骨質疏鬆症被認為是一種無聲無息疾病，患者初期不會有任何症狀，往往第一個發生的情況便是骨折，其中以髖部骨折最為嚴重，一年內死亡率為15-36 %，此數據相當於乳癌第3、4期死亡率。學者指出「跨科際整合」(multidisciplinary)是預防骨質疏鬆最佳的全方位策略。因此，本研究目的在於結合護理、醫學及電機資訊等跨領域專業，研擬一套「骨質疏鬆症智慧型健康風險評估」軟體，同時藉由完整的護理介入方案設計，主要期望能篩選出婦女罹患骨質疏鬆症風險，並提升其預防骨質疏鬆症知識、信念與遵從行為。

本研究運用所研發的「骨質疏鬆症智慧型健康風險評估」軟體，能依據婦女在骨質疏鬆症危險因子，分別提出其骨正常、骨量不足及骨質疏鬆症之程度，以作為婦女評估其罹患骨質疏鬆症之相對風險，研究結果得知，本軟體之準確率達75 %；本研究依據所研發的軟體，實際進行測量社區婦女在罹患骨質疏鬆症之風險，同時針對篩檢結果為骨量不足及骨質疏鬆之危險群婦女，提供不同護理介入方案。實驗組一主要接受個別護理指導及提供護理指導手冊，實驗組二則僅提供護理指導手冊，而控制組則未提供護理介入。護理實證研究結果得知，危險群婦女在後測知識，實驗組一得分大於控制組，同時較控制組增加42.55 %；另外於前測後第22週，危險群婦女在後後測知識，實驗組一大於實驗組二及控制組，且分別增加17.37 %及36.12 %。另外，針對成本效用分析發現，後測之實驗組一的成本花費低於控制組達5.85倍；而後後測成本效用分析發現，在知識之成本效用上，實驗組一較實驗組二及控制組，在成本花費分別減少1.22倍及1.36倍。此外，本研究所發展之「骨質疏鬆症危險因子問卷」，較國際骨質疏鬆症基金會之「一分鐘骨質疏鬆風險評估表」具有較佳的預測骨質疏鬆症風險能力，其解釋力達24.2 %。
本研究是結合護理、醫學及電機資訊等跨領域專業，於國內外相關研究均屬極為少見，因此具有創新及前瞻性研究，未來將可運用於不同疾病的健康風險評估。其次，研究結合護理方案設計，經由實證研究成果，將可作為社區護理人員，在運用先進資訊軟體同時，結合此有效的護理介入方式，能提升危險群婦女在預防骨質疏鬆症的成效。再者，研究所發展出來骨質疏鬆症智慧型健康風險評估軟體，已申請發明專利，藉由運用產學合作創新模式，將此技術加以轉移，以期能推廣至全國，達到早期預防及健康促進目標。最後，研究所研發的健康風險評估與護理照護模式，可運用於社區遠距居家照護中，提供偏遠及醫療資源不足地區，以進行簡易及有效的健康風險自我管理。

Osteoporosis used to be thought a silent disease because no symptoms can be detected in the early stage. Fracture is usually the first episode in the patients with osteoporosis, especially in hip fracture, of which the one-year mortality rate with one year after fracture was as high as 15-36 %, nearly equal to the sum of mortality rate of patients suffering from the third or fourth stage breast cancer. A multidisciplinary approach has been recommended as the best comprehensive strategy of preventing osteoporosis. Through the coordination of the disciplines of nursing, medical science, and electrical engineering, this study aimed to develop a “Assessment software of the osteoporosis risk “as a tool to evaluate the risk of osteoporosis. Furthermore, we have conducted a comprehensive nursing intervention project and expected its effect to screen the risk of women’s suffering from osteoporosis, and to help to enrich the knowledge and belief of preventing osteoporosis, strengthening the behavior following nursing instructions.
