여성 골다공증 중재프로그램에 관한 고찰 : Review of Osteoporosis Interventions for Women

김경원 서울여자대학교 여성연구소 2011 여성연구논총 Vol.26 No.-

Osteoporosis is a debilitating and silent disease, characterized by a decrease in bone mass and an increased possibility to fractures. This paper reviews the literatures regarding the osteoporosis interventions for women and suggests the directions for future osteoporosis interventions and programs. According to the 2009 Korea National Health and Nutrition Examination Survey, the prevalence of osteoporosis was 38.7% among women aged 50 and over, which was 4.8 times higher than that of men. Many intervention trials has been done and generally showed the effects of treatment (e.g. calcium or isoflavone supplementation, exercise) on some behaviors (e.g. calcium intake) and bone mineral density. Osteoporosis education programs has been partly done at public health departments in Korea. Compared to these, many education programs for osteoporosis has been reported in the United States. Some of these programs applied the theories for health behavior change, such as the Health Belief Model and the Theories of Planned Behavior. Many of these studies revealed that the education programs were effective in modifying beliefs including perceived susceptibility, perceived severity, perceived benefits and barriers, as well as self-efficacy, as suggested in the Health Belief Model. In addition, some studies reported the desirable changes in behaviors including increasing calcium intake and exercising. As osteoporosis appears the major public health problem, it is expected that osteoporosis programs for women be widely implemented in the community. Based on literature reviews, it is suggested that future programs be implemented targeting the young adult women, as well as targeting for postmenopausal women and older adult women. The general public should have more opportunity for bone mineral density tests or osteoporosis screening in the community. Osteoporosis screening might be followed by education sessions, and this will help the public to realize the seriousness of and susceptibility to osteoporosis. The education programs for osteoporosis prevention or management need to focus on behavioral changes such as increasing calcium intake and doing weight bearing exercises, and incorporate diverse methods for behavioral change. Education programs also need to be developed based on the needs of target groups. The theories, such as the Health Belief Model, the Theories of Planned Behavior, and Stages of Change Models, can be valuable guides and practical tools for the needs assessment as well as for planning osteoporosis education programs. Key words:women, osteoporosis, nutrition education, intervention

Medical treatment of severe osteoporosis including new concept of advanced severe osteoporosis

Han Seok Choi,So Young Park,Yoo Mee Kim,Se Hwa Kim,김경민,Yoon Sok Chung 대한골다공증학회 2016 Osteoporosis and Sarcopenia Vol.2 No.1

Osteoporosis is a metabolic bone disease characterized by decreased bone strength, leading to an increased risk of fracture. The World Health Organization (WHO) defines osteoporosis as a bone mineral density (BMD) of 2.5 standard deviations below that of a young adults (T-score of ?2.5 or lower). Severe osteoporosis is differentiated from osteoporosis by the presence of one or more fragility fractures in addition to this Tscore. However, the current WHO definition may be insufficient to reflect the diverse spectrum of osteoporosis or severe osteoporosis, which can encompass various number and severity of prevalent fractures. To overcome these shortcomings of the WHO definition of osteoporosis, we propose a concept of ‘advanced severe osteoporosis’, which is defined by the presence of proximal femur fragility fracture or two or more fragility fractures in addition to BMD T-score of ?2.5 or less. Based on the previous clinical trials and post-hoc analyses, we recommend selective estrogen receptor modulators, bisphosphonates, receptor activator of nuclear factor kappa-B ligand (RANKL) monoclonal antibody, and parathyroid hormone for the medical treatment of severe osteoporosis. In cases of advanced severe osteoporosis or osteoporosis that does not respond to previous anti-osteoporotic treatments, we also recommend parathyroid hormone, bisphosphonates, and RANKL monoclonal antibody. In conclusion, we need more precise assessment of osteoporosis and further stratification of the disease by number of prevalent fractures in addition to BMD. More aggressive managements should be provided for those with advanced severe osteoporosis. © 2016 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

