL
[20]	TANG N, GAO L, SONG J, et al. Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60:A nationwide cross-sectional study[J]. Sci Rep, 2024, 14(1):13319. DOI
[21]	薛春阳, 王秀会. 淫羊藿苷调节酸性微环境减轻绝经后老年骨质疏松性疼痛[J]. 中国组织工程研究, 2024, 28(28):4461-4468.
[22]	BURR J, SHEPHARD R, CORNISH S, et al. Arthritis,osteoporosis,and low back pain:Evidence-based clinical risk assessment for physical activity and exercise clearance[J]. Can Fam Physician, 2012, 58(1):59-62.
[23]	中国老年保健医学研究会老年疼痛疾病分会, 陈建平, 樊碧发, 等. 老年骨质疏松性疼痛诊疗与管理中国专家共识(2024版)[J]. 中国疼痛医学杂志, 2024, 30(4):241-250.
[24]	NAWRAT-SZOŁTYSIK A, MIODO?SKA Z, OPARA J, et al. Effect of physical activity on the quality of life in osteoporotic females living in residential facilities:A randomized controlled trial[J]. J Geriatr Phys Ther, 2019, 42(2):98-104. DOI URL
[25]	中华医学会骨质疏松和骨矿盐疾病学分会, 中华预防医学会健康传播分会. 中国骨质疏松专家意见[J]. 健康世界, 2024, 31(7):8-17.
[26]	BIANCHI M L, ORSINI M R, SARAIFOGER S, et al. Quality of life in post-menopausal osteoporosis[J]. Health Qual Life Outcomes, 2005, 3(1):78. DOI
[27]	MANDL L A, RAJAN M, LIPSCHULTZ R A, et al. The effect of social isolation on 1-year outcomes after surgical repair of low-energy hip fracture[J]. J Orthop Trauma, 2024, 38(4):e149-e156. DOI URL
[28]	刘柯汝, 何耀宇, 王玉环, 等. 社区老年人肌少-骨质疏松症风险预测模型的构建[J]. 护理研究, 2024, 38(24):4333-4340.
[29]	CHEN Y, YU J, LI W, et al. Potential causal association between leisure sedentary behaviors and osteoporosis:A two-sample Mendelian randomization analysis[J]. Medicine, 2024, 103(12):e37467. DOI URL
[30]	WANG X S, CHEN Y, ZHAO Y W, et al. Assessing the association between a sedentary lifestyle and prevalence of primary osteoporosis:A community-based cross-sectional study among Chinese population[J]. BMJ Open, 2024, 14(6):e080243. DOI URL
[31]	YU X, ZHANG Y, HAN P, et al. Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly:A 3-year cohort study[J]. J Int Med Res, 2020, 48(8):0300060520943450.
[32]	GUÐMUNDSDÓTTIR S L, BERGER C, MACDONALD H, et al. Sedentary behavior does not predict low BMD nor fracture-population-based Canadian Multicentre Osteoporosis Study[J]. J Bone Miner Res, 2024, 39(3):231-240. DOI PMID
[33]	RAMSEY K A, ROJER A G M, D'ANDREA L, et al. The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults:A systematic review and meta-analysis[J]. Ageing Res Rev, 2021, 67:101266. DOI URL
[34]	洪金涛, 王晶晶, 李岩松, 等. 久坐与社区老年人下肢肌力:跌倒恐惧与年龄的中介和调节作用[J]. 中国组织工程研究, 2025, 29(17):3566-3571.
[35]	World Health Organization. Global Recommendations on physical activity for health[EB/OL].(2010)[2025-06-30].https://www.who.int/publications/i/item/9789241599979.
[36]	KOHRT W M, BLOOMFIELD S A, LITTLE K D, et al. Physical activity and bone health[J]. Med Sci Sports Exerc, 2004, 36(11):1985-1996. DOI URL
[37]	HEJAZI K, ASKARI R, HOFMEISTER M. Effects of physical exercise on bone mineral density in older postmenopausal women:A systematic review and meta-analysis of randomized controlled trials[J]. Arch Osteoporos, 2022, 17(1):102. DOI
[38]	AOYA L, JUNPENG Z, LI X, et al. Effect of different types of exercise on bone mineral density in postmenopausal women:A systematic review and network meta-analysis[J]. Sci Rep, 2025, 15(1):11740. DOI
[39]	邓介超, 唐海, 刘建泉, 等. Otago运动训练对老年骨质疏松症患者平衡能力和跌倒风险的影响[J]. 中华骨质疏松和骨矿盐疾病杂志, 2022, 15(1):31-35.
[40]	FERRARA P E, SALINI S, MAGGI L, et al. Evaluation of quality of life and static balance in postmenopausal osteoporosis women after Tai Chi Chuan practice:An observational randomized case control study[J]. J Biol Regul Homeost Agents, 2019, 33(2 Suppl.1):163-169.
[41]	GRADY C L, MUIRHEAD F, SKELTON D A, et al. Exploring osteoporosis sufferers knowledge on sedentary behaviour in the management of their disease[J]. J Frailty Sarcopenia Falls, 2021, 6(2):36. DOI URL
[42]	ADACHI J D, IOANNIDIS G, OLSZYNSKI W P, et al. The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women[J]. BMC Musculoskelet Disord, 2002, 3(1):11. DOI URL
[43]	DAI D, XU F, SUN R, et al. Decreased lower-extremity muscle performance is associated with decreased hip bone mineral density and increased estimated fracture risk in community-dwelling postmenopausal women[J]. Arch Osteoporos, 2020, 15(1):173. DOI PMID
[44]	ZIEBART C, MCARTHUR C, LEE L, et al. "Left to my own devices,I don't know":Using theory and patient-reported barriers to move from physical activity recommendations to practice[J]. Osteoporos Int, 2018, 29(5):1081-1091. DOI
[45]	BARNETT A, SMITH B, LORD S R, et al. Community-based group exercise improves balance and reduces falls in at-risk older people:A randomised controlled trial[J]. Age Ageing, 2003, 32(4):407-414. DOI URL
[46]	CHASTIN S F M, MCGREGOR D E, BIDDLE S J H, et al. Striking the right balance:Evidence to inform combined physical activity and sedentary behavior recommendations[J]. J Phys Act Health, 2021, 18(6):631-637. DOI URL
[47]	STOCKWELL S, SCHOFIELD P, FISHER A, et al. Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults:A systematic review and meta-analysis[J]. Exp Gerontol, 2019, 120:68-87. DOI URL
[48]	WALKER R. The Development,implementation,and evaluation of a community-based intervention to increase levels of physical activity among military veterans that are wounded,injured,and/or Sick[D]. Cardiff: Cardiff Metropolitan University, 2021.