Journal of Preventive Medicine and Public Health

Original Articles

The Effect of an Educational Intervention on Health Literacy and the Adoption of Nutritional Preventive Behaviors Related to Osteoporosis Among Iranian Health Volunteers: Leila Dehghankar, Rahman Panahi, Elham Hasannia, Fatemeh Hemmati, Fatemeh Samiei Siboni; J Prev Med Public Health. 2021;54(6):404-411. Published online October 22, 2021; DOI: https://doi.org/10.3961/jpmph.21.183

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Objectives
Given the increase in osteoporosis among health volunteers and the effect of health literacy on the adoption of nutritional preventive behaviors, this study aimed to determine the effects of an educational intervention on health literacy and the adoption of nutritional preventive behaviors related to osteoporosis among health volunteers.
Methods
This was a quasi-experimental, interventional study of health volunteers conducted in 2020. In this study, 140 subjects (70 in both intervention and control groups) were selected using the random multi-stage sampling method. An educational intervention was conducted using the Telegram application, and educational messages were sent to the health volunteers in the intervention group across 6 sessions. Data were collected via a demographic questionnaire, the Health Literacy for Iranian Adults survey, and a nutritional performance questionnaire, which were completed before and 3 months after the intervention. The data were collected and analyzed using SPSS version 23.
Results
Before the intervention, there were no significant differences in the mean scores for health literacy variables and the adoption of nutritional preventive behaviors between the intervention and control groups (p>0.05). After the intervention, there was a significant change in the mean scores for health literacy and the adoption of preventive behaviors in the intervention group (p<0.05) as opposed to the control group.
Conclusions
Interventions aimed at increasing health literacy are effective for promoting the adoption of preventive and healthy nutritional behaviors related to osteoporosis.

Summary

Citations

Citations to this article as recorded by

Factors related with nursing students’ health literacy: a cross sectional study
Enrique Ramón-Arbués, José Manuel Granada-López, Isabel Antón-Solanas, Ana Cobos-Rincón, Antonio Rodríguez-Calvo, Vicente Gea-Caballero, Clara Isabel Tejada-Garrido, Raúl Juárez-Vela, Emmanuel Echániz-Serrano
Frontiers in Public Health.2023;[Epub] CrossRef
Health literacy interventions among patients with chronic diseases: A meta-analysis of randomized controlled trials
Yingshan Shao, Huaqin Hu, Yaxin Liang, Yangyang Hong, Yiqing Yu, Chenxi Liu, Yihua Xu
Patient Education and Counseling.2023; 114: 107829. CrossRef

Association Between Parity and Low Bone Density Among Postmenopausal Korean Women: Eunsun Seo, Yongrong Lee, Hyeon Chang Kim; J Prev Med Public Health. 2021;54(4):284-292. Published online June 24, 2021; DOI: https://doi.org/10.3961/jpmph.21.162

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Abstract Summary PDF Supplementary Material

Objectives
Low bone density (LBD) in the postmenopausal period has long been a pervasive public health concern; however, the association between parity and LBD has yet to be fully elucidated. Thus, we investigated the association between parity and LBD in postmenopausal Korean women.
Methods
This study used baseline data from 1287 Korean postmenopausal women aged 40 years or older enrolled in the Cardiovascular and Metabolic Diseases Etiology Research Center community-based cohort study conducted in Korea from 2013 to 2017. The main exposure was parity (nullipara, 1, 2, 3+). The main outcome was LBD, including osteopenia and osteoporosis, based on bone mineral density measured using quantitative computed tomography of the lumbar spine (L1-2).
Results
The mean age of participants was 57.1 years, and the median parity was 2. Of the 1287 participants, 594 (46.2%) had osteopenia and 147 (11.4%) had osteoporosis. No significant difference in the prevalence of LBD was found between nullipara and parous women, whereas higher parity was associated with a higher risk of LBD among parous women; the adjusted odds ratio (95% confidence interval) for the presence of LBD was 1.40 (0.97 to 2.02) for a parity of 2 and 1.95 (1.23 to 3.09) for a parity of 3 relative to a parity of 1.
Conclusions
Women who have given birth multiple times may be at greater risk of bone loss after menopause; therefore, they should be a major target population for osteoporosis prevention.

