Đánh giá hiệu quả một số biện pháp can thiệp cộng đồng phòng chống loãng xương ở người từ 45 tuổi trở lên tại thành phố Hồ Chí Minh

1 B GIO DC V O TO B Y T VIN V SINH DCH T TRUNG NG -* NGUYN TRUNG HềA NH GI HIU QU MT S BIN PHP CAN THIP CNG NG PHềNG CHNG LONG XNG NGI T 45 TUI TR LấN TI THNH PH H CH MINH LUN N TIN S Y HC Chuyờn ngnh: V SINH X HI HC V T CHC Y T Mó s: 62 72 01 64 H NI - 2015 B GIO DC V O TO B Y T VIN V SINH DCH T TRUNG NG -* NGUYN TRUNG HềA NH GI HIU QU MT S BIN PHP CAN THIP CNG NG PHềNG CHNG LONG XNG NGI T 45 TUI TR LấN TI THNH PH H CH MINH LUN N TIN S Y HC Chuyờn ngnh: V SINH X HI HC V T CHC Y T Mó s: 62 72 01 64 Hng dn khoa hc PGS.TS NGUYN VN TP GS.TS O VN DNG H NI - 2015 MC LC Mc lc i Danh mc cỏc ch vit tt v Danh mc cỏc bng vii Danh mc cỏc biu x Danh mc cỏc hỡnh, s xi T VN Chng TNG QUAN 1.1 Mt s khỏi nim v bnh loóng xng 1.1.1 nh ngha loóng xng v gim mt xng 1.1.2 Cu trỳc v chc nng ca xng 1.1.3 Sinh lý xng v bnh loóng xng 1.1.4 Nguyờn nhõn v phõn loi loóng xng 1.1.5 Cỏc du hiu lõm sng loóng xng nguyờn phỏt v bin chng 1.1.6 Cỏc xột nghim thm dũ hỡnh nh v chn oỏn loóng xng 1.1.7 iu tr v phũng bnh loóng xng 1.2 T l v mt s yu t liờn quan n loóng xng trờn th gii v Vit Nam 10 1.2.1 T l loóng xng mt s nc trờn th gii 10 1.2.2 T l loóng xng ti Vit Nam 15 1.2.3 Mt s yu t liờn quan n loóng xng 17 1.3 Cỏc bin phỏp phũng chng loóng xng trờn th gii v ti Vit Nam 25 1.3.1 Cỏc bin phỏp phũng chng loóng xng trờn th gii .25 1.3.2 Cỏc bin phỏp phũng chng loóng xng ti Vit Nam 31 1.4 Mt s c im v thnh ph H Chớ Minh 34 Chng I TNG V PHNG PHP NGHIấN CU 35 2.1 i tng nghiờn cu 35 2.1.1 i tng nghiờn cu mụ t ct ngang 35 2.1.2 i tng nghiờn cu can thip .35 2.1.3 Tiờu loi tr chn mu nghiờn cu 35 2.2 a im v thi gian nghiờn cu 35 2.2.1 a im nghiờn cu 35 2.2.2 Mt s c im ca a phng nghiờn cu 36 2.2.3 Thi gian nghiờn cu 37 2.3 Phng phỏp nghiờn cu 37 2.3.1 Thit k nghiờn cu 37 2.3.2 Phng phỏp chn mu 45 2.4 T chc thc hin nghiờn cu 48 2.4.1 Nghiờn cu mụ t 48 2.5 Bin s v cỏc ch s nghiờn cu 50 2.5.1.nh ngha cỏc bin s 50 2.5.2 Cỏc ch s nghiờn cu 55 2.6 K thut hn ch sai s nghiờn cu 57 2.6.1 Hn ch sai s chn mu 57 2.6.3 Hn ch sai s thu thp thụng tin 57 2.7 X lý v phõn tớch s liu 58 2.8 Vn o c nghiờn cu 59 Chng KT QU NGHIấN CU 60 3.1 T l loóng xng v mt s yu t liờn quan ngi dõn t 45 tui tr lờn 60 3.1.1 c im chung ca ngi dõn nghiờn cu trc can thip 60 3.1.2 T l loóng xng ca ngi dõn t 45 tui tr lờn 66 3.1.3 Mt s yu t liờn quan n mt xng ca ngi dõn 67 3.1.4 So sỏnh mt s c im ca ngi dõn nghiờn cu cỏc phng, xó nghiờn cu can thip v i chng 78 3.2 Xõy dng v ỏnh giỏ hiu qumt s bin phỏp can thip cng ng Phũng chng loóng xng 79 3.2.1 Kt qu xõy dng mt s bin phỏp can thip 79 3.2.2 ỏnh giỏ hiu qu mt s bin phỏp can thip 83 Chng BN LUN 93 4.1 T l loóng xng v mt s yu t liờn quan ngi t 45 tui tr lờn ti thnh ph H Chớ Minh trc can thip 93 4.1.1 c im chung ca ngi dõn nghiờn cu trc can thip 93 4.1.2 T l loóng xng ca ngi dõn nghiờn cu trc can thip 94 4.1.3 Mt s yu t liờn quan n mt xng 95 4.1.4 Yu t khụng liờn quan n loóng xng 107 4.2 Xõy dng v ỏnh giỏ hiu qu mt s bin phỏp can thip 108 4.2.1 Kt qu xõy dng mt s bin phỏp can thip 108 4.2.2 ỏnh giỏ hiu qu mt s bin phỏp can thip cng ng 114 4.2.3 Kt qu trỡ hot ng mụ hỡnh can thip 123 4.2.4 Hn ch ca ti 124 KT LUN 125 KIN NGH 127 TI LIU THAM KHO PH LC NHNG CH VIT TT BMC : Bone Mineral Concent - Khi lng khoỏng xng BMD : Bone Mineral Density - Mt khoỏng xng BMI : Body Mass Index - Ch s c th BT : Bỡnh thng CB-CCVC : Cỏn b - Cụng chc viờn chc CBYT : Cỏn b y t C-H : Cao ng-i hc CI : Confidence Interval Khong tin cy CLB : Cõu lc b Cs : Cng s CSHQ : Ch s hiu qu CT : Can thip CTV : Cng tỏc viờn