Through the software of “Assessment software of the osteoporosis risk” for evaluation, this study was designed to practically evaluate the risk of women’s sustaining osteoporosis in communities. At the same time, this study provided various kinds of nursing intervention programs for the women diagnosed as osteopenia or osteoporosis. The first experimental group was offered individual nursing intervention and the guide of nursing self-care。The second experimental group was given the guide of nursing self-care only. Finally, the control group was without any nursing intervention. According to the results in our evidence-based nursing studies, for the women in the risk group, in terms of post-test knowledge, belief, and obedient behaviors, the first experimental group scored more than the control group. And the knowledge of osteoporosis was improved by 42.55%. In addition, in the twenty second week after the pre-test, for the women in the risk group, in terms of post-test knowledge, belief, and obedient behaviors, the first experimental group scored better than the second experimental group and the control group. And the knowledge was enhanced by 17.37% and 36.12%, respectively. Moreover, the cost-effectiveness analysis showed that the first experimental group had a lower cost as much as 5.85 times than the control group. The cost-utility analysis in the post-test showed that, in terms of the cost utility of knowledge, the first experimental group cost 1.22 and 1.36 times less than the second experimental group and the control group. In addition, the questionnaire of the risk factors of osteoporosis developed by this study proved to be better than the “One-Minute Osteoporosis Risk Test” (by International Osteoporosis Foundation), for indeed its explanation efficiency had reached as high as 24.2 %.
This study combined the professionalism fields of nursing, medical science, and electrical engineering. With its innovation and prospective studies, the results of this study can be applied to evaluate the health risks of diverse kinds of diseases. Second, this study combining nursing project designs and evidence-based approaches can provide a model for the community nursing staff to participate the prevention program of osteoporosis and improve its effectiveness in applying such advanced information software. Currently we have applied for patent for such software of wisely evaluating health risk of osteoporosis. Via the cooperation between industries and the academic circle, this technology can be promoted to the nationwide to prevent diseases and to enhance health. Finally, the newly designed model of heath risk evaluation and nursing care can be applied to community long distance home care. And it can also be applied in remote areas and the areas with insufficient medical resources to accomplish a simple and effective health risk self-management.

參考文獻
中文文獻
于漱(1996)．衛生教育介入後對社區婦女骨質疏鬆症知識、態度與行為之影響．行政院國家專題委員會專題研究報告：NSC84-2331-B-010-113。