Summary

Korean summary
40-64세 폐경 여성 1287명을 대상으로 과거 출산 횟수와 골밀도의 관련성을 평가하였다. 정량적 전산화 단층촬영(QCT)으로 L1-L2의 평균 골무기질밀도(bone mineral density, BMD)를 측정하였으며, 그 값이 120mg/cm3 미만이면 골밀도 감소가 있는 것으로 정의하였다. 나이, 비만도, 폐경후기간, 직업, 소득, 교육, 결혼, 흡연, 음주, 신체활동, 질병력 등을 보정하여도, 출산횟수가 많을수록 평균 골밀도는 낮고 골밀도감소의 빈도는 높은 경향이 관찰되었다.

Citations

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The Heterogeneity of Post-Menopausal Disease Risk: Could the Basis for Why Only Subsets of Females Are Affected Be Due to a Reversible Epigenetic Modification System Associated with Puberty, Menstrual Cycles, Pregnancy and Lactation, and, Ultimately, Meno
David A. Hart
International Journal of Molecular Sciences.2024; 25(7): 3866. CrossRef
Genetic Prediction of Osteoporosis by Anti-Müllerian Hormone Levels and Reproductive Factors in Women: A Mendelian Randomization Study
Yuan Li, Jinquan Lai, Wenbo Wu, Shuyi Ling, Yuqing Dai, Zhisheng Zhong, Xiaodong Chen, Yuehui Zheng
Calcified Tissue International.2024; 115(1): 41. CrossRef
Bridging the Gap: Pregnancy—And Lactation—Associated Osteoporosis
Mara Carsote, Maria Roxana Turturea, Ana Valea, Cristian Buescu, Claudiu Nistor, Ionut Florin Turturea
Diagnostics.2023; 13(9): 1615. CrossRef
Associations of breastfeeding duration and the total number of children breastfed with self-reported osteoarthritis in women 50 years and older: a cross-sectional study
dajeong ham, Bae Sanghyuk
Epidemiology and Health.2023; : e2023044. CrossRef
Association between parity and bone mineral density in postmenopausal women
Yimei Yang, Shanshan Wang, Hui Cong
BMC Women's Health.2022;[Epub] CrossRef

Relationship Between Non-alcoholic Fatty Liver Disease and Decreased Bone Mineral Density: A Retrospective Cohort Study in Korea: Jisun Sung, Seungho Ryu, Yun-Mi Song, Hae-Kwan Cheong; J Prev Med Public Health. 2020;53(5):342-352. Published online July 17, 2020; DOI: https://doi.org/10.3961/jpmph.20.089

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Abstract PDF

Objectives
The aim of this retrospective cohort study was to investigate whether non-alcoholic fatty liver disease (NAFLD) was associated with incident bone mineral density (BMD) decrease.
Methods
This study included 4536 subjects with normal BMD at baseline. NAFLD was defined as the presence of fatty liver on abdominal ultrasonography without significant alcohol consumption or other causes. Decreased BMD was defined as a diagnosis of osteopenia, osteoporosis, or BMD below the expected range for the patient’s age based on dual-energy X-ray absorptiometry. Cox proportional hazards models were used to estimate the hazard ratio of incident BMD decrease in subjects with or without NAFLD. Subgroup analyses were conducted according to the relevant factors.
Results
Across 13 354 person-years of total follow-up, decreased BMD was observed in 606 subjects, corresponding to an incidence of 45.4 cases per 1000 person-years (median follow-up duration, 2.1 years). In the model adjusted for age and sex, the hazard ratio was 0.65 (95% confidence interval, 0.51 to 0.82), and statistical significance disappeared after adjustment for body mass index (BMI) and cardiometabolic factors. In the subgroup analyses, NAFLD was associated with a lower risk of incident BMD decrease in females even after adjustment for confounders. The direction of the effect of NAFLD on the risk of BMD decrease changed depending on BMI category and body fat percentage, although the impact was statistically insignificant.
Conclusions
NAFLD had a significant protective effect on BMD in females. However, the effects may vary depending on BMI category or body fat percentage.

