Korean J Intern Med.  2010 Dec;25(4):436-446. 10.3904/kjim.2010.25.4.436.

A Comparison of Three Different Guidelines for Osteoporosis Treatment in Patients with Rheumatoid Arthritis in Korea

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea. parkwon@inha.ac.kr

Abstract

BACKGROUND/AIMS
Osteoporotic fractures are an important comorbidity with rheumatoid arthritis (RA). We determined the overall fracture risk as assessed by the World Health Organization (WHO)'s FRAX(R) tool in Korean patients with seropositive RA. Additionally, we compared treatment eligibility according to the criteria of the Korean Health Insurance Review Agency (HIRA), FRAX, and the National Osteoporosis Foundation (NOF).
METHODS
Postmenopausal women and men > or = 50 years of age with seropositive RA were recruited from one rheumatism center in Korea. The FRAX score was estimated using the Japanese model. Patients were classified as eligible for treatment using the HIRA, NOF, and FRAX thresholds for intervention.
RESULTS
The study of 234 patients included 40 men (17%). The mean age was 60 +/- 9 years, and 121 (52%) patients had osteoporosis according to the WHO criteria. The overall median 10-year fracture risk was 13% for major osteoporotic fractures and 3.5% for hip fractures. HIRA guidelines identified 130 patients (56%) eligible for treatment, FRAX included 126 patients (54%), and 151 patients (65%) were included according to NOF guidelines. Older patients with a greater number of risk factors were included by FRAX compared to HIRA. The overall concordance between HIRA and FRAX, expressed as the kappa index, was 0.67, but was as low as 0.44 when limited to patients > or = 60 years of age.
CONCLUSIONS
One-half of the patients had osteoporosis requiring treatment. RA patients have a high risk of fracture, and the adoption of a risk-scoring system should be considered.

Keyword

Arthritis, rheumatoid; Osteoporosis

MeSH Terms

Aged
Arthritis, Rheumatoid/*complications
Bone Density
Cross-Sectional Studies
Female
Hip Fractures/epidemiology
Humans
Korea/epidemiology
Male
Middle Aged
Osteoporosis/epidemiology/*therapy
Osteoporotic Fractures/epidemiology
Practice Guidelines as Topic
Prevalence
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