National Healthcare Budget Impact Analysis of the Treatment for Osteoporosis and Fractures in Korea

BACKGROUND: This study was to determine the impact on the national healthcare expenditure for the treatment of osteoporosis and fractures if the coverage period for osteoporosis medication was extended from maximum a year to continuous period as required. METHODS: Preserving the current reimbursement guidelines, maximum one year's coverage for osteoporosis medication was set as scenario A. Continuous coverage for patients who require medication was set as scenario B. As costs of medical service utilization are paid by the Korean National Health Insurance Program, all items were investigated and analyzed from the payer's perspective. The combined treatment costs for osteoporosis and osteoporotic fractures were assessed for each scenario. RESULTS: Over five years the cost of osteoporosis medication in scenario A will increase from 184.3 billion KRW to 204.6 billion KRW. The cost of osteoporotic fracture treatment will increase from 1,037.3 billion KRW to 1,822.7 billion KRW. In scenario B, the cost of osteoporosis medication will increase from 209.5 billion KRW to 388.1 KRW. The cost of osteoporotic fracture treatment will increase from 600.0 billion KRW to 1,054.3 billion KRW. The result showed savings of 2.50 trillion KRW cumulatively for five years when reimbursement coverage for osteoporosis treatments is extended from one year to as long as it's clinically required. CONCLUSIONS: This study demonstrates that effective osteoporosis management through appropriate insurance coverage for osteoporosis medication should be considered not only for the patient's viewpoint, but in terms of national insurance budget as well.

Relationship between Body Composition and Bone Mineral Density in Pre- and Post-menopausal Women / 대한폐경학회지

OBJECTIVES: We analyzed the relationship between body composition, metabolic parameters, and lumbar and femur bone mineral density (BMD) in pre-and post-menopausal women. METHODS: Of 394 females who participated in a medical check-up program, anthropometric measurements and fasting glucose levels and lipid profiles were measured. Body composition analysis was performed using the bioimpedence method and the BMD of the lumbar spine, femur neck, trochanter, ward's triangle, and total were measured by dual energy X-ray absorptiometry. RESULTS: The mean age was 49.5 +/- 9.8 years, and among the subjects, 203 (51.5%) were pre-menopausal and 191 (48.5%) were post- menopausal women. Skeletal muscle mass, fat- free mass, lean body mass, and basal metabolic rate had a positive correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The abdominal fat ratio, fat mass, waist circumference, percent fat, and total cholesterol had a negative correlation with the lumbar and femur spine BMD, even after adjustment for age and weight in pre-menopausal women. The lean body mass in the legs and trunk, skeletal muscle mass, and fat free mass had a positive correlation with the BMD of the lumbar spine and femur neck, unlike the lean body mass of the arms did not, after adjustment for age and weight in post-menopausal women. CONCLUSION: In pre- and post-menopausal Korean women, body composition, lean body mass, fat -free mass, and skeletal muscle mass were positive correlates, and fat mass and percent fat were negative correlates with the lumbar spine and femur BMD.

A case report: Metroplasty of a noncommunicated uterine body and cervix due to unknown etiology / 대한산부인과학회지

Congenital anomalies of the female reproductive tract may involve the uterus, cervix, fallopian tubes, or vagian. Depending on the specific defect, a women's obstetric and gynecologic health may be adversely affected. We have experienced a case of rudimentary uterine horn with noncommunicated uterus complicated by pelvic endometriosis in a 25 years old woman with primary amenorrhea and monthly periodic pelvic pain. We observed noncommunicating uterus with blind pouch, cervix disconnected to uterus with normal appearance, and left ovarian endometrial cyst. For treatment, the metroplastic surgery with end-to end anastomosis connecting cervix and noncommunicated uterus and removal of endometrial cyst were done. Many cases of uterine anomalies have been documented but, there have been few reported cases of noncommunicated uterus with disconnected cervix and successful performance of the metroplasty. Thus hereby we report this case with a review of literatures.

