Bisphosphonate use and subsequent hip fracture in South Korea

BackgroundIn management of osteoporosis, several concerns here have been raised. The current issue included the utilization of dual energy X-ray absorptiometry (DXA) and fracture-risk assessment (FRAX), screening of vitamin D deficiency and secondary osteoporosis, and long-term use of bisphosphonate and calcium supplements. There was no study on physicians' attitude on these current issues in Korea. Therefore, we investigated the physicians' attitude on these issues by survey.MethodsWe administered a 30-item questionnaire to all members of Korean Society for Bone and Mineral Research by email survey form. One hundred participants answered the questionnaire. The questionnaire included the questions about the physicians' attitude to current issues and the barriers to osteoporosis treatment in Korea.ResultsMost physicians used bone densitometry devices (99%) and, central DXA was the most accessible device (95%). Eighty-eight percent were aware of FRAX®, but among them, only 19.3% used it. The main reason for not using FRAX® was the lack of time in their proactive (76%). Screening for vitamin D status and secondary osteoporosis was performed by 59% and 52% of the respondents, respectively. The lack of awareness among patients and high costs of medication were perceived as the most important barriers to osteoporosis management in Korea.ConclusionsThis study provides physicians' perspective to the current issue for diagnostic and treatment of osteoporosis in Korea. To further improve osteoporosis management, educational programs for patients and doctors, and the improvement of reimbursement system should be considered in Korea.

Section: Discussionmentioning

confidence: 99%

Physicians' Attitudes to Contemporary Issues on Osteoporosis Management in Korea

Lee

Lim

et al. 2014

“…During study period, South Korea reimbursement guidelines for osteoporosis treatment required that patients had T-score of less than −3.0 or history of osteoporosis- related fracture at spine or hip, and covered a period of 6 months only. [20] Therefore, our results on the number of osteoporosis-diagnosed patients would be underestimate the real number of patients with osteoporosis. Moreover, just some patients would be visit the medical institute to diagnose and treat osteoporosis, because osteoporosis does not have any symptom until fracture.…”

Section: Discussionmentioning

confidence: 90%

Characteristics of Patients Diagnosed with Osteoporosis in South Korea: Results from the National Claim Registry

Yoon

Lee

2017

BackgroundAlthough osteoporosis is increasing medical issue in the elderly population, attempts to analyze the characteristics of patients diagnosed with osteoporosis are rare in South Korea. We investigated the characteristics of patients diagnosed with osteoporosis using Korea's National Health Insurance claims data, which includes almost Korean population.MethodsWe evaluated the patients who were diagnosed and treated with osteoporosis in medical institute in South Korea, using the national database by the Health Insurance Review & Assessment Service (HIRA). We evaluated the characteristic of patients and state of medical service utilization in 2010.ResultsThe number of patients who were diagnosed with osteoporosis were 1,733,685, and almost of them (91.1%) were females. Fourteen point three percent of the patients had experienced osteoporosis-related fracture. The most commonly used type of institute and department was hospital and orthopedic surgery.ConclusionsConsidering increasing age population, basic information including characteristic of patients and current state of medical service utilization could be useful to perform appropriate management and treatment for osteoporosis patients in South Korea, using the National Health Insurance claims data.

“…The HIRA database includes diagnosis records, procedure records, prescription records, and demographic information. [3,9,10,11,12,13] The study protocol was approved by the Institute Review Board of Chungbuk National University Hospital. The age and gender distribution of Korean general population was obtained from the Korean Statistical Information Service.…”

Section: Methodsmentioning

confidence: 99%

“…[1,2,3,4] Oral bisphosphonate cause dyspepsia and inflammatory damage to esophagus. This chemical irritation has been suggested as a mechanistic link between oral bisphosphonate use and risk of esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

Oral Bisphosphonate and Risk of Esophageal Cancer: A Nationwide Claim Study

Seo

Choi

2015

BackgroundEpidemiology studies suggest that oral bisphosphonate may increase the risk of esophageal cancer. The present study aimed to investigate the association between exposure of oral bisphosphonate and risk of esophageal cancer.MethodsUsing the nationwide medical claim database in South Korea, 2,167,955 subjects, who initiated osteoporosis treatment (oral bisphosphonate, intravenous bisphosphonate or raloxifene) or performed dual energy X-ray absorptiometry (DXA) between 2008 and 2012, were analyzed. Diagnosis of esophageal cancer was estimated from medical claim database. Standardized incidence ratio (SIR) was estimated by comparing with incidence in the general population. Cox proportional hazards modeling was used to investigate age-adjusted hazard ratio (aHR) of esophageal cancer.ResultsThe present study included oral bisphosphonate group (N=1,435,846), comparator group 1 (intravenous bisphosphonate or raloxifene, N=78,363) and comparator group 2 (DXA, N=653,746). Mean age was 65.6±8.8 years and mean observation duration was 30.9±17.7 months. During 5,503,688 patient-years, 205 esophageal cancer incidences were observed. The annual incidence of esophageal cancer was 3.88, 4.21, and 3.30 for oral bisphosphonate group, comparator group 1 and comparator group 2, respectively. SIR of esophageal cancer was 1.24, 1.38, and 1.40 for oral bisphosphonate group, comparator group 1 and comparator group 2, respectively. Esophageal cancer risk of oral bisphosphonate group was not significantly different from comparator group 1 and comparator group 2 (aHR 0.87; 95% confidence interval [CI] 0.39-1.98 and aHR 0.94; 95% CI 0.68-1.30, respectively).ConclusionsThe use of oral bisphosphonate was not associated with increased risk of esophageal cancer in real clinical practice using large scale nationwide database.