臺灣博碩士論文加值系統

隨隨著世界醫療進步、現今生活型態改變及人口高齡化問題，骨質疏鬆症已是全球重視的議題之一，人口的老化嚴重，罹患骨質疏鬆症人數也會隨之增加，台灣髖骨骨折發生率是亞洲第一，尤其老年跌倒發生率高，因為跌倒而又有骨質疏鬆情形極易造成長年臥床與失能，致而影響生活品質甚至死亡風險增加。再則現今久坐、少動、少日曬的生活型態，也促使應重視預防骨質疏鬆年輕化的風險。本研究目的在探討中高齡者骨質疏鬆之健康識能、健康行為與生活品質之關係，進而對於預防骨質疏鬆疾病提早警覺，於促進健康行為的方向有所助益。研究方法為橫斷性研究，以google表單進行問卷調有效問卷為733人，研究對象是台灣地區民眾，年齡在40歲至85歲，採用描述性統計、獨立t檢定、單因子變異數(ANOVA)及多元線性回歸進行相關研究分析。
本次研究結果中高齡者平均年齡54.6歲，女性68.1%，健康識能達充足程度以上有87.8%，在骨質疏鬆知識答對率68.1%，中高齡者生活品質分數最高為生理健康69.6分，其次為環境生活品質66.8分，中高齡者之年齡、健康識能、疾病史、身體狀況及與生活品質有顯著相關，教育程度、月收入、身體活動情形與生活品質顯著差異，在本研究個人屬性、健康識能、健康行為對整體及生理健康生活品質分別有31.9%與29.7%的解釋力。由本研究結果建議中高齡者落實鈣質或牛奶的飲食補與身體活動與並進行骨質疏鬆的檢測、提高對骨質疏鬆知識與相關疾病的認識、健康識能的教育介入及鼓勵多類型的身體活動方式促進生活品質，未來並可於偏遠地區進行施測探討以利於研究醫療機構或衛生單位針對中高齡有關骨質疏鬆衛生教育及生活品質之宣導及衛生政策制定上之參考。

With the advancement of global healthcare, changes in contemporary lifestyles, and the challenges posed by an aging population, osteoporosis has become a significant global concern. The aging of the population has led to an increase in the number of individuals suffering from osteoporosis, particularly in regions like Taiwan where the incidence of hip fractures is the highest in Asia. The aim of this study is to explore the relationship between health literacy, health behavior, and quality of life concerning osteoporosis among middle-aged and elderly individuals. The research employs a cross-sectional design, utilizing Google Forms for a questionnaire survey. The study involved 733 participants from Taiwan, aged between 40 and 85 years. The research analysis incorporates descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), and multiple linear regression. The results of this study revealed that the average age of the middle-aged and elderly participants was 54.6 years, with 68.1% being female. 87.8% exhibit sufficient health literacy. The correct answer rate for osteoporosis-related knowledge was 68.1%. The highest scores for quality of life were in the physical health domain (69.6), followed by the environmental quality of life domain (66.8). Age, health literacy, medical history, physical condition, and quality of life among the middle-aged and elderly participants showed significant correlations. Educational level, monthly income, physical activity, and quality of life also suggested significant differences. Based on the study findings, it is recommended that middle-aged and elderly individuals should prioritize dietary calcium intake, engage in physical activity, undergo osteoporosis testing, enhance knowledge of osteoporosis and related conditions, receive educational interventions for health literacy, and embrace various forms of physical activity to enhance quality of life. Future research could focus on remote areas to further investigate these factors, benefiting healthcare institutions and public health agencies in designing osteoporosis health education and quality of life improvement strategies for the middle-aged and elderly population.