전북지역 성인여성의 골다공증 지식, 골다공증관련 요인에 대한 관심 및 예방적건강행동에 관한 연구

이현주,노정옥 한국영양학회 2018 Journal of Nutrition and Health Vol.51 No.6

본 연구는 전북지역 394명의 성인여성을 대상으로 골다공증 지식, 관련요인에 대한 관심 및 예방적 건강행동의 수준을 조사 하였으며, 그 결과를 요약하면 다음과 같다. 골다공증 지식의 총점은 12점 중 6.21점으로 ‘보통’ 수준이며 전체 평균값은 0.59점, 평균정답률은 60.9%이었다. 골다공증관련 요인에 대한 관심의 총점은 40점 만점 기준26.50점으로 ‘보통’ 수준이었으며 전체 평균값은 3.31점이었다. 골다공증 예방을 위한 식습관은 31.92점, 운동습관9.77점, 기호식품 제한은 15.57점이었으며 총점은 85점 기준 57.26점으로 ‘보통’ 수준이었다. 조사대상자의 일반적인 특성에 따른 골다공증관련 지식은 ‘연령’, ‘월수입’, ‘교육수준’, ‘어릴 때 우유섭취’, ‘건강관심도’, ‘골다공증 정보’에서 유의한 차이가 있었다. 골다공증관련 요인에 대한 관심은 ‘연령’, ‘월수입’, ‘건강관심도’, ‘골다공증 정보’, ‘골다공증 가족력’, ‘칼슘제 복용’에서 유의한 차이가 있었다. 골다공증 예방을 위한 건강행동은 ‘연령’, ‘월수입’, ‘어릴 때 우유섭취’, ‘건강관심도’, ‘골다공증 정보’, ‘칼슘제 복용’에서 유의한 차이가 있었다. 골다공증 예방을 위한 건강행동 실천에 미치는 관련변수들의 상대적 영향력을 알아본 결과, 골다공증 예방적 건강행동 전체 1단계에서 설명해주는 변인은 ‘건강관심도’ 가 ‘많음’, ‘연령’, ‘건강관심도’가 ‘보통’의 순이며, 설명력은 28.5%이었다. 2단계에서는 골다공증관련 지식 투입에따른 총 설명력은 30.1%이며 ‘건강관심도’가 ‘많음’의 영향력이 가장 크며, 그 다음이 ‘연령’, ‘건강관심도’가 ‘보통’, ‘골다공증 지식’의 순이었다. 3단계 골다공증요인 관심 투입에 따른 총 설명력은 41.1%이었다. 골다공증 예방 건강행동에 대한 예측변인의 영향력은 ‘골다공증 요인 관심’, ‘건강관심도’가 ‘많음’, ‘연령’, ‘건강관심도’가 ‘보통’, ‘골다공증 지식’의 순이었다. 이상의 결과, 전북지역 성인여성의 골다공증에 대한 관심수준과 예방적 건강행동의 실천은 보통수준이었다. 그러나 골다공증관련 지식수준은 높은 수준은 아니었으나골다공증예방을 위한 건강행동을 실천하는데 어느 정도의영향력을 가지고 있었다. 따라서 골다공증관련 교육은 이를 실생활에 적용하기 위하여 골다공증 교육내용 및 교육매체에 대한 재검토가 필요하겠다. 골다공증은 더 이상 중년이후에 관심을 가져야하는 질병이 아닌 성장기부터 예방관리가 필요하므로 학교의 영양교육과정에 포함하여 청소년기부터 올바른 식습관 및 운동습관 등을 포괄적으로지도할 수 있도록 학교, 보건소 및 교육청 등의 관련기관의 적극적인 지원이 필요하겠다. Purpose: The purpose of the study was to identify women’s osteoporosis knowledge, concerns about osteoporosis factors, and health behavior as well as to examine the relationship between these variables. Methods: The participants were 394 women in the Jeonbuk area. The data were analyzed using a t-test, ANOVA, Duncan test, and hierarchical regression analysis with SPSS v. 24.0. Results: The score for osteoporosis knowledge was 6.21 points out of a possible 12, the score for concern about osteoporosis factors was 26.50 points out of a possible 40. The score for the health behavior was 57.26 points out of a possible 85. The knowledge showed significant differences according age (p < 0.01), income (p < 0.05), education level (p < 0.01), drinking milk in childhood (p < 0.05), health interest (p < 0.05), and osteoporosis information (p < 0.01). The concern showed significant differences according to age (p < 0.001), income (p < 0.05), health interest (p < 0.001), osteoporosis information (p < 0.001), family history of osteoporosis (p < 0.05), and calcium medications (p < 0.001). The health behavior showed significant differences according to age (p < 0.001), income (p < 0.01), drinking milk in childhood (p < 0.05), health interest (p < 0.001), osteoporosis information (p < 0.01), and calcium medications (p < 0.01). Regression analysis showed that the concern about osteoporosis factors was the most influential variable on health behavior, followed by health interest of the subjects, age, and the osteoporosis knowledge. Conclusion: Therefore, it is necessary to consider educational programs on increasing interest in osteoporosis according to the age and health for improving the health behavior to prevent osteoporosis.

