骨质疏松症具有患病率高、早期症状不明显及脆性骨折后果严重等特点，公众筛查是推动早期发现和骨折预防的重要环节。2026年，全球骨健康筛查呈现多种实施模式，包括社区药师主导的风险筛查、移动式双能X线吸收法（DXA）、国家健康体检项目、常规影像机会性筛查，以及国际性公众宣传行动。本文梳理截至2026年10月14日可查证的代表性项目，重点介绍其组织模式、技术特点及临床转化价值，并区分实际运行项目、既有政策项目和正在开展的政策评估。

Osteoporosis is characterized by a substantial disease burden, limited early symptoms, and serious consequences following fragility fractures. Public screening is therefore an important component of early detection and fracture prevention. In 2026, global initiatives include community-pharmacist-led risk assessment, mobile dual-energy X-ray absorptiometry (DXA), national health examination programmes, opportunistic imaging-based screening, and international public awareness campaigns. This review summarizes verifiable initiatives as of October 14, 2026, distinguishing operational programmes from established policies and ongoing policy evaluations.

一、全球代表性筛查项目

1. 香港大学社区药师主导骨质疏松筛查项目

Hong Kong: Community Pharmacist-Led Osteoporosis Screening Programme

2026年7月，香港大学李嘉诚医学院宣布启动香港首个结构化社区药师主导骨质疏松筛查项目，采用经过验证的中国骨质疏松筛查算法（Chinese Osteoporosis Screening Algorithm，COSA），在社区药房识别尚未确诊的高风险人群。其亮点是利用社区药房的可及性，将风险识别前移至常规医疗机构之外，并借助药师进行初步评估与转诊衔接。该项目的长期价值仍需通过筛查覆盖率、DXA转诊完成率及治疗启动率等指标评价。

In July 2026, the University of Hong Kong's LKS Faculty of Medicine announced Hong Kong's first structured community-pharmacist-led osteoporosis screening programme, using the validated Chinese Osteoporosis Screening Algorithm (COSA). The initiative leverages community pharmacies to identify potentially undiagnosed high-risk individuals and facilitate referral. Its longer-term impact should be assessed through screening uptake, DXA referral completion, and treatment initiation rates.

2. 中国农村地区便携式DXA人群筛查模式

China: Government-Led Population Screening Using Portable DXA

中国江苏省吴江区同村社区的研究展示了政府、社区卫生服务中心与专科医院协同实施的筛查模式。研究于2021年纳入3530名60岁及以上常住居民，将前臂便携式DXA整合进年度健康体检；研究报告筛查成本约为每人6.2元。该模式的亮点在于通过便携设备提高基层可及性，并结合专科教育促进后续管理。需要注意，这是一项已发表的既往实施研究，并不能据此认定该项目在2026年仍持续运行或已全国推广。

A study from Tongcun Community in Wujiang District, Jiangsu Province, illustrates a government–community health centre–specialist hospital screening model. Conducted in 2021, it included 3,530 residents aged 60 years or older and integrated portable forearm DXA into annual health examinations, reporting a screening cost of approximately RMB 6.2 per person. The model demonstrates a potentially scalable approach for resource-limited settings, although continued operation in 2026 or nationwide adoption cannot be assumed from this study alone.

3. 新加坡社区移动式骨密度筛查服务

Singapore: Mobile and Community-Based BMD Screening

新加坡国立健保集团（NHG Health）提供固定式及移动式骨密度检测服务，覆盖综合诊疗所、社区中心和健康筛查活动。服务采用医院级DXA设备，重点面向65岁及以上女性、70岁及以上男性，以及有骨质疏松危险因素或既往骨折史的人群。其特点是将传统医院内检测延伸至社区，提高行动不便及交通受限人群的检查可及性。通常需先取得医生转诊，再预约检测。

Singapore's National Healthcare Group offers fixed and mobile bone mineral density services at polyclinics, community centres, and health screening events. Hospital-grade DXA is used, with screening recommended for women aged 65 years or older, men aged 70 years or older, and individuals with relevant risk factors or previous fractures. The model improves geographical accessibility, although physician referral and appointment requirements remain part of the pathway.

4. 韩国国家健康筛查中的骨密度检测

South Korea: BMD Testing Within the National Health Screening Programme

韩国将66岁女性骨密度检测纳入国家健康筛查政策。2026年发表的一项基于国家健康保险数据库的研究分析了24,895名女性，发现纳入骨密度检测的筛查时期，骨质疏松相关就诊的发生优势比增加至1.52，后续骨折风险的风险比为0.91。该研究支持国家筛查可能促进疾病识别并与较低骨折风险相关，但属于观察性研究，不能单独证明筛查造成了全部获益。其重要启示是，国家筛查必须与阳性结果后的诊疗和随访相衔接。

South Korea includes BMD testing for women aged 66 years in its national health screening programme. A 2026 study of 24,895 women found that periods including BMD testing were associated with increased osteoporosis-related medical visits (odds ratio 1.52) and reduced subsequent fracture risk (hazard ratio 0.91). As an observational study, it cannot establish causality, but it highlights the importance of linking screening with diagnosis, treatment, and follow-up.