王慧卿、曾泓富、陳榮福、凌美貝、張玉珍(2002)．超音波骨質密度檢查結果之相關性初探．護理雜誌，49(1)，47-54。
文羽苹、許玫玲(2005)．預防保健的成本效益評估：以乳癌篩檢為例．台灣公共衛生雜誌，24(6)，519-528。
行政院衛生署統計室(2003，10月30日)．全民健保重要統計資料．2003年10月30日取自http://www.doh.gov.tw/statistic/index.htm
行政院衛生署統計室(2003，10月30日)．全民健保重要統計資料．2007年9月6日取自http://www.doh.gov.tw/statistic/index.htm
行政院衛生署(2007，5月1日)．門診戒菸服務95年協助23732位癮君子戒菸．2007年9月6日取自http://health99.doh.gov.tw/HealthyHeadlineZone/print.aspx?TopIcNo=3645
行政院衛生署(2007，9月6日)．國人膳食營養素參考攝取量定版．2007年9月6日取自http://www.doh.gov.tw/cht2006/index_populace.aspx
行政院衛生署國民健康局(2007，9月6日)．認識骨質疏鬆症．2007年9月6日取自http://www.bhp.doh.gov.tw/BHP/index.jsp
行政院衛生署國民健康局(2007，10月19日)．1分鐘評估測試瞭解自己戰勝骨折．2007年10月26日取自http://www.bhp.doh.gov.tw/BHP/do/chinese/Press/View;jsessionid=A354EC6D64BF0961288B3A1114B107E6?p_No=20071019145224GD5JD6
李秀琴(2002)．應用人工智慧技術於人類慢性疾病管理．未發表碩士論文，彰化：彰化師範大學資訊管理學系。
林文彬(2005)．骨質疏鬆與鈣(上)．台灣中醫臨床醫學雜誌，11(2)，135-141。
林怡秀、王顯智(2002)．健康促進枝風險評估．大專體育，63，159-164。
林雅雯、童淑琴(2002)．以「評估研究」探討職場健康促進之評估．健康促進暨衛生教育雜誌，22，113-121。
吳英旬、賴妃珍、相青琪、魏婉華(2001)．比較鼻部手術患者三種衛教方式之成本效益分析．The Changhua Journal of Medicine，6(3)，174-183。
吳瑞裕(2005)．生物資訊與人工智慧的發展現況與展望．智慧科技與應用統計學報3(1)，57-71。
吳貴璃(1999)．規律運動對停經前婦女骨密度和性激素的影響．體育學報，27，183-192。
洪欽銘、黃昭諺(2006)．遠距居家照護系統設計-遠距居家照護系統設計：醫療照護診斷系統(II)．國科會計畫編號 NSC 93-2218-E-003 -001。
夏萍絗、于漱(1994)．社區婦女對骨質疏鬆症知識與其影響因素分析研究．護理研究，2(3)，275-287。
祝道松(2004)．醫院實施臨床路徑對住院日數、醫療費用及醫療照護品質影響之研究－以人工髋關節置換手術為例．健康管理學刊2(1)，21-36。
洪秀娟、楊榮森、曹昭懿(2005)．台灣髖部骨折之流行病學．台灣醫學，9(1)，29-38。
許維德、洪鵬翔(2004)．透過語音綱路服務之自動組合與執行來達成綱路．自動化電腦與通訊，108，86-96。
馬作鏹(2001)．不同媒介及指導方法運用於老人衛教之成本效益分析及老人特質與衛教之配合研究--以高血脂症為例．未發表計畫結案報告。台中：中國醫藥學院醫務管理研究所。
張大元(2004)．健康風險評估在職業衛生之方法開發與應用．未發表博士論文：臺灣大學職業醫學與工業衛生研究所。
張大元(2000)．個人健康風險評估運用在職業衛生計畫之研究．未發表碩士論文。台北：國立台灣大學職業醫學與工業衛生研究所。
張玨(2002)．骨質健康．健康促進通訊，18，1-12。
張淑芳、陳靜敏、陳品玲、楊榮森（2002）．北市某社區婦女在骨質疏鬆症預防知識、健康信念及行為現況及相關因素探討．醫護科技學刊，3 (4)，303-314。
張斐章、張雅婷、張麗秋(2004)．結合人工智慧與專家知識之智慧型水庫操作系統．農業工程學報，50(4)，14-27。
陳玉枝、林麗華(2003)．「以病人為中心的專業照護合作模式」對腰椎椎間盤手術病人照護成效之探討．新臺北護理期刊，5(1)，71-82。
陳怡樺(2007)．社區衛生護理學： 流行病學．台北：華杏。
陳鴻文、包冬意、吳德仁(2005)．模糊理論與不確定推理在教學評量系統中之應用．科學與工程技術期刊，1(1)，17-29。
陳民虹(1998)．健康信念模式在骨質疏鬆症的應用研究．未發表碩士論文，台北：國立臺灣大學流行病學研究所。
陳淑華、郭美玲、黃珊、蔡來蔭(2005)．參與社區健康篩檢婦女骨質疏鬆症與其影響因素之探討．慈濟護理雜誌4(3)，56-63。
陳耀澤(1998)．雙能量X-射線吸收儀對人體骨骼中磷酸鈣定量分析研究．未發表碩士論文，台北：中國文化大學。
彭台珠、李明憲、張芙美、黃森芳、張惠君(2002)．定量超音波骨密度儀於社區護理篩檢活動使用之可行性．慈濟護理雜誌，1(2)，56-63。
楊南屏(2004)．臺灣骨質疏鬆症之流行病學．未發表博士論文，台北：國立陽明大學公共衛生研究所。
楊再興(2003)．骨質疏鬆症防治全集．長春月刊，3，36-43。
黃建元、周川宏、邱千芳、吳重達、蘇世斌(2006)．南台灣成年人骨質疏鬆症之盛行率及相關危險因子之研究．中華職業醫學雜誌 13(2)，71-80。
黃昭諺、林登進、洪欽銘、楊榮森、張淑芳(2008)．骨質疏鬆症線上風險診斷系統．國科會計畫NSC 95-2218-E-003-004。
黃貴薰(2003)．骨質疏鬆病人之實證護理–以設計運動介入方案為例．護理雜誌，50(1)，21-29。
溫媖媖(2003)．個人健康風險評估之研究以嘉義縣阿里山鄉居民為例．未發表碩士論文，雲林：雲林科技大學工業工程與管理研究所。
劉堂桂、楊榮森、錢本文(1997)．發生髖部骨折的老年婦女之髖部骨密度研究．台灣醫學1(5)，576-584。
劉祐成(2005)．智慧型居家照護服務系統．未發表碩士論文，台北:國立臺灣師範大學工業教育學系。
劉德笙(2003)．中西醫診斷專家系統於冠狀動脈心臟病之應用．未發表碩士論文，中壢：中原大學醫學工程研究所。
蕭世平、王顯智(2003)．美國健康管理之健康風險評估介紹．大專體育，64，96-102。
羅煥鉅、王梅芳、黃立宗、郭俞良(2005)．跟骨定量超音波儀應用於健康篩檢之適當性評估．中華放射線醫學雜誌，30(4)，213-216。

英文文獻
Ali, N. S. (1999). Predictors of quality of life in women: Hormone therapy self-efficacy and health-promoting behavior. Women & Health, 29(2), 69-79.