Summary

Citations

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Anti-osteoporotic treatments in the era of non-alcoholic fatty liver disease: friend or foe
Maria Eleni Chondrogianni, Ioannis Kyrou, Theodoros Androutsakos, Christina-Maria Flessa, Evangelos Menenakos, Kamaljit Kaur Chatha, Yekaterina Aranan, Athanasios G. Papavassiliou, Eva Kassi, Harpal S. Randeva
Frontiers in Endocrinology.2024;[Epub] CrossRef
Bone mass, microarchitecture and turnover among young Indian women with non-alcoholic fatty liver disease
Alpesh Goyal, Suraj Kubihal, Yashdeep Gupta, Shalimar, Devasenathipathy Kandasamy, Mani Kalaivani, Nikhil Tandon
Endocrine.2024;[Epub] CrossRef
Effects of Metabolic Dysfunction-Associated Steatotic Liver Disease on Bone Density and Fragility Fractures: Associations and Mechanisms
Shaghayegh Khanmohammadi, Mohammad Shafi Kuchay
Journal of Obesity & Metabolic Syndrome.2024; 33(2): 108. CrossRef
Association between nonalcoholic fatty liver disease and bone mineral density: Mendelian randomization and mediation analysis
Minzhe Zheng, Junxiang Xu, Zongxian Feng
Bone Reports.2024; 22: 101785. CrossRef
Association between body fat and bone mineral density in Korean adults: a cohort study
Hyunjung Yoon, Eunju Sung, Jae-Heon Kang, Cheol-Hwan Kim, Hocheol Shin, Eunsol Yoo, Minyoung Kim, Mi Yeon Lee, Sujeong Shin
Scientific Reports.2023;[Epub] CrossRef
Liver fibrosis is associated with impaired bone mineralization and microstructure in obese individuals with non-alcoholic fatty liver disease
Ilaria Barchetta, Carla Lubrano, Flavia Agata Cimini, Sara Dule, Giulia Passarella, Arianna Dellanno, Alberto Di Biasio, Frida Leonetti, Gianfranco Silecchia, Andrea Lenzi, Maria Gisella Cavallo
Hepatology International.2023; 17(2): 357. CrossRef
Non-Alcoholic Fatty Liver Disease and Bone Tissue Metabolism: Current Findings and Future Perspectives
Oxana M. Drapkina, Anastasia Yu. Elkina, Anna F. Sheptulina, Anton R. Kiselev
International Journal of Molecular Sciences.2023; 24(9): 8445. CrossRef
Nonalcoholic Fatty Liver Disease Is Associated With Decreased Bone Mineral Density in Adults: A Systematic Review and Meta‐Analysis
Ying‐Hao Su, Kuo‐Liong Chien, Shu‐Hua Yang, Wei‐Tso Chia, Jen‐Hau Chen, Yen‐Ching Chen
Journal of Bone and Mineral Research.2023; 38(8): 1092. CrossRef
The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities
Marina V. Maevskaya, Yulia V. Kotovskaya, Vladimir T. Ivashkin, Olga N. Tkacheva, Ekaterina A. Troshina, Marina V. Shestakova, Valeriy V. Breder, Natalia I. Geyvandova, Vladimir L. Doshchitsin, Ekaterina N. Dudinskaya, Ekaterina V. Ershova, Khava B. Kodzo
Terapevticheskii arkhiv.2022; 94(2): 216. CrossRef
Nonalcoholic fatty liver disease and osteoporosis: A potential association with therapeutic implications
Ilias D. Vachliotis, Athanasios D. Anastasilakis, Antonis Goulas, Dimitrios G. Goulis, Stergios A. Polyzos
Diabetes, Obesity and Metabolism.2022; 24(9): 1702. CrossRef
Hepatic fibrosis is associated with an increased rate of decline in bone mineral density in men with nonalcoholic fatty liver disease
Ji Won Yoon, Min Joo Kim, Goh-Eun Chung, Jong In Yang, Jeong Yoon Yim, Jin Ju Kim, Sun Mie Kim, Min-Sun Kwak
Hepatology International.2021; 15(6): 1347. CrossRef
NAFLD Associated Comorbidity
L. B. Lazebnik, S. V. Turkina
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Socioeconomic Disparities in Osteoporosis Prevalence: Different Results in the Overall Korean Adult Population and Single-person Households: Jungmee Kim, Joongyub Lee, Ju-Young Shin, Byung-Joo Park; J Prev Med Public Health. 2015;48(2):84-93. Published online March 6, 2015; DOI: https://doi.org/10.3961/jpmph.14.047