DXA : Dual-Energy X-ray AbsorptiometryHp th nng lng kộp X quang H : Huyn HQCT : Hiu qu can thip HRT : Hormon Replacement TherapyLiu phỏp hormon thay th KT : Kin thc KTX : Khụng thng xuyờn LX : Loóng xng MX : Mt xng NVYT PTH : Nhõn viờn y t : Parathyroid Hormone - Hormone tuyn cn giỏp P : Phng Q : Qun OR : Odd Ratio- T sut chờnh RLHTéR : Ri lon hp thu ng rut SD : Standard Deviation - lch chun SE : Standard Error Sai s chun SL : S lng STT : S th t TB : Trung bỡnh TDTT : Th dc th thao TH : Thc hnh THCS : Trung hc c s THPT : Trung hc ph thụng TPHCM : Thnh Ph H Chớ Minh TX : Thng xuyờn IU : International Unit n v Quc t UNICEF : United Nations Children's FundQu nhi ng Liờn Hip quc USD : United State Dollars ụ la M WHO : World Health OrganizationT chc Y t th gii X : Xó 10 DANH MC CC BNG Bng Ni dung Trang 1.1 Nhng yu t nguy c gõy bnh loóng xng 17 2.1 a im nghiờn cu mụ t v can thip 36 2.2 Ni dung bin phỏp can thip trờn cỏc nhúm i tng 43 2.1 Tiờu chun chn oỏn loóng xng theo mt xng 50 2.2 Tiờu chun chn oỏn xp t sng theo phng phỏp Genant 51 2.3 Phõn loi BMI theo WHO nm 2000 khu vc Chõu 52 3.1 Phõn b t l ngi dõn nghiờn cu theo gii v nhúm tui 60 3.2 Phõn b trung bỡnh cõn nng, chiu cao, BMI theo gii 60 3.3 Phõn b t l ngi dõn nghiờn cu theo c im nhõn trc .61 3.4 Phõn b t l ngi dõn nghiờn cu theo tin s bnh v chiu cao .62 3.5 Phõn b t l ngi dõn nghiờn cu theo li sng 63 3.6 Phõn b t l ph n nghiờn cu theo kinh nguyt v s 63 3.7 Phõn b t l ngi dõn tr li ỳng v kin thc bnh loóng xng 64 3.8 Phõn b t l ngi dõn nhn thụng tin v loóng xng v ngun nhn .65 3.9 Phõn b t l ngi dõn thc hin hnh vi cú li v cú hi cho xng 65 3.10 Phõn b t l kin thc v thc hnh ca ngi dõn nghiờn cu 66 3.11 Phõn b t l loóng xng ca ngi dõn nghiờn cu theo gii tớnh 67 3.12 Phõn b tỡnh trng mt xng theo trung bỡnh BMD v gii tớnh 67 3.13 Liờn quan loóng xng vi gii tớnh ngi dõn nghiờn cu 67 3.14 Liờn quan loóng xng vi nhúm tui theo gii tớnh ca ngi dõn 68 3.15 Liờn quan loóng xng vi vi BMI ca ngi dõn 69 3.16 Liờn quan loóng xng vi yu t a d 70 3.17 Liờn quan loóng xng vi yu t ngh nghip v hc 71 3.18 Liờn quan loóng xng vi kinh nguyt v s ph n nghiờn cu 71 3.19 Liờn quan loóng xng vi s dng ru bia, hỳt thuc lỏ theo gii 72 3.20 Liờn quan loóng xng vi ung sa, th dc th thao theo gii .73 3.21 Liờn quan loóng xng vi tin s cỏ nhõn, gia ỡnh v chiu cao 73 11 3.22 Liờn quan tỡnh trng xp t sng vi BMD ca ngi b loóng xng .74 3.23 Liờn quan loóng xng vi kin thc v thc hnh ca ngi dõn .75 3.24 Liờn quan loóng xng trờn mụ hỡnh hi quy a bin 76 3.25 Liờn quan loóng xng trờn mụ hỡnh hi quy a bin n gii 77 3.26 S ngi dõn phng xó can thip c t nm ti n v t chung 80 3.27.S ngi dõn phng, xó can thip c t nm ti cỏc trm y t .81 3.28 S lt ngi dõn c truyn thụng trc tip ti cng ng cỏc phng xó can thip sau nm 81 3.29 S h v ngi dõn nghiờn cu c cng tỏc viờn thm v t sau nm can thip .82 3.30 Phõn b t l ngi dõn nghiờn cu c truyn thụng, t trc tip v bnh loóng xng 82 3.31 Phõn b t l ngi dõn can thip v i chng theo gii tớnh, tui, ngh nghip, trỡnh hc vn, tin s gia ỡnh loóng xng v BMI .83 3.32 Phõn b t l ph n can thip v i chng v kinh nguyt v s 84 3.33 Hiu qu can thip v ngun v thụng tin nhn c ca ngi dõn 85 3.34 Hiu qu can thip v cỏc ni dung thc hnh ca ngi dõn .86 3.35 Hiu qu can thip v kin thc ỳng ca ngi dõn 87 3.36 So sỏnh trung bỡnh BMD, im kin thc v thc hnh ca ngi dõn trc v sau can thip 88 3.37 Hiu qu can thip v mt xng, kin thc v thc hnh ca ngi dõn nghiờn cu trc v sau can thip 88 3.38 Hiu qu can thip v nhn thụng tin bnh loóng xng ngi cú mt xng thp 90 3.39 Hiu qu can thip v ngun thụng tin nhn c ngi cú mt xng thp .90 3.40 Hiu qu can thip v kin thc ỳng ngi cú mt xng thp 91 3.41 Hiu