A Comparison of Three Different Guidelines for Osteoporosis Treatment in Patients with Rheumatoid Arthritis in Korea
0
조회
0
다운로드
4
인용
0
참고문헌
키워드
초록
Background/Aims: Osteoporotic fractures are an important comorbidity with rheumatoid arthritis (RA). We determined the overall fracture risk as assessed by the World Health Organization (WHO)'s FRAX tool in Korean patients with seropositive RA. Additionally, we compared treatment eligibility according to the criteria of the Korean Health Insurance Review Agency (HIRA), FRAX, and the National Osteoporosis Foundation (NOF). Methods: Postmenopausal women and men ≥ 50 years of age with seropositive RA were recruited from one rheumatism center in Korea. The FRAX score was estimated using the Japanese model. Patients were classified as eligible for treatment using the HIRA, NOF, and FRAX thresholds for intervention. Results: The study of 234 patients included 40 men (17%). The mean age was 60 ± 9 years, and 121 (52%) patients had osteoporosis according to the WHO criteria. The overall median 10-year fracture risk was 13% for major osteoporotic fractures and 3.5% for hip fractures. HIRA guidelines identified 130 patients (56%) eligible for treatment, FRAX included 126 patients (54%), and 151 patients (65%) were included according to NOF guidelines. Older patients with a greater number of risk factors were included by FRAX compared to HIRA. The overall concordance between HIRA and FRAX, expressed as the kappa index, was 0.67, but was as low as 0.44when limited to patients ≥ 60 years of age. Conclusions: One-half of the patients had osteoporosis requiring treatment. RA patients have a high risk of fracture, and the adoption of a risk-scoring system should be considered. (Korean J Intern Med 2010;25:436-446)
Abstract
Background/Aims: Osteoporotic fractures are an important comorbidity with rheumatoid arthritis (RA). We determined the overall fracture risk as assessed by the World Health Organization (WHO)'s FRAX tool in Korean patients with seropositive RA. Additionally, we compared treatment eligibility according to the criteria of the Korean Health Insurance Review Agency (HIRA), FRAX, and the National Osteoporosis Foundation (NOF). Methods: Postmenopausal women and men ≥ 50 years of age with seropositive RA were recruited from one rheumatism center in Korea. The FRAX score was estimated using the Japanese model. Patients were classified as eligible for treatment using the HIRA, NOF, and FRAX thresholds for intervention. Results: The study of 234 patients included 40 men (17%). The mean age was 60 ± 9 years, and 121 (52%) patients had osteoporosis according to the WHO criteria. The overall median 10-year fracture risk was 13% for major osteoporotic fractures and 3.5% for hip fractures. HIRA guidelines identified 130 patients (56%) eligible for treatment, FRAX included 126 patients (54%), and 151 patients (65%) were included according to NOF guidelines. Older patients with a greater number of risk factors were included by FRAX compared to HIRA. The overall concordance between HIRA and FRAX, expressed as the kappa index, was 0.67, but was as low as 0.44when limited to patients ≥ 60 years of age. Conclusions: One-half of the patients had osteoporosis requiring treatment. RA patients have a high risk of fracture, and the adoption of a risk-scoring system should be considered. (Korean J Intern Med 2010;25:436-446)
참고문헌 (20)
- Sinigaglia L, "A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis", J Rheumatol, 27, pp.2582~2589 (2000)
- Sinigaglia L, "Epidemiology of osteoporosis in rheumatic diseases", Rheum Dis Clin North Am, 32, pp.631~658 (2006)
- Kanis JA, "Assessment of fracture risk", Osteoporos Int, 16, pp.581~589 (2005)
- Baim S, "Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference", J Clin Densitom, 11, pp.75~91 (2008)
- Kanis JA, "Case finding for the management of osteoporosis with FRAX:assessment and intervention thresholds for the UK", Osteoporos Int, 19, pp.1395~1408 (2008)
- Orimo H, "Diagnostic criteria for primary osteoporosis", J Bone Miner Metab, 16, pp.139~150 (1998)
- WHO Study Group, "Assessment of fracture risk and its application to screening for postmenopausal osteoporosis", World Health Organ Tech Rep Ser, 1~129 (1994)
- May WL, "The validity and power of tests for equality of two correlated proportions", Stat Med, 16, pp.1081~1096 (1997)
- Joo YS, "Generalized osteoporosis in Korean rheumatoid arthritis patients", J Korean Rheum Assoc, 7, pp.32~42 (2000)
- Haugeberg G, "Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register", Arthritis Rheum, 43, pp.522~530 (2000)
- Fujiwara S, "Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAX)", Osteoporos Int, 19, pp.429~435 (2008)
- WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level, "World Health Organization", WHO Press, ~, pp.WHO, Summary Meeting Report (2004)
- Ensrud KE, "A comparison of prediction models for fractures in older women: is more better?", Arch Intern Med, 169, pp.2087~2094 (2009)
- Leslie WD, "Simplified system for absolute fracture risk assessment: clinical validation in Canadian women", J Bone Miner Res, 24, pp.353~360 (2009)
- Donaldson MG, "Estimates of the proportion of older white women who would be recommended for pharmacologic treatment by the new U.S. National Osteoporosis Foundation Guidelines", J Bone Miner Res, 24, pp.675~680 (2009)
- Kanis JA, "European guidance for the diagnosis and management of osteoporosis in postmenopausal women", Osteoporos Int, 19, pp.399~428 (2008)