The diagnosis and treatment level of osteoporosis in Shanghai community health service institutions are still unclear, and systematic evaluation and monitoring are lacking.

To understand the current status of osteoporosis diagnosis and management in community health service in Shanghai, to evaluate their diagnosis and treatment capacity, and to explore their problems and improvement measures.

A questionnaire was distributed to 248 community health service centers and 1 873 community general practitioners (GPs) in 16 administrative districts of Shanghai in December 2023 to investigate the current status, knowledge and competence of community health service center and GPs in urban and suburban areas regarding osteoporosis diagnosis and management.

Of the 248 community health centers in the 16 administrative districts of Shanghai, 79 (31.9%) were in the urban area and 169 (68.1%) in the suburbs, and of the 1 873 GPs, 497 (26.5%) were in the urban area and 1 376 (73.5%) in the suburbs. In terms of inspection and testing equipment, the proportion of bone mineral density (BMD) in urban and suburban areas was 92.4% and 50.9%, and the proportion of bone turnover markers was 50.6% and 12.4%, respectively (P<0.05). In terms of drugs, the proportion of bisphosphonates in urban and suburban areas was 73.4% and 45.0%, and the proportion of active vitamin D and its analogues was 69.9% and 53.3%, respectively (P<0.05). In terms of non-drug treatment, the proportion of traditional Chinese medicine suitable technology in urban area and suburban area was 79.7% and 80.5% respectively (P>0.05). Exercise therapy, physical factor therapy and occupational therapy in urban areas were higher than those in suburban areas, 73.4% versus 50.3%, 73.4% versus 37.9%, 65.8% versus 38.5% (P<0.05). The difficulties of disease management mainly included insufficient examination equipment, inadequate treatment drugs, and limited doctors' diagnosis and treatment ability, especially in the suburbs. Regarding the cognition of GPs in community health centers on osteoporosis high-risk groups and screening, the proportion of urban and suburban GPs' cognition on postmenopausal women was 99.2% versus 97.8% (P<0.05), and the proportion of their cognition on the Osteoporosis Self-Screening Tool for Asians (OSTA) was 88.3% versus 84.4% (P<0.05). Regarding the cognition of common symptoms and examinations of osteoporosis, the proportion of urban and suburban GPs' cognition of compression fracture was 97.0% and 92.2% respectively (P<0.05), and the proportion of cognition of bone transformation markers was 67.6% and 45.2% respectively (P<0.05). Regarding the perception of osteoporosis treatment modalities, the proportion of urban and suburban GPs' perception of physical factor therapy and occupational therapy was 89.3% versus 84.7% and 86.3% versus 81.2%, respectively (P<0.05). The difficulties in diagnosis and treatment mainly included: insufficient experience in the use of new drugs, insufficient ability to identify high-risk groups, insufficient ability to assess the risk of osteoporosis, insufficient confidence in diagnosis, and insufficient ability to choose and mix drugs, especially among rural doctors.

All community health service institutions in Shanghai, especially those in the suburbs, need to strengthen the equipment of osteoporosis related examinations and tests such as bone mineral density and bone turnover markers, improve the types of therapeutic drugs such as bisphosphonates, active vitamins and their analogues, and strengthen the development of relevant appropriate technologies including exercise, physiotherapy and work. As for the systematic and comprehensive management of osteoporosis, it is suggested to improve the relevant information construction, coordinate and integrate multidisciplinary teams and multi-party resources.

上海市社区卫生服务机构对于骨质疏松症的诊疗水平尚不明确，缺乏系统性评价和监测。

了解上海市社区卫生服务机构对于骨质疏松症的诊疗及管理现状，评价其诊疗能力，并探讨其存在的问题和改进措施。

于2023年12月向上海市16个行政区248家社区卫生服务中心及1 873名全科医生发放调查问卷，调查城郊社区卫生服务机构和全科医生对于骨质疏松症诊疗和管理的现况、认知和能力。

上海市16个行政区248家社区卫生服务中心中城区79家（31.9%）、郊区169家（68.1%），1 873名全科医生中城区497名（26.5%）、郊区1 376名（73.5%）。上海市社区卫生服务机构在骨质疏松症的检查和检验开展方面，城区和郊区社区卫生服务中心开展骨密度检查、骨转化标志物检验的比例分别为92.4%与50.9%、50.6%与12.4%（P<0.05）；骨质疏松症药物配备方面，城区和郊区社区卫生服务中心配备有双磷酸盐类、活性维生素D及其类似物的比例分别为73.4%与45.0%、69.9%与53.3%（P<0.05）；骨质疏松症治疗方式开展方面，城区和郊区社区卫生服务中心开展运动疗法、物理因子治疗和作业疗法的比例分别为73.4%与50.3%、73.4%与37.9%、65.8%与38.5%（P<0.05）；社区卫生服务中心骨质疏松症疾病管理的困难主要包括检查设备不足、治疗药物配备不全，以郊区更为显著（P<0.05）。社区卫生服务中心全科医生对骨质疏松症高危人群和筛查的认知方面，城区和郊区全科医生对绝经后女性的认知比例分别为99.2%与97.8%（P<0.05），对亚洲人骨质疏松症自我筛查工具（OSTA）的认知比例分别为88.3%与84.4%（P<0.05）；骨质疏松症常见症状和检验认知方面，城区和郊区全科医生对其中压缩性骨折的认知比例分别为97.0%与92.2%（P<0.05），对于骨转化标志物的认知比例分别为67.6%与45.2%（P<0.05）；骨质疏松症治疗方式认知方面，城区和郊区全科医生对物理因子治疗、作业疗法认知比例分别为89.3%与84.7%、86.3%与81.2%（P<0.05）；社区卫生服务中心全科医生对骨质疏松症的诊治困难主要包括：对高危人群识别能力不足、骨质疏松风险评估能力不足、诊断信心不足、对药物的选择和配伍能力不足，以郊区更为显著（P<0.05）。

上海市各社区卫生服务机构，尤其是郊区社区卫生服务中心及全科医生，有待加强对于骨质疏松症相关检查和检验如骨密度、骨转化标志物的配备，以及完善如双磷酸盐类、活性维生素及其类似物等治疗药物种类，加强开展包括运动、理疗、作业等在内的相关适宜技术，以及对于骨质疏松症系统性综合化管理，建议提升相关信息化建设，协调整合多学科团队和多方资源。