Validation of the Thai Osteoporosis Foundation and Royal College of Orthopaedic Surgeons of Thailand Clinical Practice Guideline for bone mineral density measurement in postmenopausal women

A. Suwan,K. Panyakhamlerd,S. Chaikittisilpa,U. Jaisamrarn,P. Hawanond,T. Chaiwatanarat,S. Tepmongkol,E. Chansue,N. Taechakraichana 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.2

Objective: The primary objective of this study was to determine the sensitivity, specificity, and predictive values of the Thai Osteoporosis Foundation (TOPF) and Royal College of Orthopaedic Surgeons of Thailand (RCOST) Clinical Practice Guideline for bone mineral density (BMD) measurement for the detection of postmenopausal osteoporosis. Its secondary objective was to find better indicators to detect postmenopausal osteoporosis. Methods: Postmenopausal women were enrolled in this study between June and December 2014. The clinical risk factors following TOPF and RCOST Clinical Practice Guideline for BMD measurement were collected. Bone mineral density was measured using dual energy X-ray absorptiometry. Results: Four hundred postmenopausal women were enrolled in the study. The mean age of the studied population was 66.16 ± 6.04 years. Twenty-seven percent of the participants had either osteoporosis of the lumbar spine, femoral neck, or total hip, of which 13.3% had osteoporosis at the lumbar spine, 21.3% had osteoporosis at the femoral neck, and 2.5% had osteoporosis of the total hip. The sensitivity and specificity for detecting osteoporosis of the whole TOPF and RCOST guideline were 96.2% and 16.7%, 98.8% and 18.7%, 90.0% and 15.1%, and 97.2% and 19.5% at the lumbar spine, femoral neck, total hip, and any sites, respectively. Multiple logistic regression analysis revealed that only OSTA ??1, osteopenia on X-ray and low trauma fracture after age of 40 years were significant clinical risk factors in the detection of postmenopausal osteoporosis. The Receiver Operating Characteristics (ROC) curve was used to obtain the optimum probability value of osteoporosis at any sites which revealed that the probability value of 0.2222236 would have a sensitivity of 67% and specificity of 62% as the optimal cut point to detect osteoporosis. A simple flow diagram of “OSTA ??1”, “Osteopenia on X-ray” and “A history of low trauma fracture after age of 40 years” was developed as a better trade-off guideline for BMD measurement. Conclusions: This study revealed that the TOPF and RCOST guideline for BMD measurement provided a high true positive rate of disease detection but with an expense of high false positive rate. The simple flow diagram was proposed as a more appropriate guideline for BMD measurement in postmenopausal women. © 2015 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

