Division of Rheumatology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
Korean J Intern Med. 2010 Dec;25(4):436-46. doi: 10.3904/kjim.2010.25.4.436. Epub 2010 Nov 27.
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® 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).
Postmenopausal women and men ≥ 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.
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 ≥ 60 years of age.
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.
背景/目的：骨质疏松性骨折是类风湿关节炎（RA）的一种重要合并症。我们通过世界卫生组织（WHO）的 FRAX®工具评估了韩国血清阳性 RA 患者的总体骨折风险。此外，我们比较了根据韩国健康保险审查与评估机构（HIRA）、FRAX 和国家骨质疏松基金会（NOF）标准确定的治疗资格。
从韩国的一个风湿病中心招募了绝经后妇女和年龄≥50 岁的血清阳性 RA 男性患者。使用日本模型估算 FRAX 评分。使用 HIRA、NOF 和 FRAX 干预阈值将患者分为有治疗资格的患者。
这项纳入了 234 例患者的研究包括 40 例男性（17%）。平均年龄为 60±9 岁，根据 WHO 标准，121 例（52%）患者患有骨质疏松症。总体 10 年主要骨质疏松性骨折和髋部骨折的中位风险分别为 13%和 3.5%。HIRA 指南确定了 130 例（56%）有治疗资格的患者，FRAX 包括 126 例（54%），根据 NOF 指南，有 151 例（65%）患者有治疗资格。与 HIRA 相比，FRAX 纳入了更多年龄较大且危险因素较多的患者。HIRA 和 FRAX 的总体一致性，以 Kappa 指数表示，为 0.67，但当仅限于年龄≥60 岁的患者时，一致性低至 0.44。
一半的患者患有需要治疗的骨质疏松症。RA 患者有发生骨折的高风险，应考虑采用风险评分系统。