A Clinical analysis of sonographic and operation findings of peritoneal inclusion cyst / 대한산부인과학회지

OBJECTIVE: The aim of this study is to review 4 years' experience of peritoneal inclusion cysts at Kangnam St. Mary's Hospital. METHODS: A retrospective study of 50 cases of peritoneal inclusion cyst between April 1, 1999 and June 30, 2003 was carried out and then clinical feature, preoperative diagnostic findings, operative findings and recurrence were compared with previous reports. RESULTS: The mean age of patients was 40.2 years old and most of them were premenopausal. The majority (94%) of patients had history of laparotomy and most (70.2%) of them had history of total hysterectomy. The values of tumor makers such as CA125 and CA19-9 were normal in most of the patients. The peritoneal inclusion cysts usually generate on the left side of the pelvic cavity, size of them were often (59.6%) 5 to 10 cm and they usually (65.4%) have septum in ultrasonographic findings. They probably had pelvic adhesion or ovarian cyst with them in operative findings. Most of the recurrence occurred after only adhesiolysis was done. CONCLUSION: Because peritoneal inclusion cyst is benign and uncommon disease, its preoperative diagnosis rate was low. In our experience of 50 cases of peritoneal inclusion cyst, most of the patients have history of laparotomy and were premenopausal. When the ultrasonographic findings of cyst are 5 cm to 10 cm in size and have septum, they are likely to be peritoneal inclusion cyst. Their recurrence might be more common when adhesiolysis only was performed.

A case of spontaneous uterine perforation result from acute gangrenous myometritis in an old woman with IUD for 40 yrs / 대한산부인과학회지

Intrauterine devices (IUDs) are highly effective, long-term methods of contraception. Although evidences of direct association between IUD use and pelvic inflammatory disease are rare, the frequency of inflammatory complications associated with the use of IUDs ranges from 2% to 8%. Gynecological surgeries on the account of purulent, inflammatory disease associated with IUD are 4-7%. We report one case with spontaneous perforation of uterus due to acute gangrenous myometritis in an old woman with IUD for 40 yrs in pelvic cavity, followed by a review of the literature.

A case of Fitz-Hugh-Curtis syndrome diagnosed by pelvic CT imaging prior to diagnostic laparoscopy / 대한산부인과학회지

Fitz-Hugh-Curtis syndrome is an extrapelvic manifestation of PID. It is associated with right upper quadrant pain that likely results from the inflammation of liver capsule and diaphragm. The liver capsule becomes involved with inflammatory exudates that later forms violin string adhesion between two liver capsule and adjacent diaphragm or peritoneum. Previously, Neisseria gonorrhea was thought to be the only etiological agent, but recent studies have reported cases of Fitz-Hugh-Curtis syndrome due to Chlamydia trachomatis infection. 15 to 30 percents of women with PID develop symptom of Fitz-Hugh-Curtis syndrome. It is often mistakenly diagnosed as either pneumonia or acute cholecystitis. Laparoscopy may be the definitive method in diagnosis of Fitz-Hugh-Curtis syndrome. However, we have experienced one cases of Fitz-Hugh-Curtis syndrome, which was diagnosed preoperative by pelvic CT imaging and report with the brief review of the literatures.

The role of ceramidase in murine ovarian granulosa cell death / 대한산부인과학회잡지

OBJECTIVE: One of the models we study is the ovarian granulosa cell (GC), a somatic cell lineage that is critically important for maintenance of the female germ line and many endocrine functions of the ovaries. The objective of this study is to clarify the significance of ceramide and the role of ceramide metabolism in dictating the fate of cells exposed to stress. METHODS: We first treated GC with a C8-ceramide analog or an amine derivative of ceramide that cannot be metabolized by ceramidase (C8-ceramine). Northern blot analysis was performed to evaluate mRNA of acid ceramidease expression regualted by gonadotropin and in situ hybridization was done to identify the mRNA expression of acid ceramidase in ovaries. RESULTS: After 6 hours, C8-ceramide (50 micro M) triggered apoptosis in only 28 +/- 6% of the cells, whereas C8-ceramine (50 micro M) induced apoptosis in all cells (LD50=1 micro M). These data suggested that ceramidase activity is a critical determinant of GC survival. In situ hybridization showed that mRNA of acid ceramidase was highly expressed in GC in growing follicle. mRNA of acid ceramidase was expressed abundantly in granulosa cells and ovaries and its expression was significantly increased by gonadotropin in granulosa cells in in situ hybridization. Forty two hour after gonadotropin treatment, mRNA expression of acid ceramidase in granulosa cells was two fold increased cells comparing with no treatment control in northern blot analysis (P<0.05). In copora lutea, elevated mRNA expression of acid ceramidase was decreased. CONCLUSION: We concluded that GC possess inherently high levels of ceramidase activity, and that ceramidase has important for metabolizing ceramind to maintain GC survival in the ovary.

