| 제목 |
Corticosteroid use and bone health management in Duchenne muscular dystrophy in South Korea |
| 소속 |
Pusan National University Hospital, Department of Rehabilitation Medicine1, Pusan National University Hospital, Department of Biostatistics2 |
| 저자 |
Jin A Yoon1*, Ho Eun Park1, Sang Hun Han1, Dong Min Kim1, Jinmi Kim2, Jungmin Son2, Yong Beom Shin1† |
| 사사 |
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Purpose: The present study aimed to determine the current corticosteroid use and bone health management status of Duchenne muscular dystrophy (DMD) in South Korea based on the Korean National Health Insurance Database.
Materials and Methods: The data of patients corresponding to G71.0, and the special case V012 were extracted from National Health Information Database. To screen the patients with DMD from the diagnosis data, the operational definition was set as a male patient under 40 years old who had been diagnosed before the age of 10 years. To exclude other types of MD, patients who had been prescribed steroids were selectively extracted to construct a database. (Figure 1) In addition, patients who did not demonstrate the typical clinical course of DMD were excluded from the study. From this database, whether the patient had been given a corticosteroid prescription and the trend of regimen were analyzed. Regarding bone status, spine radiography, bone mineral density tests, and laboratory tests prescription and the frequency of these tests was determined. The proportion of spine and lower limb prostheses were prescribed was analyzed. In addition, whether scoliosis surgery had been performed, and the age at which the surgery was performed was also checked.
Results: From 2009 to 2018, approximately 489 patients met the diagnostic criteria. The number of DMD patients with prescription between 2009 to 2018 is summarized in Figure 2. The mean age of wheel chair prescription and death was 12.21 ± 3.44 years and 16.83 ± 4.99 respectively. The corticosteroid by age and year showed proportion of maintenance corticosteroid therapy for non-ambulant patients including age older than 20 years old increased over the years (Figure 3).
Among the patient, 61 (12.47%) had spine radiography, 113 (23.11%) had dual-energy x-ray absorptiometry (DXA) scan and 111 (22.7%) had vitamin D level exam. 200 (40.9%) of the patients had vitamin D prescription at the mean age of 14.6 ± 6.1 years. 50 (10.22%) of the patients had bisphosphonate prescription at mean age of 17.92 ± 3.4 years by 170.5 ± 245.4 days interval.
With regard to orthopedic management, 79 (16.1%) patients had posterior spinal instrumentation and fusion at 14.4 ± 2.3 yrs and 26 (5.3%) had anterior spinal instrumentation and fusion at 14.4 ± 2.3 yrs. 24 (4.91%) and 9 (1.84%) of the patients from 2016 to 2018 had ankle foot orthosis and spine orthosis prescription records from insurance benefits data.
Conclusions: In this study, the results of the analysis of the current status of clinical practice for patients with DMD in South Korea have been presented. Although there are recommendations related to DMD management, there is variability in treatment between countries and clinicians. The findings of this study will contribute to developing consensus among clinicians in the long term.
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Flow diagram of screening the number of DMD patients with corticosteroid use
Number of DMD patients with corticosteroid prescription between 2009 and 2018
Overview of corticosteroid use in National Health information database in South Korea
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