目 錄 頁次
口試委員審定書 I
誌謝 II
中文摘要 .III
英文摘要 .IV
目錄 VI
圖目錄 IX
表目錄 X
第一章 緒論 1
1.1 研究背景與動機 2
1.2 研究目的 2
1.3 名詞解釋 3
1.3.1健康識能 3
1.3.1健康行為 3
1.3.1生活品質 3
1.3.1疾病史 3
1.3.1骨質疏鬆 3
1.4 研究限制 3
第二章 文獻探討 4
2.1 骨質疏鬆症 5
2.1.1骨質疏鬆症定義與現況 5
2.1.2骨質疏鬆與肌少症相關性 11
2.1.3 小結 14
2.2 健康識能 15
2.2.1 小結 19
2.3 健康行為 20
2.3.1 小結 22
2.4 生活品質 23
2.4.1 小結 27
第三章 研究設計與方法 28
3.1 研究架構 28
3.2 研究假設 28
3.3 研究對象 29
3.4 研究步驟 29
3.5 資料收集方法 31
3.6 研究工具 32
3.7 研究問卷效度檢定與信度分析 33
3.8資料處理與統計分析 34
第四章 研究結果與討論
4.1描述性統計 36
4.1.1研究對象人口學特性基本資料分析 36
4.1.2研究對象骨質疏鬆風險背景資料、疾病史、使用藥物與求醫行為之分布情形 38
4.1.3研究對象目前身體狀況與自評肌肉減少的風險情形 41
4.1.4研究對象預防骨質疏鬆的健康行為分布情形 43
4.1.5研究對象健康識能程度、骨質疏疏知識認知之分布情形 48
4.1.6研究對象在生活品質題項之答題分布 43
4.1.6.1研究對象男女生之生活品質之平均數分布 52
4.2 個人屬性與生活品質之差異分析 53
4.2.1研究對象人口學特性與生活品質分析 53
4.2.2研究對象骨質疏鬆背景風險與整體生活品質分析 60
4.3預防骨質疏鬆的健康行為與生活品質之相關分析 72
4.3.1 研究對象飲食補充行為、菸酒習慣與生活品質之關係 72
4.3.2 研究對象之骨質檢測行為、戶外曬太陽、身體活動習慣與生活品質之差異分析 76
4.4 健康識能與骨質疏鬆知識認知對生活品質之相關分析 83
4.5. 個人屬性、健康識能、健康行為對生活品質之複回歸分析 84

第五章 結論與建議
5.1結論 89
5.1.1中高齡者個人屬性、健康識能、健康行為及生活品質之現況 89
5.1.2中高齡者個人屬性與生活品質之關係 89
5.1.3中高齡者健康識能、骨質疏鬆知識認知與生活品質之關係 90
5.1.4中高齡者預防骨質疏鬆的健康行為與生活品質之關係 90
5.1.5中高齡者個人屬性、健康識能、健康行為對生活品質之解釋力 90
5.2研究建議 91
5.2.1實務上的建議 92
5.2.1未來研究的建議 92
參考文獻 93
英文文獻 93
中文文獻 102
附錄一 IRB 同意研究證明書 104
附錄二 問卷內容效度專家一覽表 105
附錄三 量表使用同意函 (HLS-SF12) 106
附錄三 量表參考使用授權書 (WHOQOL-BREF臺灣簡明版) 107
附錄三 施測問卷 108

圖 目 錄
頁次
圖3-1 研究架構 28
圖3-2 研究流程圖 30
圖3-3 研究變項 35


表 目 錄
頁次
表2.1骨密度流失原因之相關研究文獻 6
表2.2骨質疏鬆相關研究文獻 7
表2.3骨質疏鬆與肌少症相關研究文獻 12
表2.4健康識能相關文獻整理 17
表2.5預防骨質疏鬆之健康行相關文獻 21
表2.6生活品質相關文獻 25
表3.7.1專家內容效度指標 33
表3.7.2量表信度指標 33
表3.8本研究採用之統計方法 35
表4.1.1 研究對象人口學基本資料分布情形 37
表4.1.2 研究對象骨質疏鬆風險背景資料，疾病史、使用藥物與求醫行為之分布情形 39
表4.1.3 研究對象目前身體狀況與自評肌肉減少的風險情形 42
表4.1.4 研究對象預防骨質疏鬆的健康行為分布情形 44
表4.1.5 研究對象的健康識能程度、骨質疏鬆知識認知分布情形 45
表4.1.6研究對象在健康識能題目答題之分布情形 46
表4.1.7 研究對象在骨質疏鬆知識之答題分布 47
表4.1.8研究對象在生活品質題項之答題分布情形 49
表4.1.9 研究對象在男女生活品質各範疇之平均分數 52
表4.2.1 研究對象人口學特性之整體生活品質差異分析 55
表4.2.2 研究對象人口學特性之生理健康生活品質差異分析 56
表4.2.3 研究對象人口學特性之心理生活品質差異分析 57
