Journal of Preventive Medicine and Public Health

Original Articles

Incidence of and Factors for Self-reported Fragility Fractures Among Middle-aged and Elderly Women in Rural Korea: An 11-Year Follow-up Study: Soon-Ki Ahn, Sin Kam, Byung-Yeol Chun; J Prev Med Public Health. 2014;47(6):289-297. Published online October 2, 2014; DOI: https://doi.org/10.3961/jpmph.14.020

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Objectives
This community-based cohort study was performed to investigate the incidence of and factors related to self-reported fragility fractures among middle-aged and elderly women living in rural Korea.
Methods
The osteoporosis cohort recruited 430 women 40 to 69 years old in 1999, and 396 of these women were followed over 11 years. In 1999, questionnaires from all participants assessed general characteristics, medical history, lifestyle, menstrual and reproductive characteristics, and bone mineral density. In 2010, self-reported fractures and the date, site, and cause of these fractures were recorded. Cox proportional hazards models were used to calculate hazard ratios (HRs).
Results
Seventy-six participants among 3949.7 person-years experienced fragility fractures during the 11-year follow-up. The incidence of fragility fractures was 1924.2 per 100 000 person-years (95% confidence interval [CI], 1491.6 to 2356.8). In the multivariate model, low body mass index (HR, 2.66; 95% CI, 1.13 to 6.24), a parental history of osteoporosis (HR, 2.03; 95% CI, 1.18 to 3.49), and postmenopausal status (HR, 3.50; 95% CI, 1.05 to 11.67) were significantly related to fragility fracture.
Conclusions
Fracture prevention programs are needed among postmenopausal, rural, Korean women with a low body mass index and parental history of osteoporosis Korea.

Summary

Citations

Citations to this article as recorded by

Comparison of intraoperative radiation exposure with and without use of distal targeting device: a randomized control study
Jun-Il Yoo, Hojin Jeong, Jaeboem Na, Sang-Youn Song, Jung-Taek Kim, Yong-Han Cha, Chan Ho Park
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Levothyroxine Dose and Fracture Risk According to the Osteoporosis Status in Elderly Women: Young-Jin Ko, Ji Young Kim, Joongyub Lee, Hong-Ji Song, Ju-Young Kim, Nam-Kyong Choi, Byung-Joo Park; J Prev Med Public Health. 2014;47(1):36-46. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.36

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Abstract PDF

Objectives

To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history.

Methods

We conducted a cohort study from the Korean Health Insurance Review and Assessment Service claims database from January 2005 to June 2006. The study population comprised women aged ≥65 years who had been diagnosed with hypothyroidism and prescribed levothyroxine monotherapy. We excluded patients who met any of the following criteria: previous fracture history, hyperthyroidism, thyroid cancer, or pituitary disorder; low levothyroxine adherence; or a follow-up period <90 days. We categorized the daily levothyroxine doses into 4 groups: ≤50 µg/d, 51 to 100 µg/d, 101 to 150 µg/d, and >150 µg/d. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with the Cox proportional hazard model, and subgroup analyses were performed according to the osteoporosis history and osteoporosis-specific drug prescription status.

Results

Among 11 155 cohort participants, 35.6% had previous histories of osteoporosis. The adjusted HR of fracture for the >150 µg/d group, compared with the 51 to 100 µg/d group, was 1.56 (95% CI, 1.03 to 2.37) in osteoporosis subgroup. In the highly probable osteoporosis subgroup, restricted to patients who were concurrently prescribed osteoporosis-specific drugs, the adjusted HR of fracture for the >150 µg/d group, compared with the 51 to 100 µg/d group, was 1.93 (95% CI, 1.14 to 3.26).

Conclusions

While further studies are needed, physicians should be concerned about potential levothyroxine overtreatment in elderly osteoporosis patients.