Association of Osteoprotegerin Gene A163G, G1181C Polymorphisms with Bone Mass in Postmenopausal Korean Women / 대한산부인과학회잡지

OBJECTIVE: To examine the relationship between Osteoprotegerin gene polymorphisms, and bone mineral density (BMD). METHODS: Restriction fragment length polymorphisms at the Osteoprotegerin A163G (promoter), G1181C (exon 1) gene site, and BMD at the lumbar spine and proximal femur were analyzed in 229 postmenopausal Korean women (81 normal, 111 osteopenic and 37 osteoporotic patients). BMDs were measured by DEXA. RESULTS: The distribution of A163G and G1181C polymorphisms in all postmenopausal women was as follows: AA 54.6%, AG 37.1%, GG 8.3%; GG 52.4%, GC 38.0%, CC 9.6%, respectively. After adjusting for potential confounding factors such as age, BMI, and menopause duration, A163G polymorphism was significantly associated with BMD at the lumbar spine and G1181C polymorphism BMD at the trochanter in all postmenopausal women. A163G polymorphism was significantly associated with BMD at the lumbar spine in normal and osteoporotic patients, and BMD at the femur neck and wards triangle in normal patients. G1181C polymorphism was significantly associated with BMD at the femur neck in osteopenic and osteoporotic patients, and BMD at the wards triangle and trochanter in osteoporotic patients. CONCLUSION: These findings suggest that osteoprotegerin gene polymorphisms may be an important contributor to the variation of BMD among postmenopausal Korean women.

Association of Vitamin D Receptor, Estrogen Receptor, Transforming Growth Factor-beta1 and Interleukin-6 Gene Polymorphism with Bone Mass in Postmenopausal Korean Women / 대한산부인과학회잡지

OBJECTIVE: To evaluate the relationship between vitamin D receptor (VDR), estrogen receptor (ER), transforming growth factor-beta1 (TGF-beta1) and interleukin-6 (IL-6) gene polymorphism, and bone mineral density (BMD). MATERIALS AND METHODS: Restriction fragment length polymorphisms at the VDR Fok I, ER Pvu II, TGF-beta1 T869C and IL-6 G174C gene sites, and BMD at the lumbar spine, proximal femur were analyzed in 161 postmenopausal Korean women. The subjects were divided in normal, osteopenic, and osteoporotic on the basis of the T-score values according to the classification of the World Health Organization (WHO). RESULTS: The genotype distribution of VDR, ER, TGF-beta1 and IL-6 gene polymorphism was as follows: FF 32.9%, Ff 50.9%, ff 16.2%; PP 13.6%, Pp 48.4%, pp 38.0%; T/T 74.1%, T/C 12.4%, C/C 13.1%; G/G 99.4%, G/C 0.6%. Significant differences in the distribution of FF genotype among normal, osteopenic and osteoporotic group were observed. No significant differences in the distribution of ER and TGF-beta1 genotypes among three groups were observed. BMD at all sites in the FF genotype was significantly higher than in the Ff and ff genotypes. There was no relationship between ER and TGF-beta1 gene polymorphism, and BMD. By combining VDR, ER and TGF-1 genotypes, BMD at lumbar spine, femur neck and ward triangle in the FFPp genotype was significantly higher than in the FfPp, Ffpp and ffpp genotypes, and BMD at femur neck and ward triangle in the FFTT genotype was significantly higher than in the FfTT and ffTT genotypes. CONCLUSION: The results suggest that VDR Fok I polymorphisms, singly and in relation to ER Pvu II and TGF-beta1 T869C polymorphism, may influence bone mass in postmenopausal Korean women.