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Abstract PDF

Objectives
The present study was conducted in order to examine the association between socioeconomic status (SES) and osteoporosis prevalence in Korea and to assess whether different associations are found in single-person households.
Methods
A cross-sectional population-based study was conducted using the Korea National Health and Nutrition Examination Survey, from 2008 to 2011. The study subjects were people aged ≥ 50 years with osteoporosis as defined by bone mineral density. Multivariate logistic models were used to estimate prevalence odds ratios (pORs) and 95% confidence intervals (CIs). Gender differences in the likelihood of osteoporosis were analyzed based on household income, education level, and residential area.
Results
There were 8221 osteoporosis patients aged ≥ 50 years, of whom 927 lived in single-person households. There was a gender-specific association between osteoporosis prevalence and all three SES factors that we analyzed: income, education, and residential area. After adjusting for age, SES, and health behaviors, including body mass index (BMI), low household income was only significantly associated with osteoporosis in men, whereas education level had an inverse relationship with osteoporosis only in women (p= 0.01, p<0.001, respectively). However, after controlling for age and BMI, rural residency was only associated with osteoporosis in women living in single-person households (pOR, 1.59; 95% CI, 1.05 to 2.43).
Conclusions
The Korean adult population showed a gender-specific relationship between SES and osteoporosis prevalence, with a different pattern found in single-person households.