表4.2.4 研究對象人口學特性之社會關係生活品質差異分析 58
表4.2.5 研究對象人口學特性之生環境活品質差異分析 59
表4.2.6 研究對象骨質疏鬆背景風險、身體狀況、疾病史與整體生活品質分析 62
表4.2.7 研究對象骨質疏鬆風險背景、身體狀況、疾病史與生理健康生活品質之分析 64
表4.2.8 研究對象骨質疏鬆風險背景、身體狀況、疾病史與心理生活品質分析 66
表4.2.9研究對象骨質疏鬆風險背景、身體狀況、疾病史與社會關係生活品質分析 68
表4.2.10研究對象骨質疏鬆風險背景、身體狀況、疾病史與環境生活品質分析 70
表4.3.1 研究對象飲食補充行為、菸酒習慣與整體生活品質之關係 73
表4.3.2 研究對象飲食補充行為、菸酒習慣與生理健康生活品質之關係 73
表4.3.3 研究對象飲食補充行為、菸酒習慣與心理生活品質之關係 74
表4.3.4 研究對象飲食補充行為、菸酒習慣與社會關係生活品質之關係 74
表4.3.5 研究對象飲食補充行為、菸酒習慣與環境生活品質之關係 75
表4.3.6 研究對象骨質檢測行為、戶外曬太陽、身體活動習慣與整體生活品質之分析 78
表4.3.7 研究對象骨質檢測、戶外曬太陽、身體活動習慣與生理健康品質之分析 79
表4.3.8 研究對象骨質檢測、戶外曬太陽、身體活動習慣與心理生活品質之分析 80
表4.3.9 研究對象骨質檢測、戶外曬太陽、身體活動習慣與社會關係生活之分析 81
表4.3.10 研究對象骨質檢測、戶外曬太陽、身體活動習慣與環境生活品質之分析 82
表4.4.1健康識能、骨質疏鬆知識認知與整體生活品質之相關分析 83
表4.5.1 個人屬性、健康識能、健康行為對整體生活品質之複迴歸分析 86
表4.5.2 個人屬性、健康識能、健康行為對生理健康生活品質之迴歸分析 86
表4.5.3個人屬性、健康識能、健康行為對心理生活品質之複迴歸分析 87
表4.5.4 個人屬性、健康識能、健康行為對社會關係生活品質之複迴歸分析 87
表4.5.5 個人屬性、健康識能、健康行為對環境生活品質之複迴歸分析 88
表4.5.6 個人屬性、健康識能及健康行為對生活品質各範疇之影響排序 88

一.英文文獻
1.Beaudart, C., Dawson, A., Shaw, S. C., Harvey, N. C., Kanis, J. A., Binkley, N., Reginster, J. Y., Chapurlat, R., Chan, D. C., Bruyère, O., Rizzoli, R., Cooper, C., Dennison, E. M., & IOF-ESCEO Sarcopenia Working Group (2017). Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 28(6), 1817–1833. https://doi.org/10.1007/s00198-017-3980-9
2.Becker,M.H(1974) THE Health belief modle and sick role behavior, Health education Monogrophs 2. 409-419, https://journals.sagepub.com/doi/10.1177/109019817400200407 http://dx.doi.org/10.1177/109019817400200407
3.Benedetti, M. G., Furlini, G., Zati, A., & Letizia Mauro, G. (2018). The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed research international,, 4840531. https://doi.org/10.1155/2018/4840531
4.Bliuc, D., Alarkawi, D., Nguyen, T. V., Eisman, J. A., & Center, J. R. (2015). Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo Osteoporosis Epidemiology Study. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 30(4), 637–646.
