Abstract: Background　In Shanghai，the construction of community-based prevention and treatment of osteoporosis has entered the second round，during which many new relevant guides have been issued，such as osteoporosis guidelines for primary care，guiding principles for osteoporosis management，and standardized management options for osteoporosis，providing rich evidence for primary care practice. However，successful application of guides in primary practice can not be achieved overnight，which should be done according to the real conditions of the community，such as human，financial and material resources，size and roles of the community. Objective　To develop a pathway for the second round construction of community-based prevention and treatment of osteoporosis based on our experience summarized from the first round of construction，and the latest osteoporosis guidelines，offering a reference for appropriate use of guidelines in community-based practice. Methods　The entire development process of the pathway to community-based osteoporosis prevention and treatment includes pre-development preparation phase，development phase，information realization phase，and acceptance phase before the offline use. The first two phases were completed from May 2018 to December 2019. In the pre-development preparation phase，we formulated project management options for developing the pathway by reviewing the latest evidence-based studies regarding osteoporosis prevention and treatment and two rounds of group discussions. In the development phase，we developed a standardized process of osteoporosis prevention and treatment used as a reference guide to primary care by analyzing and modifying the first version of osteoporosis prevention and treatment pathway in the community based on the literature review results of in the pre-development preparation phase，three rounds of expert consultation and two rounds of group discussions. Results　The document library formed in the pre-development preparation phase has updated 7 domestic guidelines and 5 foreign guidelines. The osteoporosis prevention and treatment pathway in the community was developed by general medical management and executive representatives from the community health center，orthopedics specialists from the general hospital，in collaboration with the information company，with the help of a third-party healthcare and medical and health consulting firm for data collection，analysis and translation. The final osteoporosis prevention and treatment pathway in the community demonstrates logic in terms of community-based osteoporosis screening and diagnosis，transferring to the general hospital，and osteoporosis follow-up for monitoring treatment. Conclusion　The successful application of osteoporosis guidelines in primary care practice requires multilateral cooperation（the general hospital，community health center，information company，translator as well as third-party communication and coordination）. Our exploratory process may be used as a reference for colleagues to carry out new explorations，and our pathway may be considered as a logical basis for community-based prevention and treatment of osteoporosis using the guidelines appropriately.

Key words: Osteoporosis, Community health services, Critical pathways, Project management, Guidelines, Practice

摘要： 背景　社区骨质疏松防治在上海市已进入第二周期的建设。在该周期，新版指南相继发布，基层版指南、指导原则、规范化管理方案也相继发布，为社区骨质疏松防治实践提供了丰富证据。然而，从指南到实践并非一蹴而就的事，基于社区卫生服务机构人、财、物、空间及功能定位的诸多限制，如何从“指南的逻辑正确”下沉并转化为“实践的操作正确”，还需要根据指南证据、结合社区实情进行科学开发。目的　基于前期三林社区卫生服务中心在社区骨质疏松防治路径开发中积累的经验，结合近期发布的临床实践循证证据，开展第二期社区骨质疏松防治路径开发，以期为同行开展相应工作提供参考。方法　第二期社区骨质疏松防治路径的开发包括开发前筹备阶段、开发阶段、信息化实现阶段、下线使用前验收阶段。其中，前两阶段于2018年5月至2019年12月完成。开发前筹备阶段，主要采用文献回顾法和2轮小组讨论法，最终梳理出更新版国内、外骨质疏松防治循证依据，制定出路径开发项目管理方案；开发阶段，以三林社区卫生服务中心前期开发的第一版社区骨质疏松防治路径为基础，通过文献分析法、3轮专家咨询、2轮小组讨论，开发出指导社区实践的社区骨质疏松防治路径（第二版）。结果　开发前筹备阶段形成的文献库，较之前更新了7项国内指南和5项国外指南。社区骨质疏松防治路径的开发由社区卫生服务中心全科管理和执行代表、综合医院骨科专家、信息公司共同参与，并借助第三方医疗卫生咨询公司进行数据回收、分析和翻译。最终形成的社区骨质疏松防治路径（第二版），详细呈现了社区人群的筛查诊断逻辑、与综合医院的转诊逻辑、保证居民不脱落的跟踪随访逻辑。结论　从指南到实践，需要综合医院、社区卫生服务中心、信息公司、第三方沟通协调和翻译者的分工协作。本研究围绕社区骨质疏松防治路径的探索过程可为同行开展新业务探索提供参考，研究所开发的社区骨质疏松防治路径（第二版）为社区骨质疏松防治实践的落地奠定了逻辑基础。

关键词: 骨质疏松, 社区卫生服务, 临床路径, 项目管理, 指南, 实践