골다공증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이남수,이상건,이상범,이상우,이선정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : As the average lifespan of human increases, osteoporosis and osteoporosis-related fractures have become major health care problems. Despite recent advances in medical treatment, few studies have assessed the recognition of osteoporosis in general adults. This study examined the recognition of osteoporosis and analyzed the relating factors. Method : A population-based sample of 1086 adults in Asan-city, Korea was investigated with questionnaires and height, weight, Information regarding the general characteristics(gender, age, economic state), lifestylef exercise, smoking, alcohol),medical history(progestin, GH, steroid, calcitonin, PTH), demographic parameter, obesity, stress, and family history was collected through an interview using a structural questionnaire. The level of obesity was measured by the body mass index(BMI). BMD(Bone mineral density) at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry. Osteoporosis was considered to be T-score below -2.5. Results : The prevalence of osteoporosis increased progressively with age, decreased with BMI and predominant in women by the result of x^(2) -test, T-test. Age, weight, BMI were significantly correlated with osteoporosis by the result of Pearson correlation ana1ysis(P<0.05). And age, gender, BMI, family history of osteoporosis were proved to be significant risk factors of osteoporosis by the result of multiple logistic regression(P<0.05). Conclusion : These results suggest that age, gender, BMI might be the most important risk factors of osteoporosis. And the history taking about family history of osteoporosis is helpful for diagnosing osteoporosis.

Utilization of Osteoporosis-Related Health Services: Use of Data from the Korean National Health Insurance Database 2008–2012

유태양,조혜민,김태영,하용찬,장선미,김하영 대한의학회 2018 Journal of Korean medical science Vol.33 No.3

Background: Osteoporosis and its related fractures are increasingly being recognized as major health problems because of the rapidly increasing elderly population. In this study, we investigated the annual trend of osteoporosis-related health services utilization. Methods: Participants aged over 50 years were identified from the Korean National Health Insurance Service database between 2008 and 2012. Health service utilization rate and treatment rate were calculated through the operational definition. Results: In this period, the number of osteoporosis patients, aged over 50 years, using the medical service, increased by 33.2%. This increase was higher in males than in females. Moreover, the number of newly diagnosed osteoporosis patients increased by 4.3% in women and 20.4% in men. To estimate the proportion of osteoporosis patients who utilize medical services, we analyzed prevalence data from the Korea National Health and Nutrition Examination Survey from 2008 to 2010. Less than 60% of patients with osteoporosis were estimated to have utilized medical services because of osteoporosis. Drug treatment rates were 34.1%, 31.1%, and 33.5% in 2008, 2009, and 2010, respectively. Conclusion: This study demonstrated an increasing trend in the utilization of the osteoporosis- related health services from 2008 to 2012 in Korea. The proportion of newly diagnosed osteoporosis patients and the prevalence of access to medical services increased more in men than in women. Therefore, an increasing need for prevention and treatment of male osteoporosis was observed. The osteoporosis treatment rate was lower than that for other chronic diseases; more efforts are needed to improve awareness regarding osteoporosis treatment.

Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis

Naohisa Miyakoshi,Takashi Kobayashi,Tetsuya Suzuki,Kazuma Kikuchi,Yuji Kasukawa,Yoichi Shimada 대한척추외과학회 2017 Asian Spine Journal Vol.11 No.5

Study Design: A retrospective comparative study. Purpose: To compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis. Overview of Literature: With increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis. Methods: Ninety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared. Results: Diabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p <0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal. Conclusions: The overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.

A comparison of 6 osteoporosis risk assessment tools among postmenopausal women in Kuala Lumpur, Malaysia

Li Shean Toh,Pauline Siew Mei Lai,David Bin-Chia Wu,Brian G. Bell,Cuu Phuong Linh Dang,Bee Yean Low,Kok Thong Wong,Giuseppe Guglielmi,Claire Anderson 대한골다공증학회 2019 Osteoporosis and Sarcopenia Vol.5 No.3