5.Borgström F, Lekander I, Ivergård M, et al. (2013).The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) – quality of life during the first 4 months after fracture. Osteoporosis Int,24(3),811–823.
6.Chen, F. P., Huang, T. S., Fu, T. S., Sun, C. C., Chao, A. S., & Tsai, T. L. (2018). Secular trends in incidence of osteoporosis in Taiwan: A nationwide population-based study. Biomedical journal, 41(5), 314–320. https://doi.org/10.1016/j.bj.2018.08.001
7.Ciubean, A. D., Ungur, R. A., Irsay, L., Ciortea, V. M., Borda, I. M., Onac, I., Vesa, S. C., & Buzoianu, A. D. (2018). Health-related quality of life in Romanian postmenopausal women with osteoporosis and fragility fractures. Clinical interventions in aging, 13, 2465–2472. https://doi.org/10.2147/CIA.S190440
8. Clynes, M. A., Gregson, C. L., Bruyère, O., Cooper, C., & Dennison, E. M. (2021). Osteosarcopenia: where osteoporosis and sarcopenia collide. Rheumatology (Oxford, England), 60(2), 529–537. https://doi.org/10.1093/rheumatology/keaa755
9.Dehghankar L, Panahi R, Hasannia E, Hemmati F, Samiei Siboni F.(2021). The Effect of an Educational Intervention on Health Literacy and the Adoption of Nutritional Preventive Behaviors Related to Osteoporosis Among Iranian Health Volunteers. Journal of Preventive Medicine and Public Health.54(6),404-411. doi: 10.3961/jpmph.21.183.
10.Don Nutbeam.(2000), Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century, Health Promotion International, 3, 259–267, https://doi.org/10.1093/heapro/15.3.259
11.Duong TV, Aringazina A, Kayupova G, Nurjanah, Pham TV, Pham KM, Truong TQ, Nguyen KT, Oo WM, Su TT, Majid HA, Sørensen K, Lin IF, Chang Y, Yang SH, Chang PWS. (2019) Development and Validation of a New Short-Form Health Literacy Instrument (HLS-SF12) for the General Public in Six Asian Countries. Health Lit Res Pract.10,3(2),91-102. doi: 10.3928/24748307-20190225-01. PMID: 31294310; PMCID: PMC6607763.
12.Daly, R. M., Rosengren, B. E., Alwis, G., Ahlborg, H. G., Sernbo, I., & Karlsson, M. K. (2013). Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study. BioMed Central geriatrics, 13, 71. https://doi.org/10.1186/1471-2318-13-71
13.Efendi, V., Özalevli, S., Naz, İ., & Kılınç, O. (2018). The effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life among healthy women. Sağlıklı kadınlarda sigaranın vücut kompozisyonu, pulmoner fonksiyonlar, fiziksel aktivite ve sağlıkla ilişkili yaşam kalitesi üzerine etkisi. Tuberkuloz ve toraks, 66(2), 101–108. https://doi.org/10.5578/tt.50724
14.Eum, M. J., & Choi, M. J. (2021). Association between Exposure to Alcohol's Harm to Others and Health-Related Quality of Life in Korean Adults: A Nationwide Population-Based Study. International journal of environmental research and public health, 18(5), 2714. https://doi.org/10.3390/ijerph18052714
15.Freedman, D. A., Bess, K. D., Tucker, H. A., Boyd, D. L., Tuchman, A. M., & Wallston, K. A. (2009). Public health literacy defined. American journal of preventive medicine, 36(5), 446–451. https://doi.org/10.1016/j.amepre.2009.02.001
16.Garg, A. and Kay, S. (2018) Osteoporosis: A Disease of Men. Health, Vol.10 No.1, January,10, 69-74. doi: 10.4236/health.2018.101005. www.scirp.org/journal/health
17.Gasperini, B., Cherubini, A., Montanari, R., Lamanna, P., Martinez, V., Prospero, E., & Espinosa, E. (2021). How much do patients know about osteoporosis? A survey among patients referred to the dual-energy X-ray absorptiometry exam. Aging clinical and experimental research, 33(12), 3183–3189. https://doi.org/10.1007/s40520-021-01860-9
18.Geboers, B., Reijneveld, S. A., Jansen, C. J., & de Winter, A. F. (2016). Health Literacy Is Associated With Health Behaviors and Social Factors Among Older Adults: Results from the LifeLines Cohort Study. Journal of health communication, 21(2), 45–53. https://doi.org/10.1080/10810730.2016.1201174
19.Girgis CM, Mokbel N, Digirolamo DJ. (2014).Therapies for musculoskeletal disease: can we treat two birds with one stone? Current Osteoporosis Reports. Jun;12(2),142-53. doi: 10.1007/s11914-014-0204-5. PMID: 24633910; PMCID: PMC4083371.