Summary

Citations

Citations to this article as recorded by

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Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients: Dong-Yoon Kang, Soyoung Park, Chul-Woo Rhee, Ye-Jee Kim, Nam-Kyong Choi, Joongyub Lee, Byung-Joo Park; J Prev Med Public Health. 2012;45(4):219-226. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.219

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Abstract PDF

Objectives

To evaluate the risk of fractures related with zolpidem in elderly insomnia patients.

Methods

Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the casecrossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem.

Results

One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup.

Conclusions

Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

Summary

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English Abstracts

The Risk of Fracture with Taking Alpha Blockers for Treating Benign Prostatic Hyperplasia.: Joongyub Lee, Nam Kyoung Choi, Sun Young Jung, Ye Jee Kim, Jong Mi Seong, Seung June Oh, Byung Joo Park; J Prev Med Public Health. 2009;42(3):165-170.; DOI: https://doi.org/10.3961/jpmph.2009.42.3.165

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Abstract PDF

OBJECTIVES
We evaluated the risk of fracture associated with hypotension-related adverse drug reaction caused by taking alpha blockers to treat benign prostatic hyperplasia (BPH). METHODS: We used the Health Insurance Review and Assessment Service database from January 1st 2005 to June 30th 2006 for this study. The male patients with BPH and who had a prescription for alpha blockers following any fractures were defined as the cases. We set the 20 day long hazard period prior to the index date and the four control periods whose lengths were same with hazard period. After 1:4 matching of the hazard and control periods, conditional logistic regression was used to calculate the odds ratios for the risk of fractures as related to the alpha blocker exposure. RESULTS: Doxazosin and tamsulosin showed the increased risk of fractures, whereas terazosin did not. After stratification using the defined daily doses, a protective effect was shown for the patients who took terazosin at the doses lower than 0.4 DDD and the hazardous effect at the doses higher than or equal to 0.4 DDD. There was no significant difference for the risk of patients taking tamsulosin at the doses higher than 1.0 DDD but there was a statistically significant increase in the risk at the doses higher than or equal to 1.0 DDD. CONCLUSIONS: Alpha blockers for BPH may increase the risk of fracture in elderly patients who have comorbidities and take the concomitant medications. Alpha blockers need to be prescribed with caution, although some have high prostate specificity.

Summary

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Risk for Hip Fracture due to Alpha Blocker Treatment in Korean Women: National Health Insurance Database Study
Gi H. SEO, Sung R. SHIM, Hwan W. LEE, Jin H. KIM, Dong‐Il CHUN, Hyun J. KIM, Hyun Y. LEE, Jae H. KIM
LUTS: Lower Urinary Tract Symptoms.2018; 10(2): 175. CrossRef
Risk of hip/femur fractures during the initiation period of α‐adrenoceptor blocker therapy among elderly males: a self‐controlled case series study
Chao‐Lun Lai, Raymond Nien‐Chen Kuo, Ho‐Min Chen, Ming‐Fong Chen, Kinwei Arnold Chan, Mei‐Shu Lai
British Journal of Clinical Pharmacology.2015; 80(5): 1208. CrossRef
The Association of Alpha-Blockers and 5-Alpha Reductase Inhibitors in Benign Prostatic Hyperplasia With Fractures
Sian Yik Lim, Pavis Laengvejkal, Ragesh Panikkath, Kenneth Nugent
The American Journal of the Medical Sciences.2014; 347(6): 463. CrossRef
Alpha-adrenergic blocker mediated osteoblastic stem cell differentiation
Yoon Jung Choi, Jue Yeon Lee, Seung Jin Lee, Chong-Pyoung Chung, Yoon Jeong Park
Biochemical and Biophysical Research Communications.2011; 416(3-4): 232. CrossRef
Risk of fractures associated with treatment for benign prostate hyperplasia in men
P. Vestergaard, L. Rejnmark, L. Mosekilde
Osteoporosis International.2011; 22(2): 731. CrossRef
Databases in Asia and Record-Linkage
Kiyoshi KUBOTA
Japanese Journal of Pharmacoepidemiology/Yakuzai ekigaku.2011; 16(1): 27. CrossRef