qu can thip v thc hnh phũng chng loóng xng ngi cú 12 mt xng thp .91 3.42 So sỏnh trung v BMD, im kin thc, im thc hnh ngi cú mt xng thp trc v sau can thip 91 3.43 Hiu qu can thip v mt xng ngi cú mt xng thp 92 3.44 Hiu qu can thip v kin thc, thc hnh ngi mt xng thp 92 142 DANH MC CC CễNG TRèNH KHOA HC CễNG B Nguyn Trung Hũa, Nguyn Vn Tp, o Vn Dng, Nguyn Th Thựy Dng (2013),T l loóng xng v mt s yu t liờn quan ngi 45 tui tr lờn ti thnh ph H Chớ Minh nm 2011, Tp Y hc d phũng, XXIII, s 7(143), 2013, tr.93-98 Nguyn Trung Hũa, Nguyn Thanh Bỡnh, Nguyn Vn Tp, Phm Thanh Bỡnh (2014), Kin thc, thỏi phũng chng loóng xng ngi 45 tui tr lờn ti thnh ph H Chớ Minh, Tp Y hc Cng ng, s 8, 2014, tr 8-13 Nguyn Trung Hũa, Nguyn Vn Tp, o Vn Dng (2014), Hiu qu mt s bin phỏp can thip cng ng phũng chng loóng xng ngi t 45 tui tr lờn ti thnh ph H Chớ Minh,Tp Y hc d phũng, XXIV, s (155), tr 103108 143 TI LIU THAM KHO Ting Vit Nguyn Th Hoi Chõu (2003), Kho sỏt mt xng v tỡm hiu nhng yu t liờn quan n bnh loóng xng ca ph n thnh ph H Chớ Minh v mt s tnh Tõy,Tp Y hc thnh ph H Chớ Minh, 7(1), tr 126129 Trn Hong Minh Chõu (2010), T l góy xng cú triu chng lõm sng v mt s yu t nguy c ngi trờn 50 tui ti qun Gũ Vp thnh ph H Chớ Minh sau nm theo dừi, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 16-26 Cc Thng kờ thnh ph H Chớ Minh (2010), Bỏo cỏo dõn s v mt dõn s nm 2010, thnh ph H Chớ Minh Mai Th Cụng Danh (2010), Kin thc v thúi quen sinh hot cú liờn quan n loóng xng ca ph n sau kinh ti thnh ph H Chớ Minh nm 2006, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 71-72 o Vn Dng, Hong ỡnh Hu, Vừ Vn Thng v cs (2008), Thit k nghiờn cu h thng y t, Nh xut bn Y hc, H Ni Lờ Dng, Nguyn Trung Kiờn (2012), Kho sỏt tỡnh hỡnh loóng xng ngi cao tui ti thnh ph Cn Th nm 2011, Tp Y hc thc hnh, 825(6), tr 6-9 Lu Ngc Giang (2011), Mi liờn quan gia loóng xng v thi gian kinh ca ph n thnh ph M Tho, Tp Y hc thc hnh, 751(2), tr 21-24 V Th Thu Hin v cs (2007), Xỏc nh mc ph bin v yu t liờn quan n bnh loóng xng ph n Vit Nam bng phng phỏp siờu õm nh lng, Tp Nghiờn cu Y hc, 50(4), tr 7-15 144 Nguyn Trung Hũa (2008), Nghiờn cu tỡnh hỡnh loóng xng v mt s yu t liờn quan ngi trờn 45 tui ti qun Gũ Vp thnh ph H Chớ Minh nm 2008,Lun ỏn Chuyờn khoa cp 2, i hc Y dc Hu 10 Lu Ngc Hot (2008), Thng kờ Tin hc ng dng nghiờn cu y hc, Nh xut bn Y hc, H Ni, tr 36-63 11 Nguyn Th Kim Hng (2003), Can-xi v dinh dng phũng nga loóng xng, K yu cỏc bỏo cỏo khoa hc hi ngh khoa hc chuyờn loóng xng v bnh ct sng,thnh ph H Chớ Minh, tr 21-24 12 Th Khỏnh H (2008), Tỡm hiu mt xng, tỡnh trng loóng xng v mt s yu t nh hng ph n sau kinh, Tp Nghiờn cu Y hc, 58(5), tr 75-81 13 o Th Võn Khỏnh, Nguyn Hong Thanh Võn, Nguyn Th Huyn Trang (2009), Kho sỏt tỡnh hỡnh loóng xng ph n ln tui bng mỏy siờu õm nh lng, Tp Y hc thc hnh, 644, 645(2), tr 20-22 14 Nguyn Thy Khuờ (2008), Loóng xng glucocorticoid, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 25-27 15 H Phm Thc Lan v cs (2008), n chay trng v loóng xng: mt nghiờn cu trờn cỏc ni cụ pht giỏo, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 16 16 H Phm Thc Lan v cs (2011), Chn oỏn loóng xng: nh hng ca giỏ tr tham chiu,Thi s y hc - Tp Y khoa ca Hi Y hc thnh ph H Chớ Minh, 1-2(57), tr 3-10 17.H Phm Thc Lan v cs (2011), Chn oỏn góy xng t sng: Phỏt trin giỏ tr tham chiu cho ngi Vit Quy mụ góy xng t sng ngi Vit, Thi s Y hc-Tp Y khoa ca Hi Y hc thnh phH Chớ Minh, 8(63), tr 3-16 18 H Phm Thc Lan, Nguyn Vn Tun (2011), Sinh lý hc loóng xng, Thi s Y hc-Tp Hi Y hc thnh ph H Chớ Minh, 7(62), tr 22-28 145 19 H Phm Thc Lan (2011), Cm nang iu tr Loóng xng, Nh xut bn Y hc, H Ni, tr 100-107 20 Nguyn Th Lc, Hu Th Chung (2003), ỏnh