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Patient-reported outcomes (PROs) provide practical guides for treatment; however, studies that have evaluated PROs of women in Korea with postmenopausal osteoporosis (PMO) are lacking. This cross-sectional, multi-center (29 nationwide hospitals) study, performed from March 2013 to July 2014, aimed to assess PROs related to treatment satisfaction, medication adherence, and quality of life (QoL) in Korean PMO women using osteoporosis medication for prevention/treatment. Patient demographics, clinical characteristics, treatment patterns, PROs, and experience using medication were collected. The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) (score-range, 0-100; domains: effectiveness, side effects, convenience, global satisfaction), Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS) (score-range, 0-8), and EuroQol-5 dimensions questionnaire (index score range, - 0.22 to 1.0; EuroQol visual analog scale score range, 0-100) were used. To investigate factors associated with PROs, linear (treatment satisfaction/QoL) or logistic (medication adherence) regression analyses were conducted. A total of 1804 patients (age, 62 years) were investigated; 60.1% used bisphosphonate, with the majority (67.2%) using weekly medication, 27.8% used daily hormone replacement therapy, and 12.1% used daily selective estrogen receptor modulator. Several patients reported gastrointestinal (GI) events (31.6%) and dental visits due to problems (24.1%) while using medication. Factors associated with the highest OS-MMAS domain scores were convenience and global satisfaction. GI events were associated with non-adherence. TSQM scores for effectiveness, side effects, and GI risk factors were significantly associated with QoL. Our study elaborately assessed the factors associated with PROs of Korean PMO women. Based on our findings, appropriate treatment-related adjustments such as frequency/choice of medications and GI risk management may improve PROs.

Background: Odanacatib, a cathepsin K inhibitor, reduces bone resorption while maintaining bone formation. Previous work has shown that odanacatib increases bone mineral density in postmenopausal women with low bone mass. We aimed to investigate the efficacy and safety of odanacatib to reduce fracture risk in postmenopausal women with osteoporosis. Methods: The Long-term Odanacatib Fracture Trial (LOFT) was a multicentre, randomised, double-blind, placebo-controlled, event-driven study at 388 outpatient clinics in 40 countries. Eligible participants were women aged at least 65 years who were postmenopausal for 5 years or more, with a femoral neck or total hip bone mineral density T-score between −2·5 and −4·0 if no previous radiographic vertebral fracture, or between −1·5 and −4·0 with a previous vertebral fracture. Women with a previous hip fracture, more than one vertebral fracture, or a T-score of less than −4·0 at the total hip or femoral neck were not eligible unless they were unable or unwilling to use approved osteoporosis treatment. Participants were randomly assigned (1:1) to either oral odanacatib (50 mg once per week) or matching placebo. Randomisation was done using an interactive voice recognition system after stratification for previous radiographic vertebral fracture, and treatment was masked to study participants, investigators and their staff, and sponsor personnel. If the study completed before 5 years of double-blind treatment, consenting participants could enrol in a double-blind extension study (LOFT Extension), continuing their original treatment assignment for up to 5 years from randomisation. Primary endpoints were incidence of vertebral fractures as assessed using radiographs collected at baseline, 6 and 12 months, yearly, and at final study visit in participants for whom evaluable radiograph images were available at baseline and at least one other timepoint, and hip and non-vertebral fractures adjudicated as being a result of osteoporosis as assessed by clinical history and radiograph. Safety was assessed in participants who received at least one dose of study drug. The adjudicated cardiovascular safety endpoints were a composite of cardiovascular death, myocardial infarction, or stroke, and new-onset atrial fibrillation or flutter. Individual cardiovascular endpoints and death were also assessed. LOFT and LOFT Extension are registered with ClinicalTrials.gov (number NCT00529373) and the European Clinical Trials Database (EudraCT number 2007-002693-66). Findings: Between Sept 14, 2007, and Nov 17, 2009, we randomly assigned 16 071 evaluable patients to treatment: 8043 to odanacatib and 8028 to placebo. After a median follow-up of 36·5 months (IQR 34·43–40·15) 4297 women assigned to odanacatib and 3960 assigned to placebo enrolled in LOFT Extension (total median follow-up 47·6 months, IQR 35·45–60·06). In LOFT, cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 3·7% (251/6770) versus 7·8% (542/6910), hazard ratio (HR) 0·46, 95% CI 0·40–0·53; hip fractures 0·8% (65/8043) versus 1·6% (125/8028), 0·53, 0·39–0·71; non-vertebral fractures 5·1% (412/8043) versus 6·7% (541/8028), 0·77, 0·68–0·87; all p