Summary

Citations

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Assessment of osteoporosis knowledge and its determinants among tuberculosis patients in tertiary care hospital Malaysia: A prospective study
Zohra Bhatti, Madeeha Laghari, Amer Hayat Khan, Bandeh Ali Talpur, Syed Azhar Syed Sulaiman
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases.2024; 34: 100416. CrossRef
Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review
Manju Chandran, Katherine Brind’Amour, Saeko Fujiwara, Yong-Chan Ha, Hai Tang, Jawl-Shan Hwang, James Tinker, John A. Eisman
Osteoporosis International.2023; 34(6): 1037. CrossRef
Current issues in evaluation and management of osteoporosis in Thailand
Nipith Charoenngam, Chatlert Pongchaiyakul
Osteoporosis and Sarcopenia.2023; 9(2): 53. CrossRef
Regular Exercise and Weight-Control Behavior Are Protective Factors against Osteoporosis for General Population: A Propensity Score-Matched Analysis from Taiwan Biobank Participants
Chih-Yi Hsu, Chun-Ying Huang, Ching-Hua Hsieh, Peng-Chen Chien, Chih-Chun Chen, Shao-Yun Hou, Shao-Chun Wu
Nutrients.2022; 14(3): 641. CrossRef
Prevalence and diagnosis experience of osteoporosis in postmenopausal women over 50: Focusing on socioeconomic factors
Min Hyeok Choi, Ji Hee Yang, Jae Seung Seo, Yoon-ji Kim, Suk-Woong Kang, Jose M. Moran
PLOS ONE.2021; 16(3): e0248020. CrossRef
Influence of Residence Area and Basic Livelihood Conditions on the Prevalence and Diagnosis Experience of Osteoporosis in Postmenopausal Women Aged over 50 Years: Evaluation Using Korea National Health and Nutrition Examination Survey Data
Suk-Woong Kang, Ji-Hee Yang, Won-Chul Shin, Yoon-Ji Kim, Min-Hyeok Choi
International Journal of Environmental Research and Public Health.2021; 18(18): 9478. CrossRef
Effects of different living conditions on the risk of osteoporosis in Chinese community-dwelling elderly: a 3-year cohort study
Xing Yu, Yuanyuan Zhang, Peipei Han, Liyuan Fu, Xiaoyu Chen, Lin Hou, Peiyu Song, Yong Zhao, Qi Guo
Journal of International Medical Research.2020; 48(8): 030006052094345. CrossRef
Determinants of Bone Mineral Screening Behavior among Three Ethno-Cultural Groups of Women in Israel
Offer E. Edelstein, Netta Achdut, Iris Vered, Orly Sarid
International Journal of Environmental Research and Public Health.2020; 17(17): 6138. CrossRef
Validation of an integrated service model, Health-RESPECT, for older patients in long-term care institution using information and communication technologies: protocol of a cluster randomised controlled trial
Jung-Yeon Choi, Kwang-il Kim, Hongsoo Kim, Young-il Jung, In-Hwan Oh, Seungyeon Chun, Gi-Soo Kim, Jae-Young Lim, Jin Young Ko
BMJ Open.2020; 10(10): e038598. CrossRef
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Hee-Sook Lim, Mi-Nam Lee
Journal of Bone Metabolism.2019; 26(1): 25. CrossRef
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Dong-Hyun Kim, Jin-Kyung Cho, Hyunsik Kang
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Sajjad Moradi, Sakineh Shab-bidar, Shahab Alizadeh, Kurosh Djafarian
Metabolism.2017; 69: 199. CrossRef
Association between household size, residential area, and osteoporosis: analysis of 2008 to 2011 Korea National Health and Nutrition Examination Survey
Sung-Woo Kim, Kwi-Hyun Bae, Jung-Beom Seo, Jae-Han Jeon, Won-Kee Lee, In-Kyu Lee, Jung-Guk Kim, Keun-Gyu Park
The Korean Journal of Internal Medicine.2016; 31(4): 712. CrossRef
A cross-sectional study for estimation of associations between education level and osteoporosis in a Chinese men sample
Cai-Xia Yu, Xiu-Zhen Zhang, Keqin Zhang, Zihui Tang
BMC Musculoskeletal Disorders.2015;[Epub] CrossRef

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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Abstract PDF

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

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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
Archives of Orthopaedic and Trauma Surgery.2019; 139(11): 1579. CrossRef

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

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Endocrine Reviews.2016; 37(2): 135. CrossRef

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries: Won Kyung Lee, Kyoung Ae Kong, Hyesook Park; J Prev Med Public Health. 2012;45(5):283-290. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.283

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Abstract PDF

Objectives

People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea.

Methods

We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group.

Results

The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08).

Conclusions

One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.

Summary

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English Abstract

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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Abstract PDF

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.

Summary

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Original Articles

Quantitative Ultrasound for Osteoporosis Screening in Postmenopausal Women.: Min Ho Shin, Hee Young Shin, Eun Kyung Jung, Jung Ae Rhee, Jin Su Choi; Korean J Prev Med. 2001;34(4):408-416.