giỏ mt xng 840 ph n bng phng phỏp siờu õm, K yu cỏc bỏo cỏo khoa hc chuyờn loóng xng v bnh ct sng, thnh ph H Chớ Minh, tr 25-28 21 Marlena C Kruger v cs (2010), Tỏc dng ca sa tng cng can-xi v vitamin D i vi tỡnh trng vitamin D v chu chuyn xng ph n sau kinh ụng Nam , K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 55-70 22 Trn Vn Nam, Nguyn Vn Cụng (2010), BMD v góy xng, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 34 23 Nguyn ỡnh Nguyờn (2010), Vai trũ ca cỏc yu t nguy c tiờn oỏn góy xng, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 35-40 24 Ninh Th Nhung, Phm Ngc Khỏi, Phm Ngc Chõu (2010), Loóng xng v gim mt xng ca ph n 40-65 tui ti mt s khu vc ca tnh Thỏi Bỡnh, Tp Dinh dng v Thc phm, 6(1) 25 Ninh Th Nhung, Phm Ngc Khỏi, Phm Ngc Chõu (2010), Hiu qu ca mt s bin phỏp can thip d phũng loóng xng cho ph n 40-65 tui ti Thỏi Bỡnh, Tp Dinh dng v Thc phm, 6(1) 26 Nguyn Vn Quang (2008), Bỏc s chnh hỡnh v loóng xng, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 65-66 27 Trung Quõn (2005), Bnh ni tit chuyn húa thng gp, Nh xut bn Y hc, H Ni, tr 481-496 28 S Y t TPHCM (2013), Hng dn chn oỏn, iu tr v d phũng bnh loóng xng, Ban hnh theo Quyt nh s 1983/Q-SYT, thnh ph H Chớ Minh 146 29 Nguyn Vn Thỏi, ng Th Bộ Thu, Phm Thanh Tõn (2010), Góy u di xng quay, c xng ựi, c phu thut xng cỏnh tay, iu tr v phũng nga ti Bnh vin Chn thng chnh hỡnh TPHCM, K yu cỏc bỏo cỏo hi ngh khoa hc loóng xng, góy xng v vitamin D, Cn Th, tr 27-29 30 Trn c Th (2005), Bnh loóng xng ngi cao tui, Nh xut bn Y hc, H Ni 31 Nguyn Vn Th, Lờ Nguyn Thy Khanh, Lờ Th Tuyt Lan (2010), Nghiờn cu mt xng bng o hp th nng lng tia X kộp ngi s dng corticoides kộo di, Tp Y hc thnh ph H Chớ Minh, 14(1), tr 2127 32 Nguyn Huy Thụng, Nguyn Ngc Chõu, Nguyn Th Phi Nga, on Vn (2010), ỏnh giỏ mt xng v t l loóng xng cỏc bnh nhõn khỏm v iu tr ti Bnh vin 103 bng phng phỏp hp th tia X nng lng kộp, Tp Y-Dc hc quõn s, 35(1), tr 107-113 33 V Th Thanh Thu, Trn Ngc n (2003), Tng quan nghiờn cu loóng xng ti Bnh vin Bch Mai t 1992-2002, K yu cỏc bỏo khoa hc chuyờn loóng xng v bnh ct sng, thnh ph H Chớ Minh, tr 15-17 34 V Th Thanh Thy (2009), Nhng tin b mi iu tr loóng xng, K yu bỏo cỏo chuyờn : C xng khp-Nhng tin b chn oỏn v iu tr, Tp ca Tng Hi y hc Vit Nam, H Ni, s 4, tr 33-35 35 V Th Thanh Thy, Trn Ngc n (2010), ỏnh giỏ nhng nguy c loóng xng sau kinh Vit Nam, Tp Nghiờn cu Y hc, 68(3),tr 49 36 Lờ Anh Th (2008), Chn la thuc iu tr loóng xng Vit Nam, K yu cỏc bỏo cỏo khoa hc Tm nhỡn Chõu v loóng xng, thnh ph H Chớ Minh, tr 32-33 37 Lờ Anh Th (2009), Nhng tin b chớnh lnh vc loóng xng v thỏch thc chn la-qun lý iu tr loóng xng, Bỏo cỏo khoa hc chuyờn cp nht mi chn oỏn, iu tr loóng xng v bnh xng khp, Hi Loóng xng thnh ph H Chớ Minh 147 38 Lờ Thanh Ton, V ỡnh Hựng (2011), Loóng xng bnh nhõn ỏi thỏo ng ti Bnh vin Ch Ry, K yu cỏc bỏo cỏo ti hi ngh khoa hc ln th chuyờn : Thnh tu 10 nm xng khp ti TPHCM, tr.113-119 39 Phm Vn Tỳ, Trn Ngc n, V Th Thanh Thy (2003), Nhn xột mt xng ca nam gii bỡnh thng t 50 tui tr lờn bng phng phỏp o hp th tia X nng lng kộp, K yu cỏc bỏo cỏo khoa hc chuyờn loóng xng v bnh ct sng, thnh ph H Chớ Minh, tr 41-44 40 Nguyn Vn Tun (2007), Loóng xng chn oỏn, iu tr v phũng nga, Nh xut bn Y hc, H Ni 41 Nguyn Vn Tun (2008), Loóng xng, Thi s Y hc Tp Hi Y hc thnh ph H Chớ Minh, 7(29), tr 11-33 42 Nguyn Vn Tun (2009), Di truyn loóng xng: Tin ti cỏ nhõn húa tiờn lng v iu tr, K yu cỏc bỏo cỏo chuyờn ni tit-ỏi thỏo ng, thnh ph H Chớ Minh, tr 311-315 43 i Phi Võn, Nguyn Thỏi Thnh, Trn Th Ngc Dung (1998), o t trng xng ph n tin kinh v kinh tui t 45-70, K yu cỏc bỏo cỏo khoa hc chuyờn loóng xng v bnh ct sng, thnh ph H Chớ Minh, tr 57-58 44 Bựi c Vn, Nguyn Vn Tớn, Bựi Vn D (2010), T l loóng xng v cỏc yu t nguy c trờn bnh nhõn 50 tui ti khoa ni BVKKV Cỏi Nc-C Mau, Tp Y hc thnh ph H Chớ Minh, 14, tr 418-423 45 Vin Dinh dng Quc gia, B Y t (2006), Nhu cu dinh dng khuyn ngh cho ngi Vit Nam, Nh xut bn Y hc,tr 33-35, 56-58 Ting Anh 46 Amani A Osman (2013), Assessment of Osteoporosis KAP among women in Assir region, Saudi Arabia, Journal of Medicine and Medical Sciences, Vol 4(2),pp 50-55 47.Ann-Charlotte, Grahn Kronhed (2003), Community-based osteoporosis prevention: Physical activity in relation to bone density, fall prevention, and the 148 effect of training programmes,The Vadstena Osteoporosis Prevention Project, Sweden 48.Anoop Kuttikat et al (2004), Management of Osteoporosis, Journal Indian Rheumatol Association, Vol 12, pp 104-118 49.Australian Institute of Health and Welfare (2011), A Snapshot of Osteoporosis in Australia, Report of the National Center for Monitoring Arthritis and Musculoskeletal Conditions at the Australian Institute of Health and Welfare 50 B Họussler, H Githe, D Gửl, G Glaeske, L Pientka, D Felsenberg (2007), Epidemiology, treatment and cost of osteoporosis in Germany the BoneEVA Study, Osteoporosis Int., Vol 18, pp.77-84 51 D Nick Carteret al (2002), Community-based exercise program reduces risk factors for falls in 65 to 75 year-old women with osteoporosis: randomized controlled trial,CMAJ, Vol 167(9), pp 997-1004 52.Didier B.Hans et al (2008), Peripheral Dual-Energy X-Ray Absorptiometry in the Management of Osteoporosis: The 2007 ISCD Official Position, Journal of Clinical Densitometry: Assessment of Skeletal Health, Vol 11(11), pp 188206 53.Elizabeth Barrett-Connor et al (2005), Osteoporosis and Fracture Risk in Women of Different Ethnic Groups, Journal of Bone and Mineral research, Vol 20(2), pp 185-194 54.Ellen Edmonds et al (2012), Osteoporosis knowledge, beliefs, and calcium intake of college students: Utilization of the health belief model, Journal of preventive Medicine, Vol 2(1), pp 27-32 55.Fahad M Al-Shahrani et al (2010), Knowledge of osteoporosis in middle-aged and elderly women, Saudi Medicine Journal, Vol 31(6), pp 684-687 56.Farida Habid et al (2012), Assessment and modification of risk behavior osteoporosis among childbearing working women, Journal of American Science, Vol 8(9), pp.111-119 149 57.Francis KL et al (2009), Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial, Osteoporosis Int., Vol 20(9), pp 1563-1570 58.G Maalouf et al (2007), Middle East and North Africa consensus on osteoporosis, Journal Musculoskelet Neuronal Interact, Vol 7(2), pp.131143 59.Glen M Blake, Ignac Fogelman (2001), Peripheral or Central Densitometry: Does It Matter Which Technique We use?, Journal of Clinical Densitometry, Vol 4(2), pp 83-96 60.Gourlay ML, Callahan LF, Preisser JS, Sloane PD (2007), Osteoporosis preventive care in white and black women in community family medicine settings, Journal Family Medicine, University of North Carolina, Vol 100(7), pp 677-682 61.Gourlay Margaret L et al (2006), Survey of Osteoporosis Preventive Care in Community Family Medicine Settings, Journal Family Medicine, Vol 38(10), pp 724-730 62.Health Service Excutive and the Department of Health and Children and the National Council on Ageing and Older People (2008), Strategy to prevent falls and fractures in Irelands Ageing population Sumary, Conclusions and Recommendations, Ireland 63.International Osteoporosis Foundation (2004), Invest in your bones Osteoporosis in Men the silent epidemic strikes men too, Report of International Osteoporosis Foundation, pp.1-16 64.International