Binaghi, E., De Giorgi, O., Maggi G., Motta T., & Rampini, A. (1993). Computer-assisted diagnosis of postmenopausal osteoporosis using a fuzzy expert system shell. Computer and Biomedical Research, 26(6), 498-516.
Bliuc, D., Eisman, J. A., & Center, J. R. (2006). A randomized study of different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporosis International, 17, 1309-1317.
Blalock, S. J., Currey, S. S., DeVellis, R. F., DeVellis, B. M., Giorgino, . B., Anderson, J. J. B., Dooley, M. A., & Gold, D. T. (2000). Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behavior. American Journal of Health Promotion, 14, 161-169.
Cappccio, F. P., Strazgullo, P., & Farinaro, E. (1993). Uric Acid Metabolism and Tubular Sodium Handling, JAMA, 270, 354-359.
Chang, S. F. (2004). Explore the effectors of bone mineral density in community women. Journal of Nursing Research, 12(4), 327-336.
Chang, S. F. (2006). A cross-sectional survey of calcium intake in relation to knowledge of osteoporosis and beliefs about in young adult women. International Journal of Nursing Practice, 12(2), 21-27.
Chang, S. F., Chen, C. M., Chen, P. L., ＆ Chung, U. L. (2003). Predictors of community women’s osteoporosis prevention intention — A pilot study. Journal of Nursing Research, 11(4), 231-240.
Chang, S. F., Hong, C. M., & Yang, R. S. (2007). Cross-sectional survey of women in Taiwan with First-Degree Relatives with osteoporosis: Knowledge, health beliefs, and preventive behaviors. Journal of Nursing Research, 15(3), 1-11.
Cooper, C., & Jordan, K. M. (2002). Epidemiology of osteoporosis. Best Practice & research Clinical Rheumatology, 16(5), 795-806.
Dever, G. E. A. (1976). An epidemiological model for health policy analysis. Social Indicators Research, 2, 453-466.
Doheny, M. O.; Sedlak, C. A.; Estok, P. J.; Zeller, R. (2007). Osteoporosis knowledge, health beliefs, and DXA T-Scores in men and women 50 years of age and older. Orthopaedic Nursing, 26(4), 243-250.
FRAX (2008). FRAX - WHO fracture risk assessment Tool. Retrieved May. 6, 2008, from http://www.google.com.tw/search?sourceid=navclient&hl=zh-TW&ie=UTF-8&rlz=1T4GZHZ_zh-TWTW236TW236&q=FRAX
Hawker, G. A., Jamal, S. A., Ridout, R., & Chase, C. (2002). A clinical prediction rule to identify premenopausal women with low bone mass. Osteoporosis International, 13, 400-406.
Hawker, G., Ridout, R., Ricupero, M., Jaglal, S., & Bogoch, E. (2003). The impact of a simple fracture clinic intervention in improving the diagnosis and treatment of osteoporosis in fragility fracture patients. Osteoporosis International, 14, 171-178.
Hsieh, C.; Novielli, K. D.; Diamond, J. J., & Cheruva, D. B. A. (2001) Health beliefs and attitudes toward the prevention of osteoporosis in older women. Menopause, 8(5), 372-376.
Hurst, P. R., & Wham, C. A. (2007). Attitudes and knowledge about osteoporosis risk prevention: a survey of New Zealand women. Public Health Nutrition, 10, 747-753.
