With the deepening aging of China's population and the growing prominence of health issues among adolescents, bone health has emerged as a critical factor affecting the nation's overall health and quality of life. The report of the 20th National Congress of the Communist Party of China emphasized the implementation of a national strategy to actively respond to population aging, while the Healthy China 2030 Planning Outline advocates for the launch of a "Healthy Bones Initiative".
Focusing on the key populations of "the elderly and the young" in China's primary-level regions, this study analyzes the epidemiological status and influencing factors of representative bone health conditions-osteoporosis, adolescent idiopathic scoliosis, and lumbar disc herniation-in order to provide scientific evidence for the formulation of national and local health policies.
Relying on the strategic research and consultation project of the Chinese Academy of Engineering, a comprehensive literature search was conducted across databases including CNKI, PubMed, WHO, Embase, and Cochrane Library. The focus was on recently published sources such as the National Health Statistical Yearbook, the China Osteoporosis Epidemiology Report, the Health Examination Management Measures for Primary and Secondary School Students, the China Degenerative Spine Health Report 2023, as well as relevant provincial and municipal bone health statistics, disease white papers, and reports from related organizations. The search period covered publications from January 2010 to June 2024. The study primarily summarizes the epidemiological characteristics of three major bone-related conditions-osteoporosis, adolescent idiopathic scoliosis, and lumbar disc herniation-and explores associated influencing factors from demographic, socioeconomic, and lifestyle perspectives.
Analysis of 40 studies published between 2010 and 2024 (≈2.1 million participants) shows that osteoporosis affects 4.5% of adults aged 40-49 years, 20.0% of those 50-59 years, and 29.0% of those ≥ 60 years, with prevalence exceeding 40.0% among women aged ≥ 50 years. The national diagnostic rate of adolescent idiopathic scoliosis was 1.2%, rising to 5.6% in high-altitude regions. Lumbar disc herniation occurs in 3.0%, 8.0%, and 11.0% of individuals aged 26-40, 41-60, and≥ 60 years, respectively, and its overall detection rate had increased from 2.0% to 12.0 % in the past decade. Sedentary behaviour, poor nutrition, and inadequate primary-level medical resources collectively drive the high burden of these three conditions.
Osteoporosis, adolescent idiopathic scoliosis, and lumbar disc herniation impose a substantial public health burden in China, highlighting the urgent need to address bone health issues among the key populations of the elderly and the youth. It is recommended to continuously improve the primary-level prevention and control system, enhance early screening, stratified diagnosis, and targeted intervention capabilities, and accelerate the advancement of health education and comprehensive management for high-risk groups.
In the context of an aging society, the incidence of chronic degenerative bone and joint diseases has been increasing year by year, and the serious lack of capacity of primary bone health services has become a key constraint to the efficiency of disease prevention and treatment, and there is an urgent need to identify its weak points for accurate optimization and effective enhancement.
This study aims to construct an evaluation index system of bone health service capacity of primary healthcare institutions to cope with the increasing burden of chronic musculoskeletal diseases and the insufficient capacity of primary bone health services in an aging society.
From September 2024 to January 2025, Chinese journal databases such as CNKI, Wanfang Data Knowledge Service Platform, Wipu Chinese Science and Technology Journal Database, China Biomedical Literature Database, and English databases such as Web of Science, PubMed, Embase, etc. were used to search for information on the evaluation of the capacity of the primary osteopathic health care service related literature on the indicator system. We checked and sorted out the relevant policies and regulations and guidance outlines on the official websites of the Chinese Government Website, the National Health and Health Commission, and the State Administration of Traditional Chinese Medicine, etc., so as to get a preliminary understanding of the current research status of the evaluation of the capacity of bone health services, and to summarise and analyse the latitudinal framework that affects the evaluation results. Literature research method was used to sort out related literature and policies, semi-structured interviews and brainstorming method were used to construct a preliminary pool of index system entries. Delphi method was used to carry out two rounds of expert consultation to screen and optimize the indexes, and Hierarchical Analysis Method was used to determine the weights of the indexes.
The study invited 24 experts from 21 regions and different professional fields in China. The positive coefficient of the experts reached 100.0%, and the authority degree was 0.906. The coordination coefficient of the experts' opinions in the two rounds suggested that the results of the study were credible. The finally constructed indicator system contains 3 first-level indicators, 15 second-level indicators and 40 third-level indicators. The first-level indicators are resource allocation, basic medical and public health services, and management and security, with weights of 0.198, 0.490, and 0.312, respectively, and the latitude of "basic medical and public health services" has the highest weight (0.490), which suggests that the enhancement of medical and public health services should be taken as the key task of capacity building of grassroots bone health services. The highest weight (0.490) was given to "basic medical and public health services", suggesting that the improvement of medical and public health service capacity should be regarded as the key task of primary bone health capacity building. In addition, the weights of indicators in the dimensions of talent cultivation, service efficiency, and medical collaboration are also relatively high, which is significant to the improvement of service capacity.
The evaluation index system of bone health service capacity of primary healthcare organizations formed in this study has high authority and scientificity, which provides reference and basis for further assessing the current status of bone health medical service capacity of primary healthcare organizations in China, and helps to promote the enhancement of bone health service capacity of primary healthcare organizations, and provides a scientific basis for the development of medical decision-making.