Estimating the Economic Burden of Osteoporotic Vertebral Fracture among Elderly Korean Women.: Hye Young Kang, Dae Ryong Kang, Young Hwa Jang, Sung Eun Park, Won Jung Choi, Seong Hwan Moon, Kyu Hyun Yang; J Prev Med Public Health. 2008;41(5):287-294.; DOI: https://doi.org/10.3961/jpmph.2008.41.5.287

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OBJECTIVES
To estimate the economic burden of osteoporotic vertebral fracture (VF) from a societal perspective. METHODS: From 2002 to 2004, we identified all National Health Insurance claims records for women > or = 50 years old with a diagnosis of VF. The first 6-months was defined as a "clearance period," Ysuch that patients were considered as incident cases if their first claim of fracture was recorded after June 30, 2002. We only included patients with > or = one claim of a diagnosis of, or prescription for, osteoporosis over 3 years. For each patient, we cumulated the claims amount for the first visit and for the follow-up treatments for 1 year. The hospital charge data from 4 hospitals were investigated to measure the proportion of the non-covered services. Face-to-face interviews were conducted with 106 patients from the 4 study sites to measure the out-of-pocket spending outside of hospitals. RESULTS: During 2.5 years, 131,453 VF patients were identified. The patients had an average of 3.38 visits, 0.40 admissions and 6.36 inpatient days. The per capita cost was 1,909,690 Won: 71.5% for direct medical costs, 20.6% for direct non-medical costs and 7.9% for indirect costs. The per capita cost increased with increasing age: 1,848,078 Won for those aged 50-64, 2,084,846 Won for 65-74, 2,129,530 Won for 75-84and 2,121,492 Won for those above 84. CONCLUSIONS: Exploring the economic burden of osteoporotic VF is expected to motivate to adopt effective treatment options for osteoporosis in order to prevent the incidence of fracture and the consequent costs.

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A Study of Prevalence and Awareness of Low Bone Density of Female Utilizing Dental Panoramic Radiographs
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Hea Sun Chun
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Absolute Bed Rest Duration of 3 Days for Osteoporotic Vertebral Fractures: A Retrospective Study
Sung Tan Cho, Seung Joo Kim, Bum Joon Nam, Kun Woo Kim, Gyu Hyeon Lee, Jin Hwan Kim
Asian Spine Journal.2022; 16(6): 898. CrossRef
Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in South Korea: a simulation projection model from 2020 to 2040
Micah Jackson, Kyu Hyun Yang, Matthew Gitlin, Zachary Wessler
Archives of Osteoporosis.2021;[Epub] CrossRef
Healthcare Resource Utilization and Direct Medical Costs for Patients With Osteoporotic Fractures in China
Jing Wu, Yi Qu, Ke Wang, Yu Chen
Value in Health Regional Issues.2019; 18: 106. CrossRef
A meta-analysis of breastfeeding and osteoporotic fracture risk in the females
X. Duan, J. Wang, X. Jiang
Osteoporosis International.2017; 28(2): 495. CrossRef
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Jinhyun Kim, Eunhee Lee, Sungjae Kim, Tae Jin Lee
Value in Health Regional Issues.2016; 9: 36. CrossRef
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Kyung-Ae Park, Yeon-Hwan Park, Min-Hee Suh, Smi Choi-Kwon
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The Epidemiology and Importance of Osteoporotic Spinal Compression Fracture in South Korea
Hun-Kyu Shin, Jong-Hyon Park
Journal of Korean Society of Spine Surgery.2015; 22(3): 99. CrossRef
The Socioeconomic Burden of Coronary Heart Disease in Korea
Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang
Journal of Preventive Medicine and Public Health.2012; 45(5): 291. CrossRef
Epidemiology and Economic Burden of Osteoporosis in South Korea
Yong-Chan Ha
Journal of the Korean Fracture Society.2011; 24(1): 114. CrossRef
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Kyung Sik Park
The Korean Journal of Gastroenterology.2011; 58(6): 297. CrossRef
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Effects of Long-term Fluoride in Drinking Water on Risks of Hip Fracture of the Elderly: An Ecologic Study Based on Database of Hospitalization Episodes.: Eun Young Park, Seung Sik Hwang, Jai Yong Kim, Soo Hun Cho; J Prev Med Public Health. 2008;41(3):147-152.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.147