Hutchins,E. B., Amler, R. W., Evans, R. C., Jacobs, T. A., Sceigaj, M., & Sligh, D. (1991). Healthier People: Version 4.0. Atlanta, GA: The Carter Center of Emory University, Health Risk Appraisal Program.
International Osteoporosis Foundation (2008). New IOF one-minute osteoporosis risk test. Retrieved May, 6, 2008, from http://www.iofbonehealth.org/mena/about-osteoporosis/risktest.html
Ioannidis, G., Gordon, M., ＆ Adachi, J. D. (2001). Quality of life in osteoporosis. Nursing Clinics of North America, 36(3), 481-489.
Jackson, R. D. (1997). Forestalling fracture in osteoporosis. Hospital Practice, 15, 234-242.
Kanis, J. A. (2008). FRAX - WHO fracture risk assessment tool. Retrieved May. 6, 2008, from http://www.google.com.tw/search?sourceid=navclient&hl=zh-TW&ie=UTF-8&rlz=1T4GZHZ_zh-TWTW236TW236&q=FRAX
Kanis, J. A., Burlet, N., Cooper, C., Delmas, P. D., Reginster, J. Y., Borgstrom, F., & Rizzoli, R. (2008). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International Online early article, 2008.
Kessenich, C. R., Guyatt, G. H., Patton, C. L., Griffith, L. E., Hamlin, A., ＆ Rosen, C. J. (2000). Support group intervention for women with osteoporosis. Rehabilitation Nursing, 25(3), 88-92.
Laframboise, H. L. (1973). Health policy: Breaking it down into more manageable segments. Journal of Canadian Medical Association, 108, 388-393.
Lappe, J. M. (2001). Pathophysiology of osteoporosis and fracture. Nursing Clinics of North America, 36(3), 393-340.
Lappe, J. M. (1998). Bone fragility: Assessment of risk and strategies for prevention. Journal of Obstetric Gynecologic and Neonatal Nursing, 23 (3), 260-268.
Lynn, M. R. (1986). Determination and quantification of content validility. Nursing Research, 35(6), 382-385.
Mikhail, M. B., Flaster, E., & Aloia, J. F. (1999). Stiffness in discrimination of patients with vertebral fractures. Osteoporosis International, 9(1), 24-28.
Melanie, W., & Gopal, S. (1998). A health education initiative: Teaching college women about osteoporosis. Journal of Nursing Education, 37(6), 271-274.
National Osteoporosis Foundation. (2006). Osteoporosis: Review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis, status report. Washington, DC: Author.
Nilsson, N. J. (1998). Artificial Intelligence: A New Synthesis. Morgan Kaufmann Publishers, Inc., USA, 1-17.
Orsini, L. S., Rousculp, M. D., & Long, S. R. (2005). Health care utilization and expenditures in the United States: a study of osteoporosis related fractures. Osteoporosis International, 16, 359-371.
Pachucki - Hyde, L. (2001). Assessment of risk factors for osteoporosis and fractue. Nursing Clinics of North America, 36(3), 401-408.
Robbins, L. C., Hall, J. (1970). How to practice prospective medicine. Indianapolis, IN: Methodist Hospital of Indiana.
Sedlak, C. A., Doheny, M. O., Estok, P. J., Zeller, R. A., & Winchell, J. (2007). DXA, health beliefs, and osteoporosis prevention behaviors. Journal of Aging and Health, 19(5), 742-756.
Wallace, L. S. (2002). Osteoporosis prevention in college women: Application of the expanded health belief model. American Journal of Health Behavior, 26, 163–172.
WHO. (2003, Nov. 4). World Osteoporosis Day. Retrieved Sep. 6, 2007, from http://www.searo.who.int/EN/Section1257/Section2181/Section2211/Section2214_11364.htm
WHO. (2003, Nov. 4). Practice guidelines on the use of bone mineral density measurements. Retrieved Sep. 6, 2007, from www.emro.who.int/ncd/publications/osteoporosis-guidelines.pdf. http://www.searo.who.int/EN/Section1257/Section2181/Section2211/Section2214_11364.htm
Zhang, X., Xi, G., & Wang, Y. (2004). Influence of nursing intervention on living quality of elder patients with osteoporosis in community. Chinese Nursing Research, 18(6), 1035-1036.