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Abstract PDF: OBJECTIVES
To evaluate the diagnostic value of quantitative ultrasound (QUS) in the prediction of osteoporosis as defined by dual energy x-ray absorptiometry (DEXA) in postmenopausal women. METHODS: Questionnaires and height and weight measurements were used in the investigation of 176 postmenopausal women. QUS measurements were taken on the right calcaneus while bone mineral density (BMD) measurements of the lumbar spine and femoral neck were made with DEXA. The areas under the curves (AUC) of the speed of sound (SOS) for osteoporosis in the lumbar spine and femoral neck were obtained through receiver operating characteristic (ROC) analysis and evaluated. A comparison was made, for osteoporosis in the lumbar spine and femoral neck, between the AUCs of the logistic model with clinical risk factors and SOS. RESULTS: Pearson's correlation coefficients of SOS and lumbar spine BMD, and of SOS and femoral neck BMD were 0.26 and 0.37. The AUC for the logistic model in its discrimination for lumbar spine osteoporosis was 0.764, and for SOS 0.605. The AUCs for the logistic model in its discrimination for femoral neck osteoporosis and for SOS were 0.890 and 0.892, respectively. CONCLUSIONS: These results suggest that the diagnostic value of QUS as a screening tool for osteoporosis is moderate for the femoral neck, but merely low for the lumbar spine and that the predictability provided by SOS is no better than that by the sole use of clinical risk factors in postmenopausal women.; Summary

Association of osteoarthritis and bone mineral density in women: The health and nutritional examination survey in Kuri.: Seung Soo Sheen, Soon Young Lee, Byung Hyun Min, Il Suh; Korean J Prev Med. 1997;30(4):669-685.

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Abstract PDF: Previous studies, reporting the inverse relationship between osteoarthritis and osteoporosis suggest the existence of possible pathophysiologic mechanisms between them. To examine the hypothessis that "bone mineral densities of women with osteoarthritis are significantly higher than that of women without osteoarthritis in Korea", subjects from the health and nutritional examination survey in Kuri city were sampled. Samples were selected through multi-stage sampling frame using established clusters in Kuri city. From August 18 to September 10, 1997, the survey was conducted. Among the total number of selected sample population(1,656 people), response rate was 52.4 percent(348 men and 519 women). 420 women who took BMD measurement, radiologic exam, and anthropometric exam were selected for the analysis. The analysis results are as follows. 1. General characteristics : Mean BMD was 0.493 g/cm2, mean age was 43.0, mean BMI was 23.9 kg/m(3). The number of women who experienced menopause was 106, hysterectomy was 19. There were 0 case of osteoarthritis of hip, 64 cases of osteoarthritis of knee, and 2 cases of osteoarthritis of hand. 2. Univariate analysis results : Mean BMD of women with the osteoarthritis of knee was significantly lower than that of women without the osteoarthritis of knee(0.4296 vs. 0.5057 g/cm2). But, there were to few cases of osteoarthritis of hip and hand, so comparative studies of BMD in ostearthritis of hip and hand could not be conducted. There were significant differences of BMD among pre-menopause group(0.5204), post-menopause group(0.4206), and hysterectomy group(0.4881). Additionally, there were significant differences of BMD among diabetes group(0.4297), impaired glucose tolerance group(0.4874), and normal group(0.5057). Furthermore, age, parity, BMI, bioimpedance wer significantly related with BMD. 3. Multivariate analysis results : To examine the relationship between osteoarthritis and BMD while controlling the other variables' effects which were significant in the univariate analyses, multiple linear regression analysis was done. But, it was found that osteoarthritis of knee was not a significant variable to BMD anymore. While age and menopause had significant negative relationship with BMD. Diabetes, parity, BMI, and bioimpedance did not have significant relationships with BMD. After stratification of subjects according to menopause, multiple linear regression analyses were done to each strata. Consequently, age in post-menopause group, age and osteoarthritis of knee in hysterectomy group showed significant negative relationship with BMD. The results did not support the many results of other previous studies done with white men and women. Further studies of biological plausibility to Korean women are recommended. Also it is suggested that longitudinal study to verify the relationship between osteoarthritis and BMD will be valuable.; Summary

A Case-control Study on Risk Factors of Osteoporosis in Some Korean Outpatient Women of One General Hospital of Seoul.: Sun Ok Woo, Sangsoo Bae, Dong Hyun Kim; Korean J Prev Med. 1995;28(3):609-622.