Objectives: To compare and assess the performance of 6 osteoporosis risk assessment tools for screening osteoporosis in Malaysian postmenopausal women. Methods: Six osteoporosis risk assessments tools (the Simple Calculated Osteoporosis Risk Estimation [SCORE], the Osteoporosis Risk Assessment Instrument, the Age Bulk One or Never Estrogen, the body weight, the Malaysian Osteoporosis Screening Tool, and the Osteoporosis Self-Assessment Tool for Asians) were used to screen postmenopausal women who had not been previously diagnosed with osteoporosis/osteopenia. These women also underwent a dual-energy X-ray absorptiometry (DXA) scan to confirm the absence or presence of osteoporosis. Results: A total of 164/224 participants were recruited (response rate, 73.2%), of which only 150/164 (91.5%) completed their DXA scan. Sixteen participants (10.7%) were found to have osteoporosis, whilst 65/150 (43.3%) were found to have osteopenia. Using precision-recall curves, the recall of the tools ranged from 0.50 to 1.00, whilst precision ranged from 0.04 to 0.14. The area under the curve (AUC) ranged from 0.027 to 0.161. The SCORE had the best balance between recall (1.00), precision (0.04e0.12), and AUC (0.072e0.161). Conclusions: We found that the SCORE had the best balance between recall, precision, and AUC among the 6 screening tools that were compared among Malaysian postmenopausal women.

Osteoporosis prevention and osteoporosis exercise in community-based public health programs

Vu H. Nguyen 대한골다공증학회 2017 Osteoporosis and Sarcopenia Vol.3 No.1

Osteoporosis is a serious public health concern worldwide, and community-based public health programs that increase osteoporosis preventive behaviors are ideal to combat this major public health issue. A review of community-based public health programs for osteoporosis prevention show that programs vary in numerous ways and have mixed results in increasing osteoporosis preventive behaviors, although most programs have had success in significantly increasing calcium intake, only a few programs have had success in significantly increasing weightbearing exercise. Regarding calcium intake, all community-based public health programs that implemented: 1) at least one theoretical behavior change model, such as the health belief model, or 2) bone mineral density (BMD) testing for osteoporosis screening, have shown success in significantly increasing calcium intake. As community-based public health programs for osteoporosis prevention have shown limited success in increasing weight-bearing exercise, an additional review of community-based public health programs incorporating osteoporosis exercise showed that they have high compliance rates to increase weight-bearing exercise, but require high-intensity weight-bearing exercise of 80e85% 1-repetition maximum to significantly increase BMD to prevent osteoporosis. In the prevention of osteoporosis, for community-based public health programs to be most effective, they should implement theoretical behavior change models and/or BMD testing for osteoporosis screening, along with high-intensity resistance training. Recommendations for future research to further study effective community-based public health programs are also provided.

골다공증 한약제제 임상시험 참여자의 골다공증 한의치료에 대한 인식 : 질적 연구

안재현,조예은,김지혜,이승훈,강중원,이재동,Ahn, Jae-hyun,Cho, Ye-eun,Kim, Ji-hye,Lee, Seung-hoon,Kang, Jung-won,Lee, Jae-dong 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.2

Objective: This research aimed to understand patients' perceptions of Korean medicine treatment for osteoporosis in a clinical trial setting. Methods: Ten patients participating in a clinical trial of a herbal medicine drug for osteoporosis were invited to an interview. Data were collected by in-depth interviews and patient observations. This qualitative study adopted the case study research method, and within-case and cross-case analyses were conducted. Results: A model of the patients' osteoporosis management planning was derived from the study. The results showed that the patients' perceptions of osteoporosis were derived from their knowledge and experience during diagnosis and treatment of the condition. Two groups of patients were recognized: those who overlooked the importance of osteoporosis and those who recognized the importance of osteoporosis. Before making treatment decisions about osteoporosis, the patients evaluated the treatment options and weighed the advantages and disadvantages of each option. When evaluating their treatment, the patients combined their knowledge and experience of Korean and western medicine treatments. Their experience of participating in the clinical trial influenced the management planning of osteoporosis. Two major reasons for low compliance with osteoporosis treatment were ignorance of the disease and insufficient information provided by doctors. Conclusion: The results of this qualitative study pointed to four strategies that could be employed to improve accessibility to Korean medicine treatment for osteoporosis: the dissemination of comprehensive information on osteoporosis in the clinic and mass media, promotion of Korean medicine therapies for osteoporosis, management of clinical trial participants, and insurance coverage for Korean medicine.