Osteoporosis Foundation (2005), Invest in your bones Move it or Lose it How excercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation, Report annual of International Osteoporosis Foundation 150 65.International Osteoporosis Foundation (2006), Bone Appetite The role of food and nutrition in building and maintaining strong bones, Report annual of International Osteoporosis Foundation, pp.1-22 66.International Osteoporosis Foundation (2007), Know and reduce your risk of osteoporosis, Report annual of International Osteoporosis Foundation 67.International Osteoporosis Foundation (2008), Beat the Break Know and reduce your osteoporosis risk factors,Report annual of International Osteoporosis Foundation, pp 1-14 68.International Osteoporosis Foundation (2008), Osteoporosis in the European Union in 2008: Ten years of progress and ongoing challengers, Report of International Osteoporosis Foundation 69.International Osteoporosis Foundation (2009), FRAX đ Identifying people at high risk of fracture, WHO Fracture Risk Assessment Tool, a new clinical tool for informed treatment decisions, Report of International Osteoporosis Foundation, pp.1-16 70.International Osteoporosis Foundation (2009), The Asian Audit Epidemiology, cost and burden of osteoporosis in Asia 2009, Report annual of International Osteoporosis Foundation, pp.1-57 71.International Osteoporosis Foundation (2010), The Breaking Spin, Report of International Osteoporosis Foundation 72.International Osteoporosis Foundation (2010), The Eastern European and Central Asian regional audit: Epidermiology, cost and burden of osteoporosis in 2010, Report annual of International Osteoporosis Foundation 73.International Osteoporosis Foundation (2011), The Middle East and Africa regional Audit, Report annual of International Osteoporosis Foundation 74.International Osteoporosis Foundation (2011), Three steps to unbreakable bones: Vitamin D, Calcium and Exercise, Report of International Osteoporosis Foundation 151 75.International Osteoporosis Foundation (2012), The Latin America regional Audit: Epidemiology, cost and burden of osteporosis in 2012, Report annual of International Osteoporosis Foundation, pp 1-67 76.International Osteoporosis Foundation (2012), Facts and Statistics, Report of International Osteoporosis Foundation 77.John A Kanis et al (2008), European guidance for the diagnosis and management of osteoporosis in postmenopausal women, Osteoporosis int Vol 19, pp 399-428 78.Jian-min Liu, Guang Ning, Jia-lun Chen (2007), Osteoporotic fractures in Asia: risk factors and strategies for prevention, Journal Bone Mineral Metabolism, Vol 25, pp 1-5 79.Jorge Morales-Torres (2007), Strategies for the prevention and control of osteoporosis in developing countries, Review of Clinical Rheumatology Mexico, Vol 26(3), pp 139-143 80.Julienne K Kirk, Mindy Nichols, John G.Spangler (2002), Use of a Peripheral Dexa Measurement for Osteoporosis Screening, Clinical Research and Methods, Vol 34(3), pp 201-205 81.Kamila POSLUN et al (2008), Risk factors of osteoporosis- Knowledge and practices among adolescent females, School and Health, Vol 21, pp 211220 82.Karen Bohaty, Holly Rocole, Kelli Wehling, Nancy Waltman (2008), Testing the effectiveness of an educational intervention to increase dietary intake of calcium and vitamin D in young adult women, Journal of the American Academy of Nurse Practioners, Vol 20, pp 93-99 83.L K H Koh (2007), Osteoporosis in Asian populations, Menopausal Medicine, Vol 5, pp 10-14 84.Lin Pao-Hwa et al (2003), The DASH diet and sodium reduction improve markers of bone turnover and calcium metabolism in