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.
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

We analyzed national data collected by the Health Insurance Review and Assessment Service in Korea from 2007 to 2011; 1) to document procedural numbers and procedural rate of bipolar hemiarthroplasty (BH), primary and revision total hip arthroplasties (THAs), 2) to stratify the prevalence of each procedure by age, gender, and hospital type, and quantified, 3) to estimate the revision burden and evaluate whether the burden is changed over time. Our final study population included 60,230 BHs, 40,760 primary THAs, and 10,341 revision THAs. From 2007 to 2011, both the number and the rate of BHs, primary THAs increased steadily, whereas there was no significant change in revision THAs. Over the 5 yr, the rate of BHs and primary THAs per 100,000 persons significantly increased by 33.2% and 21.4%, respectively. The number of revision THAs was consistent over time. The overall annual revision burden for THA decreased from 22.1% in 2007 to 18.9% in 2011. In contrast to western data, there were no changes in the number and rate of revision THAs, and the rates of primary and revision THAs were higher for men than those for women. Although 5 yr is a short time to determine a change in the revision burden, there have been significant decreases in some age groups.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/economics/*statistics & numerical data ; Databases, Factual ; Female ; Hemiarthroplasty/economics/statistics & numerical data ; Hip Fractures/epidemiology/*therapy ; Hospitals ; Humans ; Male ; Middle Aged ; Republic of Korea ; Sex Factors

BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.
Aged ; Aged, 80 and over ; Female ; Hip Fractures/*epidemiology/mortality/*therapy ; Humans ; Length of Stay/*statistics & numerical data ; Los Angeles/epidemiology ; Male ; Managed Care Programs/*statistics & numerical data ; Middle Aged ; Patient Readmission ; Postoperative Complications ; Prospective Studies ; Quality of Health Care

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use ; Aspirin/administration & dosage/pharmacology/*therapeutic use ; Female ; Hip Fractures/complications/*surgery ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Platelet Aggregation Inhibitors/*therapeutic use ; Postoperative Complications/drug therapy/*epidemiology/*prevention & control ; Regression Analysis ; Venous Thromboembolism/complications/*epidemiology/*prevention & control