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Abstract PDF

OBJECTIVES
Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. METHODS: Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. RESULTS: The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the nonfluoridated cities. CONCLUSIONS: We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

Summary

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The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea
Naae Lee, Sungchan Kang, Woojoo Lee, Seung-sik Hwang
International Journal of Environmental Research and Public Health.2020; 17(24): 9170. CrossRef
Community water fluoridation and health outcomes in England: a cross‐sectional study
Nicholas Young, John Newton, John Morris, Joan Morris, John Langford, Jonathan Iloya, Diane Edwards, Semina Makhani, Julia Verne
Community Dentistry and Oral Epidemiology.2015; 43(6): 550. CrossRef
Exposure to Fluoride in Drinking Water and Hip Fracture Risk: A Meta-Analysis of Observational Studies
Xin-Hai Yin, Guang-Lei Huang, Du-Ren Lin, Cheng-Cheng Wan, Ya-Dong Wang, Ju-Kun Song, Ping Xu, Yi-Hsiang Hsu
PLOS ONE.2015; 10(5): e0126488. CrossRef
Effects of Life-long Fluoride Intake on Bone Measures of Adolescents
S.M. Levy, J.J. Warren, K. Phipps, E. Letuchy, B. Broffitt, J. Eichenberger-Gilmore, T.L. Burns, G. Kavand, K.F. Janz, J.C. Torner, C.A. Pauley
Journal of Dental Research.2014; 93(4): 353. CrossRef

Original Articles

Physical Activity and Hip Fracture in Elderly People: A Cohort Study in Korea.: Kyung Eun Youn, Seung Mi Lee, Yooni Kim, Byung Joo Park; Korean J Prev Med. 2002;35(4):351-358.

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Abstract PDF: OBJECTIVE
To evaluate the relationship between physical activity and the risk of hip fracture in the elderly Korean people. METHODS: The study population was a Physical Activity Subcohort (n=8,908) extracted from the Korean Elderly Pharmacoepidemiological Cohort (KEPEC). Physical activity information was obtained from a mailed questionnaire surveys. The outcome data was collected from claims data gathered between Jan. 1993 and Dec. 1998. A hospital survey relating to potential cases was conducted to confirm the final diagnoses. The abstracted data was reviewed by a medical doctor before the final diagnoses were confirmed. A mailing questionnaire survey was performed to obtain information on potentially confounding variables, including alcohol intake, smoking habits, weight, height and postmenopausal duration. There were 79 confirmed cases hospitalized due to hip fractures between Jan. 1993 and Dec. 1998. Relative risk of physical activity scores on the hip fracture, and their 95% confidence intervals, were estimated by a Cox's proportional hazard model using SAS for Windows ver. 6.12. RESUJLTS: Compared to the reference group, the adjusted relative risk of hip fracture associated with the most physical active category; after controlling for age, weight and alcohol intake in the males, and for weight, alcohol intake and postmenopausal duration in the females, were 1.04 (95% CI=0.35-3.06) and 0.44 (95% CI=0.26-0.77), respectively. CONCLUSIONS: Physical activity may protect elderly women from hip fracture.; Summary

Reproductive History and Hip Fracture in the Elderly Women in Korea: A Cohort Study.: Seung Mi Lee, Yooni Kim, Koung Eun Youn, Byung Joo Park; Korean J Prev Med. 2002;35(4):305-312.

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Abstract PDF: OBJECTIVES
The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. METHODS: The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. RESUJLTS: Following up 5,219 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25 - 1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34 - 1.08) compared with those who had giving birth at 22 years or older. CONCLUSIONS: According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.; Summary

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