20.Hosking, S. M., Brennan-Olsen, S. L., Beauchamp, A., Buchbinder, R., Williams, L. J., & Pasco, J. A. (2018). Health literacy in a population-based sample of Australian women: a cross-sectional profile of the Geelong Osteoporosis Study. BioMed Central public health, 18(1), 876. https://doi.org/10.1186/s12889-018-5751-8 https://doi.org/10.1007/s00198-012-2240-2
21.International osteoporosis foundation (IOF),What is osteoporosis, https://www.osteoporosis.foundation/ (visited 2022/8/30)
22.International osteoporosis foundation (IOF), (2023).New FRAXplus® (Beta version) illustrates potential of refined risk factor information entered to the world’s most widely used fracture risk assessment tool. https://www.osteoporosis.foundation/news/new-fraxplusr-beta-version (visited 2023/6/10)
23.Jafari, A., Nejatian, M., Momeniyan, V., Barsalani, F. R., & Tehrani, H. (2021). Mental health literacy and quality of life in Iran: a cross-sectional study. BioMed Central psychiatry, 21(1), 499. https://doi.org/10.1186/s12888-021-03507-5
24.Johansson, L., Svensson, H. K., Karlsson, J., Olsson, L. E., Mellström, D., Lorentzon, M., & Sundh, D. (2019). Decreased physical health-related quality of life-a persisting state for older women with clinical vertebral fracture. Osteoporosis international , a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(10), 1961–1971. https://doi.org/10.1007/s00198-019-05044-0
25.Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). (2013).European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international,24(1),23-57. doi: 10.1007/s00198-012-2074-y. PMID: 23079689
26.Kanis, J. A., Johnell, O., Oden, A., Johansson, H., & McCloskey, E. (2008). FRAX and the assessment of fracture probability in men and women from the UK. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 19(4), 385–397. https://doi.org/10.1007/s00198-007-0543-5
27.Kanis, J. A., Cooper, C., Rizzoli, R., Reginster, J. Y., & Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the Committees of Scientific Advisors and National Societies of the International Osteoporosis Foundation (IOF) (2019). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 30(1), 3–44. https://doi.org/10.1007/s00198-018-4704-5
28.Kawakami, R., Miyachi, M., Sawada, S. S., Torii, S., Midorikawa, T., Tanisawa, K., Ito, T., Usui, C., Ishii, K., Suzuki, K., Sakamoto, S., Higuchi, M., Muraoka, I., & Oka, K. (2020). Cut-offs for calf circumference as a screening tool for low muscle mass: WASEDA'S Health Study. Geriatrics & gerontology international, 20(10), 943–950. https://doi.org/10.1111/ggi.14025
29.Liu, D. H., Hsu, C. Y., Wu, P. C., Chen, Y. C., Chen, Y. Y., Chen, J. F., Yu, S. F., & Cheng, T. T. (2021). Simple Self-Assessment Tool to Predict Osteoporosis in Taiwanese Men. Frontiers in medicine, 8, 713535. https://doi.org/10.3389/fmed.2021.713535
30.Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, Ju X, Zhang X. What is the meaning of health literacy? (2020).A systematic review and qualitative synthesis. Fam Med Community Health,8(2),e000351. doi: 10.1136/fmch-2020-000351. PMID: 32414834.