Aims The aims of this study are to estimate the hysterectomy rate for benign disease and determine recent trends in laparoscopic surgery for hysterectomies, including subtotal, total, and radical hysterectomy, in Korea. Material and Methods Computerized discharge summaries from private and public hospitals for 2007–2009 were obtained from the Health Insurance Review & Assessment Service. All records listing subtotal and total hysterectomies for benign disease and radical hysterectomies in women aged ≥ 16 years in each period were selected (n = 99 388). All women living in Korea aged ≥ 16 years were the denominator population. Laparoscopic surgery was identified when the code for laparoscopic materials was used. Statistical analysis included a trend test. Results The hysterectomy rates for benign disease were 1.48, 1.49, and 1.52/1000 women aged ≥ 16 years in 2007, 2008, and 2009, respectively, and the overall rate was 1.49/1000 women. The trend increased (P for trend

Pregnancy-induced osteoporosis is a rare disorder characterized by fragility fracture and low bone mineral density (BMD) during or shortly after pregnancy, and its etiology is still unclear. We experienced a case of a 39-year-old woman who suffered from lumbago 3 months after delivery. Biochemical evidence of increased bone resorption is observed without secondary causes of osteoporosis. Radiologic examination showed multiple compression fractures on her lumbar vertebrae. We report a case of patient with pregnancy-induced osteoporosis improved her clinical symptom, BMD and bone turnover marker after teriparatide therapy.

ObjectiveThe aim of this study was to assess the expression of DKK3 protein and its target, beta-catenin, in uterine cervical squamous cell carcinoma and to determine potential clinical correlations.Materials and MethodsSix carcinoma in-situ (CIS) tissues and 88 invasive cervical cancer tissues were included in the study. Twenty-two normal cervical tissues and one gastric cancer tissue were used as controls. The expression of DKK3 and beta-catenin proteins was evaluated by immunohistochemical analysis. Clinical and pathological parameters were obtained from medical records. Survival data were estimated using Kaplan-Meier estimates and compared with a log-rank test. Multivariate analysis was performed using the Cox regression method.ResultsDKK3 was predominantly present in the cytoplasm. Beta-catenin was observed only on the cellular membrane of both normal and cancer cells in contrast to earlier reports, in which beta-catenin was localized to the cytoplasm and nucleus of cancer cells. The expressions of beta-catenin and DKK3 were not correlated. Three of 6 CIS (50%) and 57 of 88 invasive cancer specimens (64.8%) had lower DKK3 expression than normal controls. DKK3 expression was decreased in a stage-dependent manner (P = 0.021). The patients with low expression of DKK3 were older than those with high expression of DKK3 (P < 0.01). Moreover, the patients with low DKK3 expression had a significantly lower 5-year disease-free survival rate than those with high DKK3 expression (P = 0.026). A multivariate analysis showed that International Federation of Gynecology and Obstetrics clinical stage and parametrial involvement were independent prognostic factors.ConclusionDecreased DKK3 expression was associated with advanced International Federation of Gynecology and Obstetrics clinical stages and was predictive of lower disease-free survival in patients with cervical squamous cell carcinoma. DKK3 may be implicated in cervical carcinogenesis through a beta-catenin–independent mechanism.

Objective To examine the relationship between nutritional intake and bone mineral density (BMD) in postmenopausal Korean women. Methods Dietary intake was recorded in postmenopausal Korean women using a semiquantitative questionnaire. The frequency of consumption of various food groups and nutrient intake were calculated. BMD T-scores were measured at the lumbar spine, femoral neck and total hip using dual-energy X-ray absorptiometry. Associations between T-scores and dietary intake were analysed using partial correlation coefficients and multiple linear regression analysis. Results A total of 189 postmenopausal women were included in the study. β-Carotene intake was positively correlated with the lumbar spine T-score. Sodium and vitamin C intake were positively associated and folate intake negatively associated with the femoral neck T-score. Sodium, zinc and vitamin C intake were positively correlated and potassium intake was negatively correlated with the total hip T-score. Vegetable intake showed a positive association with the femoral neck and total hip T-scores. Conclusion In postmenopausal Korean women, β-carotene, vitamin C, zinc and sodium intakes were positively associated with bone mass. Furthermore, frequency of vegetable consumption was positively associated with femoral neck and total hip T-scores.

Aim: To evaluate prognostic factors in Korean patients with endometrial cancer. Methods: A retrospective analysis was conducted on 248 patients who were staged surgically at the Samsung Medical Center between 1995 and 2004. Survival data were analyzed using Kaplan-Meier estimates, and multivariate analysis was performed using the Cox regression method. Results: The median age was 51 years (range 21–75), which was younger than in previous studies in Western patients, and the age of 50 years was the cutoff to predict survival. More than half (55.6%) were normal weight or underweight (BMI Conclusions: Korean patients with endometrial cancer were younger and had a lower BMI than previously reported. Furthermore, age greater than 50 years was predictive of a poor outcome. Age, FIGO stage, histopathology and a p53 mutation were independent prognostic factors for survival.

