Abstract: Background　Bi-directional referrals are essential in the promotion of community-based prevention and treatment of single diseases，but there is a lack of practical guidance scheme for clinical referrals. We aimed to explore the bi-directional referrals for osteoporosis between primary care and secondary or tertiary care involving primary care physicians，orthopedic specialists and other medical workers. Objective　To summarize the facilitators and barriers to successful bi-directional referrals for community osteoporosis patients based the reviewing of such studies，providing a reference for the improvement of bi-directional referrals for such patients. Methods　Databases of CNKI，Wanfang Data，Web of Science and Science Direct were searched in June 2019 for studies about bi-directional referrals for community osteoporosis patients included during January 1，1999 to June 15，2019. Meta-analysis was conducted on the practices and explorations of bi-directional referrals for community osteoporosis patients with a focus on the expected goal，types of referrals，development methods for new referral patterns，effects and problems during the implementation of referrals，and based on the results，improvement recommendations were proposed. Results　Finally, 14 Chinese documents and 5 English documents were included. The management modes and standards for transferring community osteoporosis patients were different in China and foreign countries during the period. Domestic residents did not attach much weight to osteoporosis，and showed poor adherence to treatment. Moreover，there were no osteoporosis department and sophisticated equipments for detecting osteoporosis as well as a sound system for communicating with higher level hospitals in domestic community hospitals. The types of referrals for such patients in foreign countries were mainly about the referrals for post-osteoporotic fracture patients. Conclusion　To promote community-based prevention and control of osteoporosis，bi-directional referrals for community osteoporosis patients should be implemented effectively，and to do this，priority should be given to：the determination of coverage of long-term preventive and control services of osteoporosis，enriching general practitioners' osteoporosis-related knowledge，improving the resources needed by community-based prevention and treatment of osteoporosis，and the development of a procedure for bi-directional referrals for osteoporosis including four factors such as division of labor，referral indicators and other details.

Key words: Osteoporosis, Community health services, Hierarchical diagnosis and treatment, Two-way referral, Specialized clinic, General practitioners

摘要： 背景　在推进单病种社区防治进程中，双向转诊是不可或缺的环节，但目前仍缺乏可指导一线实践的双向转诊实施方案。以骨质疏松为例，在整个诊疗路径中，骨科及相关科室专家的参与不可或缺，但全-专之间如何开展双向转诊仍有待探索。目的　分析国内、外社区骨质疏松双向转诊实施现状，整理经验和不足，梳理有效做法和阻碍因素，为下一步落实社区骨质疏松双向转诊提供参考。方法　于2019年6月，计算机检索中国知网、万方数据知识服务平台、Web of Science、Science Direct数据库中与社区开展骨质疏松双向转诊相关的文献，发表时间设定为1999-01-01至2019-06-15。分别从双向转诊的预期目标、双向转诊类型、双向转诊模式构建方法、双向转诊实施效果及当前面临的困境等方面，对国内、外社区骨质疏松双向转诊情况进行汇总分析，并提出优化建议。结果　最终纳入中文文献14篇、英文文献5篇。国内、外骨质疏松双向转诊具有不同管理模式及转诊标准。在执行过程中，国内居民对骨质疏松重视度较低、治疗依从性较差，社区无正式专科、缺乏完善的检查设备及与二、三级医院间的信息沟通机制。国外的模式类型则局限于针对骨质疏松性骨折后患者的管理。结论　要有效落实社区骨质疏松双向转诊，进而做好骨质疏松防控，应划定可长效防控骨质疏松的防治范围、加强社区全科医生骨质疏松诊疗知识储备、完善社区卫生机构防治环节所需物资配备、开发包含双向转诊分工细节与转诊指标的转诊流程四要素。

关键词: 骨质疏松, 社区卫生服务, 分级诊疗, 双向转诊, 专病门诊, 全科医生