31.Lin, L. P., Lai, W. J., Hsu, S. W., & Lin, J. D. (2020). Health Literacy of Osteoporosis Risks among Caregivers Serving in Disability Care Facilities. International journal of environmental research and public health, 17(13), 4903. https://doi.org/10.3390/ijerph17134903
32.Locquet, M., Beaudart, C., Bruyère, O., Kanis, J. A., Delandsheere, L., & Reginster, J. Y. (2018). Bone health assessment in older people with or without muscle health impairment. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 29(5), 1057–1067. https://doi.org/10.1007/s00198-018-4384-1
33.Miller T. A. (2016). Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis. Patient education and counseling, 99(7), 1079–1086. https://doi.org/10.1016/j.pec.2016.01.020
34.National Institutes of Health(NIH)，https://www.nia.nih.gov/health/osteoporosis (visited 2022/8/30)
35. Neale, R. E., Lucas, R. M., Byrne, S. N., Hollestein, L., Rhodes, L. E., Yazar, S., Young, A. R., Berwick, M., Ireland, R. A., & Olsen, C. M. (2023). The effects of exposure to solar radiation on human health. Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology, 22(5), 1011–1047. https://doi.org/10.1007/s43630-023-00375-8
36.Nielson, C. M., Srikanth, P., & Orwoll, E. S. (2012). Obesity and fracture in men and women: an epidemiologic perspective. Journal of bone and mineral research , 27(1), 1–10. https://doi.org/10.1002/jbmr.1486
37.Nutbeam, D., & Muscat, D. M. (2021). Health Promotion Glossary. Health promotion international, 36(6), 1578–1598. ttps://doi.org/10.1093/heapro/daaa157
38.Papadopoulou S. K. (2020). Sarcopenia: A Contemporary Health Problem among Older Adult Populations. Nutrients, 12(5), 1293. https://doi.org/10.3390/nu12051293
39.Paskins, Z., Crawford-Manning, F., Bullock, L., & Jinks, C. (2020). Identifying and managing osteoporosis before and after COVID-19: rise of the remote consultation? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 31(9), 1629–1632. https://doi.org/10.1007/s00198-020-05465-2
40.Pastor-Robles MB, Mayo-Íscar A, Cárdaba-García RM, Niño-Martín V. (2022). Quality of Life in Women over 65 Years of Age Diagnosed with Osteoporosis. International Journal of Environmental Research and Public Health,19(9):5745. doi: 10.3390/ijerph19095745. PMID: 35565140.
41.Pourhassan, M., Buehring, B., Stervbo, U., Rahmann, S., Mölder, F., Rütten, S., Trampisch, U., Babel, N., Westhoff, T. H., & Wirth, R. (2021). Osteosarcopenia, an Asymmetrical Overlap of Two Connected Syndromes: Data from the OsteoSys Study. Nutrients, 13(11), 3786. https://doi.org/10.3390/nu13113786
42.Schönfeld, M. S., Pfisterer-Heise, S., & Bergelt, C. (2021). Self-reported health literacy and medication adherence in older adults: a systematic review. British Medical Journal(BMJ open), 11(12), e056307. https://doi.org/10.1136/bmjopen-2021-056307
43.Senior, H. E., Henwood, T. R., Beller, E. M., Mitchell, G. K., & Keogh, J. W. (2015). Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas, 82(4), 418–423. https://doi.org/10.1016/j.maturitas.2015.08.006
44.Sitati, F. C., Obimbo, M. M., & Gichangi, P. (2021). Knowledge and Beliefs on Osteoporosis among African Postmenopausal Women in a Kenyan Semi-Rural County of Kiambu. Journal of bone metabolism, 28(1), 91–98. https://doi.org/10.11005/jbm.2021.28.1.91
45.Song J, Lee E. (2021).Health-Related Quality of Life of Elderly Women with Fall Experiences. Int J Environ Res Public Health,18(15),7804. doi: 10.3390/ijerph18157804. PMID: 34360100; PMCID: PMC8345432.