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Abstract PDF: Until now there are few available epidemiologic data of osteoporosis in Korea, and the severity of osteoporosis-related health problem has not been widely recognized yet. But the numbers of the old people are increasing in Korea, and in 2000, the proportion of people over 65 will be up to about 6.8% of total population. Therefore, osteoporosis, one of the most common metabolic bone disease among the old people, will be one of the most important public health problem. on this background this study was performed to find out risk factors of the development of osteoporosis in Korean women through case-control approach. The subject of this study were selected among the women one general hospital in seoul and were checked bone density from sep. 1988 to sep. 1993. Those who were diagnosed to have hypertension, diabetes mellitus, thyroid disease, breast disease, or liver disease, which are thought to influence bone density, were excluded. Also excluded those who are age-unknown. Finally the subjects were 2,139 women aged between 18 and 79. We operatively defined patient group as those whose bone density is below 1.03 g/cm2, 90% of average bone density of women of 4th decade who visited the same hospital. And we defined control group as whose bone density is above 1.15g/cm2. we randomly selected 201 women from the patient group and 202 from the control. As independent variables we chose age, menarche age, menopause age, menopause type, the number of siblings, the number of pregnancies, body mass index, taking oral pill or not, feeding type, and educational state. Multiple logistic regression analysis was done to see the influence of these variables on the risk of osteoporosis. Results are as follows; 1. menopausal status was statistically significant risk factor to all women irrespective of her age, while obesity and later menopause age were food to be statistically significant protective factors. 2. The more siblings and pregnancies, the greater the risk of osteoporosis, but these factors were not statistically significant. This result is not consistent with other studies. Further studies are strongly needed.; Summary

English Abstract

Prevalence and Associated Factors of Osteoporosis among Postmenopausal Women in Chuncheon: Hallym Aging Study(HAS).: Soong Nang Jang, Young Ho Choi, Moon Gi Choi, Sung Hyun Kang, Jin Young Jeong, Yong Jun Choi, Dong Hyun Kim; J Prev Med Public Health. 2006;39(5):389-396.

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Abstract PDF: OBJECTIVES
A community-based, cross-sectional survey was conducted to determine theprevalence of osteoporosis and to evaluate the effects of body composition, health behaviors and reproductive history on bone density in postmenopausal women. METHODS: The study subjects were 362 postmenopausal women, aged 45 years old or over, who were invited to the hospital. Information on their socio-demographic characteristics and the potential risk factors such as their past medical history, smoking, alcohol intake, exercise, diet and menstrual/reproductive histories were collected by trained interviewers. Weight, height, the body mass index (kg/m2), and body composition variables were measured. Bone mineral density of the lumbar spine was measured by dual energy X-ray absorptiometry (DXA). RESULTS: The prevalence of osteoporosis was 30.6% in the 45~64 years old women, 52.5% in the elderly women aged 65~74, and 68.7% in the women aged 75 years or over. After adjustment for the effect of potential covariates, those women in the highest 25% (4th quartile) of the lean body mass are less likely to have osteoporosis (aOR=0.31, 95% CI=0.12-0.76), compared with the lowest quartile group. More parity also had significantly detrimental effects on osteoporosis. CONCLUSIONS: These findings suggest that the prevalence of osteoporosis in postmenopausal women increased with age from 46.3% of those aged 45-64 to 68.7% fo those aged 75 and over. Lean body mass and parity appeared significant contributor to bone mineral density in postmenopausal women in this population.; Summary

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