adults, Journal Nutrition, Vol 133, pp 3130-3136 152 85.Linda Yin-King Lee et al (2006), Osteoporosis in older Chinese men: knowledge and health beliefs, Journal of Clinical Nursing, Vol 15, pp 353355 86.Lionel S Lim, Laura J Hoeksema, Kevin Sherin (2009), Screening for osteoporosis in the adult U.S population ACMP position statement on preventive practice, American Journal of Preventive Medicine, Vol 36(4), pp 366-375 87.Loh KY, Shong HK (2007), Osteoporosis: Primary Prevention in the Community, Med J Malaysia, Vol 62(4), pp 355-358 88.Lorentzon Mattias et al (2007), Smoking is associated with lower bone mineral density and reduced cortical thickness in young men, The Journal of Clinical Endocrinology and Metabolism, Vol 92(2), pp 497-503 89.M Allison Ford et al (2011), Osteoporosis knowledge, self-efficacy, and beliefs among college students in the USA, Journal of Osteoporosis, Vol 2011, pp 1-8 90 M Duyvendak et al (2011), Doctors beliefs and knowledge on corticosteroid-induced osteoporosis: identifying barriers to improve prevention, Journal of Clinical Pharmacy and Therapeutics, Vol 36(3), pp 356-366 91 M Sadat-Ali et al (2009), Osteoporosis-related vertebral fractures in postmenopausal women: Prevalence in a Saudi Arabian sample, La Revue de Santộ de la Mộditerranộe orientale, Vol 15(6), pp 1420-1425 92.Mahfouz et al (2007), Osteoporosis-related lifestyle choices and knowledge among adolescent females in El-Minia city, Egypt, El-Minia Med., Bull., Vol 18(1), pp 29-41 93.Marian T.Hannan et al (2000), Effect of Dietary Protein on Bone Loss in Elderly Men and Women: The Framingham Osteoporosis Study, Journal of Bone and Mineral Research, Vol 15(12), pp 2504-2512 153 94.Mervat M.A El-Sayed et al (2013), Osteoporosis-Related Life Habits, Knowledge and Attitude among Group of Female Employees in King Saud University, World Applied Sciences Journal, Vol 22(7), pp 919-925 95.Ministry of Health and Long-Term Care (2003), Osteoporosis Action Plan: An Osteoporosis Strategy for Ontario, Report of the Osteoporosis Action Plan Committee, Ontario Canada 96.Miriam F Delaney (2006), Strategies for the prevention and treatment of osteoporosis during early postmenopause,American Journal of Obstetrics and Gynecology, Vol 194, pp 12-23 97.Moon Fai Chan et al (2006), Osteoporosis prevention education programme for women, Journal of Advanced Nursing, Vol 54(2) , pp 159-170 98.National Osteoporosis Society United Kingdom (2006), Osteoporosis Facts and Figures, Report of National Osteoporosis Society, United Kingdom 99.Neil Hirschenbein (2002), Nutritional Stretegies in the Prevention of Osteoporosis, ANSR-Applied Nutritional Science Reports, pp 1-5 100.Ngoc Lan T Nguyen, Minh Thuy T Tao (2013), Assessing the risk factors for osteoporosis in women aged from 50 years and above in the Northern part of Vietnam, Report of The Fifth Strong Bone Asia conference: Osteoporosis in Asean (+), Danang city Vietnam, p 49 101.H.T.T Nguyen et al (2009), Peak bone mineral density in Vietnamese women, Arch Osteoporosis, Vol 4, pp 9-15 102.H.T.T Nguyen, N.D Nguyen, T.T Le, T.V Nguyen (2013), Knowledge of Osteoporosis among Tertiary Students in Vietnam, Report of The Fifth Strong Bone Asia conference: Osteoporosis in Asean (+), Danang city Vietnam, p 91 103.Patricia M Ciaschini et al (2010), Community-based intervention to optimize osteoporosis management: randomized controlled trial,BMC Geriatric,Vol.10 (60) 104.Pensylvania Department of Health and Pensylvania Osteoporosis Coalition (2004), Osteoporosis and Bone health: Pennsylvania Osteoporosis prevention 154 and education strategic plan, Report of