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Jang, Park, Jang, Yoon, Shin, Kim, Ha, Lee, Choi, Lee, Kim, and Choi: Medical Service Utilization with Osteoporosis
Original Article
Endocrinology and Metabolism

Endocrinology and Metabolism 2010; 25(4): 326-339.

Published online: 31 December 2010

DOI: https://doi.org/10.3803/EnM.2010.25.4.326

Medical Service Utilization with Osteoporosis

Sunmee Jang1, Chanmi Park1, Suhyun Jang1, Hyun-Koo Yoon2, 3, Chan Soo Shin2, 4, Deog-Yoon Kim2, 5, Yong-Chan Ha2, 6, Seong-Su Lee2, 7, Hyung Jin Choi2, 4, Young-Kyun Lee2, 8, Bom-Taeck Kim2, 9, Ji-Yeob Choi2, 10

1Health Insurance Review & Assessment Service, Seoul, Korea.

2The Korean Society of Bone Metabolism, Seoul, Korea.

3Department of Medicine, Kwandong University College of Medicine, Seoul, Korea.

4Department of Internal Medicine, Seoul National University college of Medicine, Seoul, Korea.

5Department of Nuclear Medicine, Kyung Hee University College of Medicine, Seoul, Korea.

6Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

7Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea.

8Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

9Department of Family Practice & Community Health, Ajou University School of Medicine, Suwon, Korea.

10Pharmacogenomics Research Center, Inje University College of Medicine, Busan, Korea.

Corresponding author: Hyun Koo Yoon. Department of Medicine, Kwandong University College of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 100-380, Korea. Tel: +82-2-2000-7244, Fax: +82-2-2000-7895, hyunkooyoon@hotmail.com

Received 27 September 2010       Accepted 25 November 2010

Copyright © 2010 Korean Endocrine Society

Abstract

Background

Although osteoporosis is increasing in the elderly population, attempts to analyze the patterns of medical service utilization for osteoporosis are currently not sufficient. The medical services and treatment patterns were investigated using Korea's National Health Insurance claims data, which includes all of the Korean population.

Methods

Through the patient identification algorithm developed by using the administrative claims data in 2007, the adult patients (between 50-100 years) with osteoporosis were identified. The age and gender of the patients who used medical service for osteoporosis were described, in relation with six dichotomous variables. The medical service use patterns such as the type of medical institution and conducting bone mineral density measurement were investigated.

Results

The number of patients who used medical service were 1,230,580 (females 89.9%). Sixty one point six percent of the patients were prescribed osteoporosis medicine (indicated for osteoporosis only), and 12.9% of the patients had experienced osteoporotic fracture. The primary medical institutions for treatment were clinics (54.3%), while hospitals were mainly used among the patients with a history of fracture and disease or drug use that may induce secondary osteoporosis. The number of visited medical institutions was 6.4 (as an outpatient) and 0.2 (as admissions) during 6 months. The proportion of patients who conducted bone mineral density measurements within one year before and after the diagnosis of osteoporosis was 66.7% and DXA was the most frequently used densitometry (46.3%). The average number of days for the prescriptions for osteoporosis medicine was 70 days.

Conclusion

In order to prevent further osteoporotic fractures, appropriate management and treatment should be implemented for osteoporosis patients. To do this, we need to understand the current state of medical service utilization and the treatment of osteoporosis using the National Health Insurance claims data.

Keywords: Osteoporosis, National Health Insurance Claims Data, Medical service utilization

Figures and Tables

Fig. 1
Patient identification algorithm using National Health Insurance claims data.
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Table 1
Therapeutic agents for osteoporosis
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*Oxymetholone is classified as a therapeutic agent for osteoporosis though it is not a commonly used in osteoporosis intervention, because it was included in the formulary reevaluation list.

SERM, selective estrogen receptor modulator.

Table 2
Indications of bisphosphonates
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Table 3
Disease classification according to fracture sites
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NEC, necrotizing enterocolitis.

Table 4
Agents related to drug-induced osteoporosis on the treatment guidelines of seven countries
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*Glucocorticoids were defined as daily prednison 5 mg or daily same dosage for more than 3 months.

WHO, World Health Organization; FRAX, fracture risk assessment tool.

Table 5
Drugs related to drug-induced osteoporosis
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*Glucocorticoid agents for external use (ointments, creams, opthalmics, sprays, inhalants) are excluded.

†Thyroid hormone use were counted only when there is more than one claim for thyroid carcinoma (C73, D34) within 1 year prior to the first medical service use.

Table 6
Conditions related to secondary osteoporosis
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ESRD, end stage renal disease; COPD, chronic obstructive pulmonary disease.

Table 7
Comorbid conditions that are included in Charlson comorbidity index
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*Among Charlson's Index, P29.0 (Neonatal cardiac failure) was excluded because the study population of this study is over 18 years old.

†Among chronic pulmonary diseases converted to ICD-10, J40 (Bronchitis, not specified as acute or chronic) and J450 (allergic asthma) are excluded.

‡Diabetes coded only for first three digits are classified as uncomplicated diabetes (E10, E11, I12, E13, E14).

§I09.9 (Rheumatic heart disease, unspecified) is excluded, because it is difficult to be determined as congestive heart failure.

∥Other cerebrovascular disease: I68.x are excluded because it is classified as other disease.

Table 8
Comorbid conditions that are not included in Charlson comorbidity index
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*Depression comorbid with schizophrenia, bipolar disorder, manic disorder, etc are excluded.

Table 9
Number of osteoporosis patients who utilized medical service
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Table 10
Number of osteoporosis patients according to the criteria
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Table 11
Subject demographics and comorbidity
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*Diabetes complicated with retinopathy, neuropathy, renal disease.

†Non-metastatic solid cancer, leukemia, lymphoma, multiple myeloma.

Table 12
Medical institutions that individuals with osteoporosis diagnosis primarily used
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*P < 0.0001 by the chi-square test.

Table 13
The number of visiting medical institutions with osteoporosis (during 6 months)
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*P value: Wilcoxon rank sum test, Kruskal Wallis test.

Table 14
BMD measurement rates among the type of bone densitometry
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BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry ; QCT, quantitative computed tomography; RA, radiographic absorptiometry.

*The proportion of the total patients.

Table 15
BMD test rates of medical institutions
enm-25-326-i015

BMD, bone mineral density.

Table 16
The average number of days of prescription among the anti-osteoporosis medicine (during 6 months)
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*P-value: Wilcoxon rank sum test, Kruskal Wallis test.

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