Su Chan Lee; Chang Hyun Nam; Ji Yeol Yoon; Kwang Am Jung; Bo Hyun Hwang; Hye Sun Ahn

doi:10.4055/jkoa.2012.47.5.368

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Lee, Nam, Yoon, Jung, Hwang, and Ahn: Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX® Criteria

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(5): 368-374.

Published online: 30 October 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.5.368

Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX® Criteria

Su Chan Lee, M.D., Chang Hyun Nam, M.D., Ji Yeol Yoon, M.D.^*, Kwang Am Jung, M.D., Bo Hyun Hwang, M.D., Hye Sun Ahn, M.S.

Department of Orthopedic Surgery, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.

^*Department of Internal Medicine, Joint & Arthritis Research, Himchan Hospital, Seoul, Korea.

Correspondence to: Chang Hyun Nam, M.D. Department of Orthopedic Surgery, Joint & Arthritis Research, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul 158-806, Korea. TEL: +82-2-3219-9114, FAX: +82-2-3219-9126, changcape@naver.com

Received 1 January 2012 Revised 7 February 2012 Accepted 5 June 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX®, http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO.

Materials and Methods

From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of ≤-2.5 points, or the FRAX® criteria, defined as the 10-year probability of a major osteoporotic fracture and hip fracture of ≥20% or ≥3%, respectively.

Results

Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX® criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX® criteria.

Conclusion

A combination of the HIRA and FRAX® criteria is required to improve the current guidelines for osteoporosis treatment.

Keywords: osteoporosis, knee joint, osteoarthritis, HIRA, FRAX®

Figures and Tables

Figure 1

WHO fracture risk assessment tool (FRAX®, http://www.shef.ac.uk/FRAX/).

Table 1

Demographic and Clinical Characteristics of Patients

Values are presented as number or mean±standard deviation or number (%). ^*When the patient takes 3 or more units of alcohol daily. A unit of alcohol varies slightly in different countries from 8-10 g of alcohol. This is equivalent to a standard glass of beer (285 ml), a single measure of spirits (30 ml), a medium-sized glass of wine (120 ml), or 1 measure of an aperitif (60 ml). M, male; F, female; BMI, body mass index.

Table 2

The Comparison of Korean HIRA and FRAX® Criteria of Osteoporosis Treatment

Values are presented as number (%). OA, osteoarthritis; HIRA, Health Insurance Review & Assessment Service; FRAX®, WHO fracture risk assessment tool; fx, fracture.

Table 3

Distribution of Results of Bone Densitometry and Absolute Fracture Risks

Values are presented as number (%) or number.

Table 4

Characteristics of Discordant Patients between Korean HIRA and FRAX® Criteria

Values are presented as number (%), number or mean±standard deviation. ^*Statistically significant different between two groups: p<0.05. HIRA, Health Insurance Review & Assessment Service; RAX®, WHO fracture risk assessment tool; Tx, treatment; M, male; F, female; BMI, body mass index.

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