Department of Health Harrisburg, Commonwealth of Pennsylvania 105.Peter M Wayne et al (2012), Impact of Tai Chi exercise on multiple fracturerelated risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial, BMC Complement Alternal Medicine, Vol 12(7), pp 1-12 106.Philip Sambrook, Cyrus Cooper (2006), Osteoporosis, The Lancet, Vol 367, pp 2010-2018 107.Prema B Rapuri et al (2000), Alcohol intake and bone metabolism in elderly women, American Journal Clinical Nutrition, Vol 72, pp.1206-1213 108.R.Bartl, B.Frisch (2009), Osteoporosis, đ Springer-Verlag Berlin Heidelberg 109.R Rizzoli et al (2008), The role of calcium and vitamin D in the management of osteoporosis, Bone, Vol 42, pp.246-249 110.Rafraf M, Bazyun B, Afsharnia F (2009), Osteoporosis-related life habits knowledge about osteoporosis among women in Tabriz, Iran, The International Medical Journal, Vol.8(2), pp 17-20 111.Rebecca L Kesman et al (2010), Population informatics-based system to improve osteoporosis screening in women in a primary care practice, J Am Med Inform Assoc., Vol 17(2), pp 212216 112.Rizzoli Renộ, Jean-Philippe Bonjour (2004), Dietary Protein and Bone Health, Journal of Bone and Mineral Research, Vol 19(4), pp 527-531 113.Rohini Handa et al (2008), Osteoporosis in developing countries, Best Practice and Research Clinical Rheumatology, Vol 22(4), pp 693-708 114.Russel Burge et al (2007), Incidence and Economic Burden of OsteoporosisRelated Fractures in the United States 2005-2025, Journal of Bone and Mineral Research, Vol 22(3), pp 465-475 115.S.Boonen et al (2006), Calcium and vitamin D in the prevention and treatment of osteoporosis a clinical update, Journal of Internal Medicine, Vol 259, pp 539-552 155 116.Saneya A Wahba et al (2010), Osteoporosis knowledge, beliefs, and behaviors among Egyption female students, JASMR, Vol 5(2), pp 173-180 117.Sarina Schrager (2003), Osteoporosis Prevention in Primary Care, Winconsin Medical Journal, Vol 102(3), pp.52-55 118.South Eastern Health and Social Care Trust(2012), Falls and Osteoporosis Strategy 2012-2016, Report of National Health Services Lothian, Scotland 119.Shu-Wen Chen et al (2012), Osteoporosis Prevention-Adolescents knowledge, attitudes, and practices, American Journal of Health Behavior, Vol 36(6), pp.736-745 120.Susan B Jaglal et al (2003), How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs, Canadian Family Physician, Vol 49, pp 462-468 121.Susan B Jaglal et al (2012), Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial, Osteoporos Int., Vol.23(1), pp 8795 122.Tania Winzenberg et al (2006), The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial, BMC Public Health, Vol 6(12) 123.The Taiwanese Osteoporosis Association (2011), Taiwanese Guidelines for the Prevention and Treatment of Osteoporosis, Report of The Taiwanese Osteoporosis Association, Taiwan 124.Thu Hien T.Vu, Bach Mai Le, Lam T Nguyen (2013), Effect of nutrition education on calcium intake and bone mass in Vietnamese women, Report of The Fifth Strong Bone Asia conference: Osteoporosis in Asean (+), Danang city Vietnam, pp 99-101 125.W.C.Tung, Iris F.K Lee (2006), Effects of an osteoporosis educational programme for men, Issues and Innovations in Nursing practice, pp 26-34 156 126.Wan Arfah Nadiah Wan Jamil et al (2010), Knowledge, Attitude and Dietary and Lifestyle Practices on Bone Health Status among Undergraduate University Students in Health Campus, University Sains Malaysia, Kelantan, Health and Environment Journal, Vol 1(1), pp.34-40 127.Xingqiong Meng et al (2010), Calcium Intake in Elderly Australian Women Is Inadequate, Nutrients, Vol 2(9), pp 10361043