1.Backgrounds
Osteoporosis is one of the prevailing chronic diseases of musculoskeletal system in elderly. It is a disease growing rapidly with aging population, which easily causes fractures due to weaker bone density, resulting in high socio-economic
costs. The World Health Organization (WHO) analyzed that the prevalence of osteoporosis will quadruple in 2050, and in Republic of Korea, the number of osteoporosis patients is expected to increase significantly as we already entered the aging society in 2017 and are expecting to enter the ultra-aged society in 2026. Amid the recent increase in the proportion of conservative treatment in managing osteoporosis, the development of systematic and high-quality clinical practice guidelines is imperative for Korean medicine, of which patients have a high preference, to contribute to the improvement of public health.
This clinical practice guideline is Korea's first standard guideline for managing osteoporosis with Korean medicine. In the development procedure, various domestic and foreign clinical guidelines, including domestic and international practice guidelines developed by the Korean Society of Osteoporosis in 2018, were reviewed and the Manual for developing Evidence-based Clinical Practice Guidelines of Korean Medicine was applied. The guidelines have been developed with the aim of more objective and versatile guidelines, to which a systematic literature search strategy has been established and the GRADE methodology has been applied to the development of guidelines and recommendations.
Through this process, this clinical practice guideline has been developed to help Korean medical doctors and decision-making in the clinical field and to enhance patient confidence in the treatment of Korean medicine. Therefore, the
guidelines could be used to systematically analyze the clinical basis for osteoporosis so that Korean medical doctors could provide standardized care in terms of diagnosis and treatment. Through this, the government tried to improve the public health by improving the quality of medical services, as well as increasing objectivity and reliability in the treatment of Korean medicine.
2.Summary of disease
Osteoporosis covered in this clinical practice guideline is not limited to osteoporosis with women after menopausal state or secondary fractures. The patient population dealt with in this clinical practice guideline is not limited to post-
menopausal women or osteoporosis patients with secondary fractures. Rather, it encompasses all osteoporosis patients with reduced bone density, with no limitations in age or sex. The Korean Standard Disease Classification (KCD) codes for this population are M80, M81, and M82. WHO defined osteoporosis as “a systemic skeletal disorder characterized by reduced bone mass and abnormalities in microstructure, resulting in fragile bones”, which the National Institute of Health abbreviated and labeled as “a skeletal disease that increases the risk of fractures due to bone strength.”
Bone strength is determined by bone mass and structure expressed in bone density (BMD), bone replacement rate, mineralization, and micro-damage accumulation. Currently, bone density is measured to diagnose osteoporosis. Bone density is currently the most clinically useful diagnostic criterion for osteoporosis, with dual-energy X-ray absorptiometry (DXA) tests to measure bone density in the lumbar and femur, and the WHO presents T-value≤-2.5 as the basis for osteoporosis diagnosis.
Bone metabolism is distinguished by bone formation of bone cells that make new bones and bone absorption of bone cells that remove old bones. The subsequent occurrence of bone absorption and bone formation is called aggregate
formation with bones. The increase in bone formation or the decrease in bone absorption results in a decrease in bone volume.
Estrogen, a female gender hormone, is the most important osteo-regulating hormone of all genders, which promotes endometrial bone growth. The deficiency of estrogen has been found to increase the number and duration of osteoclasts, increase the number and depth of aggregate bone formation units, and induce premature apoptosis of osteogenous cells, making bone formation less than bone absorption. Two major risk factors for osteoporosis occurrence are low maximum bone mass formation and fast bone loss in the growth ages. Although maximum bone mass formation is determined by genetic and environmental factors, genetic effects are known to be greater at about 50-90%.
For the Korean medical treatment of osteoporosis, treatments such as acupuncture, moxibustion, herbal decoction, acupoint injection, chu-na manual therapy, thread embedding, cupping can be used. Each treatment method may be used alone or in parallel, depending on the severity of the patient, the symptoms appealing, the duration of the disease, the presence or absence of drug intake.
Prevention, treatment, and post-fracture management of secondary fractures are very important factors in managing osteoporosis. Osteoporosis can also be caused by weak external forces, so there is less damage to soft tissue compared to traumatic fractures caused by huge external forces. However, the prevention and management of fractures are also critical, as complications associated with fractures can occur in elderlies. In order to reduce the risk of secondary fractures, overall bone strengthening should be conducted not only by increasing bone density but also by improving bone structure. Furthermore, lifetime education is also needed to prevent osteoporotic fractures in daily life.