5. 常规胸部X线AI机会性筛查研究

Singapore and Asia: AI-Enabled Opportunistic Screening

2026年发表的研究评估了深度学习分析常规胸部X线以识别骨质疏松风险的临床与经济价值，研究对象为新加坡50岁及以上女性。模型可利用既有影像进行初筛，减少部分人群直接接受DXA检查的需求；研究的经济学模拟提示，该策略可能具有成本效益。与组织专门筛查活动相比，机会性筛查能够利用既有医疗数据，减少额外检查负担。不过，这项研究主要提供模型分析与经济学证据，不等于已建立覆盖公众的常规筛查项目。

A 2026 study evaluated the clinical and economic implications of deep-learning analysis of routine chest radiographs to identify osteoporosis risk among women aged 50 years or older in Singapore. By using existing images, this approach may reduce the need for immediate DXA testing in some individuals. Economic modelling suggested potential cost-effectiveness, but the study does not establish that a population-wide AI screening programme has already been implemented.

6. 世界骨质疏松日2026公众行动

World Osteoporosis Day 2026: Lifelong Bone Health Campaign

国际骨质疏松基金会（IOF）将每年10月20日设为世界骨质疏松日。2026年活动强调全生命周期骨健康，从儿童期骨量积累、成年期骨骼维护，到老年期骨质疏松防治和骨折预防。该行动可通过公众教育、风险自评、社区健康活动及专业机构宣传，提高公众对筛查和早期干预的认知。它属于全球公众倡导行动，而非统一实施的DXA人群筛查项目；具体筛查服务取决于各地组织安排。

The International Osteoporosis Foundation marks World Osteoporosis Day on October 20 each year. The 2026 campaign emphasizes lifelong bone health, from building peak bone mass in childhood to maintaining skeletal health and preventing fractures in later life. Activities can include public education, risk self-assessment, and community outreach. This is a global awareness campaign rather than a standardized DXA screening programme; actual screening availability depends on local implementation.

7. 英国骨质疏松人群筛查政策评估

United Kingdom: National Screening Policy Review

2026年，英国国家筛查委员会（UK National Screening Committee）就女性骨质疏松筛查证据开展公众咨询。其证据综述认为，目前尚缺乏足够高质量证据支持在成年女性中实施全国性或目标性筛查项目；咨询截止日期为2026年10月7日。该工作并非筛查项目启动，而是国家层面对筛查收益、风险及证据质量的审查。其亮点在于明确区分面向无症状人群的国家筛查与临床医生针对个体风险开展的评估。

In 2026, the UK National Screening Committee consulted on evidence concerning osteoporosis screening in women. Its evidence review concluded that current evidence was insufficient to support population-wide or targeted screening programmes for adult women. The consultation closed on October 7, 2026. This is a policy evaluation rather than a screening launch and illustrates the distinction between population screening and individualized clinical risk assessment.

二、讨论与展望

2026年全球骨健康筛查呈现三类互补模式：一是以香港社区药房为代表的主动风险识别；二是以中国农村便携式DXA、新加坡移动检测和韩国国家健康筛查为代表的服务可及性提升；三是以AI影像分析和世界骨质疏松日为代表的技术创新与公众动员。各模式的适用人群、证据强度及实施成熟度存在差异，不能简单比较筛查覆盖率或成本。

Three complementary approaches are evident in 2026: proactive risk identification through community pharmacies; improved access through portable DXA, mobile services, and national health examinations; and technological innovation and public engagement through AI and awareness campaigns. These approaches differ in target populations, evidence strength, and implementation maturity, so their coverage and costs should not be compared without considering context.

未来项目评价应重点报告筛查参与率、高风险人群检出率、DXA转诊完成率、确诊后的治疗启动率、随访依从性、骨折结局及成本效益。公众筛查的核心不是单纯发现低骨密度，而是建立从风险识别到确诊、干预和长期管理的完整闭环。

Future programme evaluations should report participation, high-risk detection, DXA referral completion, treatment initiation, follow-up adherence, fracture outcomes, and cost-effectiveness. The ultimate goal of public screening is not simply to identify low bone density, but to establish a complete pathway from risk identification to confirmation, intervention, and long-term management.

参考文献

1.  University of Hong Kong, LKS Faculty of Medicine. HKU Launches First Community Pharmacist-Led Osteoporosis Screening Programme in Hong Kong. 2026 Jul 23.

2.  Zhao W, Wu Q, Liu Q, et al. Government-implemented population osteoporosis screening in rural China: achieving universal coverage with portable DXA. BMC Geriatrics. 2025;25:815.

3.  National Healthcare Group. Detect Early Bone Thinning with BMD Scan.

4.  Lim JH, Chun J, Min GJ, et al. Impact of bone mineral density testing in the national health screening program on osteoporosis-related medical visits and fractures among women. Archives of Osteoporosis. 2026;21:56.

5.  Chandran M, Reginster JY, Kim MY, et al. Clinical and economic impact of deep learning-enhanced opportunistic osteoporosis screening using chest radiographs with and without OSTA. Osteoporosis International. 2026;37:717–726.

6.  International Osteoporosis Foundation. World Osteoporosis Day 2026: Get Involved.

7.  UK National Screening Committee. UK NSC Opens Consultation on Screening for Osteoporosis in Women. 2026 Jul 15.