정형외과 외래 진료에서 골다공증 진단 및 치료지침의 진료양상 및 국내 치료지침의 문제점

Abstract

Background: We planned to present the percentage of patients neglected and deprived of a chance to be treated for osteoporosis by comparing the treatment guidelines and also analyze how well the screening and treatment guidelines were kept by the clinicians in orthopedic surgery outpatient unit.

Methods: A cross sectional study was done to patients who visited orthopaedic surgery outpatient clinic from January 1, 2007 to February 28. Data on patients’ age, sex, comorbidities, past medical history, presence and location of previous fractures, whether osteoporosis screening was done using DXA, T-score, osteoporosis medications were collected.

Results: The study population consisted of 6301 patients (males 2513, females 3788). 16.2~23.6% of patients who were indicated for osteoporosis treatment could not benefit from the public health insurance, and when T-score for the treatment indication by Korean Health Insurance Review Agency was raised from -3.0 to -2.5, the percentage of patients in the intermediate group was decreased to less than 10%. Among patients who were indicated for osteoporosis screening, only 44.5% actually received DXA, and among patients indicated for osteoporosis treatment, only 67.0% were taking medications. In addition, in females than males, and when the attending doctor was subspecialized in osteoporosis, the osteoporosis screening and treatment rates were significantly higher.

Conclusion: More attention and strenuous effort on osteoporosis should be endowed with by orthopaedic surgeons in order to modify the propensity to underdiagnose and undertreat osteoporosis.