46.Sørensen K, Pleasant A. (2017).Understanding the conceptual importance of the differences among health literacy definitions. Stud Health Technol Inform,240,3–14.
47.Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H; (2012). (HLS-EU) Consortium Health Literacy Project European. Health literacy and public health: a systematic review and integration of definitions and models. BioMed Central Public Health.,12,80. doi: 10.1186/1471-2458-12-80. PMID: 22276600
48.Sutton RAL, Dian L, Guy P. (2011).Osteoporosis in men: an underrecognized and undertreated problem. British Columbia Medical Journal, 53(10),535–540. https://bcmj.org/articles/osteoporosis-men-underrecognized-and-undertreated-problem
49.The Foundation for the National Institutes of Health (FNIH). Biomarkers Consortium – Bone Quality Project. https://www.fnih.org/(visited 2022/8/30)
50.The Journal of The North American Menopause Society. (2021).The North American Menopause Society,vol.28,9, 973-997 DOI:10.1097/GME.0000000000001831
51. The World Health Organization (WHO), (2003). Prevention and management of osteoporosis. report of a WHO scientific group. Retrieved from https://apps.who.int/iris/handle/10665/42841
52. The World Health Organization (WHO),(2012). The World Health Organization Quality of Life .WHOQOL: Measuring Quality of Life (technical report series, NO.921). http://www.who.int/tools/whoqol/whoqol-bref
53.Tong, T.Y.N., Appleby, P.N., Armstrong, M.E.G. et al. (2020).Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. Biomedicine, medicine 18, 353. https://doi.org/10.1186/s12916-020-01815-3
54.Tu KN, Lie JD, Wan CKV, Cameron M, Austel AG, Nguyen JK, Van K, Hyun D.(2018) Osteoporosis: A Review of Treatment Options. P T.,43(2),92-104. PMID: 29386866; PMCID: PMC5768298.
55.Ulley, J., Harrop, D., Ali, A., Alton, S., & Fowler Davis, S. (2019). Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review. BMC geriatrics, 19,(1), 15. https://doi.org/10.1186/s12877-019-1031-4
56.Urstad KH, Andersen MH, Larsen MH, Borge CR, Helseth S, Wahl AK. (2022).Definitions and measurement of health literacy in health and medicine research: a systematic review. British Medical Journal Open,12(2) e056294. doi: 10.1136/bmjopen-2021-056294
57.Weaver, C. M., Gordon, C. M., Janz, K. F., Kalkwarf, H. J., Lappe, J. M., Lewis, R., O'Karma, M., Wallace, T. C., & Zemel, B. S. (2016). The National Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 27(4), 1281–1386. https://doi.org/10.1007/s00198-015-3440-3
