Endocrinol Metab.  2021 Dec;36(6):1178-1188. 10.3803/EnM.2021.1215.

10-Year Fracture Risk in Postmenopausal Women with Osteopenia and Osteoporosis in South Korea

• Baek YH
• Cho SW
• Jeong HE
• Kim JH
• Hwang Y
• Lange JL
• Shin JY

• KMID: 2523487
• DOI: http://doi.org/10.3803/EnM.2021.1215

Abstract

Background
In South Korea, women aged 66 years are eligible for complimentary bone mineral density (BMD) screening via the National Screening Program for Transitional Ages. We aimed to evaluate the 10-year fracture risk in women receiving BMD screening between January 2008 and December 2015.
Methods
BMD was classified as normal (T-score ≥–1.0 standard deviation [SD]), osteopenia (T-score <–1.0 SD and >–2.5 SD), and osteoporosis (T score ≤–2.5 SD) from dual-energy X-ray absorptiometry. Follow-up continued from the screening date until a diagnosis for clinical fragility fracture (including sites of the vertebrae, hip, pelvis, clavicle, humerus, forearm, wrist, lower leg, and ankle), censored at the earliest date of trauma, death, or December 2017; fracture was ascertained using diagnostic codes from the National Health Insurance Service database. A multivariable Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of fracture in women with osteopenia or osteoporosis relative to women with normal BMD.
Results
Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%, 37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis, respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95% CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women with normal BMD.
Conclusion
Women with osteopenia and women with osteoporosis, identified by the national BMD screening program, demonstrated a substantially elevated risk of fracture.

Keyword

Bone density; Bone diseases; metabolic; Fractures; bone; Osteoporosis; Postmenopause

Figure

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  Fig. 1 Selection of study subjects who underwent dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening from the National Screening Program for Transitional Ages (NSPTA). OP, osteoporosis; HIV, human immunodeficiency virus. a≥5 mg prednisolone-equivalent steroid/day for ≥3 months.

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  Fig. 2 Cumulative incidence curves for the time to (A) overall, (B) vertebral, (C) hip, and (D) non-hip and non-vertebral fractures after dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) screening test in subjects with normal BMD, osteopenia, or osteoporosis.

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