58.Wu, D., Cline-Smith, A., Shashkova, E., Perla, A., Katyal, A., & Aurora, R. (2021). T-Cell Mediated Inflammation in Postmenopausal Osteoporosis. Frontiers in immunology, 12, 687551. https://doi.org/10.3389/fimmu.2021.687551
59.Yin, T., Zhang, J. X., Wang, F. X., Zhao, J. H., Zhao, Y., Liu, L., Liu, X. Y., Zhang, Y. H., & Zhao, Y. (2021). The Association Between Sarcopenic Obesity and Hypertension, Diabetes, and Abnormal Lipid Metabolism in Chinese Adults. Diabetes, metabolic syndrome and obesity,targets and therapy, 14, 1963–1973. https://doi.org/10.2147/DMSO.S308387
60.Zheng, M., Jin, H., Shi, N., Duan, C., Wang, D., Yu, X., & Li, X. (2018). The relationship between health literacy and quality of life: a systematic review and meta-analysis. Health and quality of life outcomes, 16(1), 201. https://doi.org/10.1186/s12955-018-

二.中文文獻
1.方耀凡、吳至行、宋永魁、林高田、周威宇、郝德慧、洪暐傑..羅淑芬等人(2021) 。台灣成人骨質疏鬆症防治之共識及指引2021。中華民國骨質疏鬆症協會。P13-P15。
2. 王立亭、方怡堯、何信弘、張少熙(2020) 。台北都會區不同性別高齡者休閒時間身體活動和靜態行為與健康生活品質之關係。台灣衛誌，39(6) 696-708。
3.中華民國110年國民生活狀況意向調查報告。調查時間111年6月8日至6月2 2日。內政部統計處(2021) 。2-14。
4.李威儒、彭莉甯、林明憲、陳亮恭(2020)。學術專論-亞洲肌少症診治共識2019更新介紹。台北市醫師公會會刊，64(7) 46-52。
5.李蘭、晏涵文、陳富莉、陸玓玲、吳文琪、江宜珍(2010)。健康行為與健康教育。巨流圖書出版。5-49。
6.林瑞模、姚美雲、唐建生、吳至行、楊宜青、郭柏秀、謝忠焚、鍾達榮(2009) 。國內民眾社區骨質疏鬆篩檢結果正確性和知識、態度及行為調查。GRB-DOH98-HP-1104，http://grbsearch.stpi.narl.org.tw。
7.林季緯、何青蓉、黃如薏、王維典(2016)。健康識能的概念與實務應用，台灣家醫誌。26(2)65-76。
8.吳岱穎、廖振焜、蔡秉諺(2018)。台灣社區老年人跌倒與生活品質相關因素長期追蹤研究(第3年)。科技部補助專題研究計畫成果報告。GRB-MOST103-2314-B-532-001-MY3)。https://www.grb.gov.tw/search/planDetail?id=8343977。
9.吳至行、呂宗學(2021)。驗證台灣十年骨折風險評估計算工具-雙世代研究。https://www.grb.gov.tw/search/planDetail?id=12279567。
10.吳萬益(2019)。企業研究方法。華泰文化出版。
11周輝政、楊東川(2018)。更年期與骨質疏鬆。衛生福利部國民健康署。https://www.toa1997.org.tw/problem。

12.姚開屏(2002)。台灣版世界衛生組織生活品質問卷之發展與應用。台灣醫學6(3)193-200
13.侯文萱、謝耿南、石曜堂、江東亮、胡淑貞、…蘇千田(2019)。我國高齡長者健康識能之決定因子與其健康結果。國家衛生研究院論壇。94-110。
14莊素雲(2021) 。台灣長者健康識能與手部衛生之探討。臺北醫學大學公共衛生學系碩士論文。
15.陳榮邦、林高田、陳芳萍、宋永魁、陳重桓、傅再生、洪暐傑…楊榮森等人(2020)。骨質疏鬆的定義與診斷。台灣成人骨質疏鬆症防治之共識及指引2020。中華民國骨質疏鬆症協會。P4-P5 。
16.陳雪芬（2020）。從社區長者觀點探討健康信念、行動線索與自我效能對採取預防跌倒行動可能性之影響。福祉科技與服務管理學刊，8(4), 299-317。
17.張德華(2014)。以骨質疏鬆知識、健康信念量表對五十歲以上民眾對此疾病及知識、態度及行為相關研究。國立中山大學醫務管理碩士論文。
18.許禎元(2004)。社會科學信度與效度的檢定及其關聯性。醒吾學報。27 民93.01：1-23。
19.張美娟(2018)，健康識能。健康促進工作手冊(2018)。[1-5] 1-27。
20.黃森芳、陳杰(2020)。運動有效降低臨床醫療花費。北市醫學雜誌。17(3): 257-271。
21.衛生福利部國民健康署國民營養健康狀況變遷調查成果報告2017-2020年。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=3999&pid=15562。
22.戴大為(2020)。骨質疏鬆&肌少症診治照護全書。原水文化出版。
23.魏米秀,張美娟, 謝至鎠, 尤瑞鴻, Jürgen M. Pelikan(2018)。健康識能機構實務指引。衛生福利部國民健康署13-14。

24.羅予婕(2022)使用穿戴型運動手環之骨質疏鬆患者及其高危險族群生理指標、生活型態、健康素養及生活品質之研究。元培醫事科技大學醫務管理碩士論文。