Osteoporosis, which has become a serious public health concern, is influenced by diet, especially calcium intake. Dairy products are a good source of calcium, but plant calcium may also be important in populations that do not consume a large amount of milk. The purpose of the present study was to examine the hypothesis that calcium from vegetable sources is associated with osteoporosis risk and bone mineral density in postmenopausal Korean women with osteoporosis and age-matched controls (N = 144). The results of multivariate-adjusted regression analyses indicated that the intake of calcium, plant calcium, potassium, vitamin A, carotene, vitamin B(1), niacin, vitamin E, vitamin C, and vegetables was associated with significantly reduced risk of osteoporosis after adjusting for age, body mass index, hormone replacement therapy, and energy intake. In addition, intake of vegetables alone, as well as calcium, plant calcium, potassium, and antioxidant vitamins (vitamin C, vitamin E, β-carotene), which are abundant in vegetables, was significantly and positively associated with bone mineral density. However, in this population of low-dairy consumers, intake of calcium from meat and dairy products was not related to risk of osteoporosis and bone mineral density. Our results suggest that high dietary intake of calcium, especially plant calcium, reduces the risk of osteoporosis and increased bone mineral density in postmenopausal Korean women. Vegetables may be an important source of calcium and may also provide vitamins and minerals that exert additional beneficial effects on the bone.

The present study was conducted to measure health-related utility for post-menopausal symptoms among Korean woman. A survey questionnaire was developed to measure utility based on visual analogue scale(VAS) and time trade-off method (TTO). From January 29 to February 3, 2007, a face-to-face interview was conducted with 274 women aged 45 to 60 to ask about their subjective utility for hypothetical health status of mild or severe post-menopausal symptoms. Among the participants, 160 were recruited from outpatient departments of 3 hospitals and 114 from 2 sports centers located in Seoul. For mild symptom, the average utility score of the respondents was based on VAS and based on ITO. For severe symptoms, the average utility was (VAS) and (TTO). For severe symptom, a higher utility score was observed for TTO than for VAS, which is consistent with earlier studies and thus supports the validity of the utility measurement in this study. Overall, the severity of post-menopausal symptoms of the respondents themselves was not significantly associated with the utility score that the respondents answered for hypothetical health status. Multiple regression analysis results showed that the utility score was significantly higher among respondents with older age, higher education, higher family income, and from hospitals. It is expected that the utility score measured in this study will enhance the understanding of the quality of life of women after menopause and will be used to conduct cost-utility analysis of health care interventions to treat post-menopausal symptoms.

The aim of this study was to demonstrate that the therapeutic efficacy of an estradiol 1 mg/drospirenone 2mg (E2/DRSP) preparation is superior to a placebo in postmenopausal Korean women with hot flushes and other climacteric symptoms and to demonstrate that this treatment is both safe and tolerable. This was a double-blind randomized placebo-controlled multicenter study over four 28-day treatment cycles. A total of 158 subjects were screened and 90 women were randomized into two treatment groups (E2/DRSP group n = 45; placebo group n = 45). The primary efficacy parameter was the individual relative change of hot flushes. The secondary efficacy parameters such as other climacteric urogenital symptoms and vaginal bleeding patterns were also evaluated and the occurrence of any adverse events was noted. In addition physical gynecological examinations and laboratory analyses were performed at the beginning and end of the study. The mean number of hot flushes per week during treatment weeks 3-16 decreased by 48.1% during treatment with placebo and by 84.4% during treatment with E2/DRSP (p < 0.001). The E2/DRSP combination also reduced the incidence and intensity of menopausal symptoms in postmenopausal women. Most of adverse events was mild or moderate degree of intensity. None of the parameters measured in the study including laboratory analyses physical and gynecological examinations vital signs and weight led to any concerns of safety. The E2 1 mg/DRSP 2mg combination tested in the study was efficacious and safe in the treatment of hot flushes and other climacteric symptoms in postmenopausal Korean women. (authors)

Background We evaluated the prevalence of sarcopenia, presarcopenia, and severe sarcopenia in healthy Korean elderly women. Methods We measured the muscle mass and muscle function of 196 ambulatory women over the age of 65 years who visited the University Hospital Menopause Clinic. Appendicular skeletal muscle mass was measured by dual energy X-ray absorptiometry to measure skeletal muscle mass index (SMI). Assessment of hand grip strength (HGS) of the dominant hand was performed to measure the muscle strength, and 4-m straight on-way path was used to measure gait speed for physical performance. The values used to define the presarcopenia, sarcopenia, and severe sarcopenia were based on the cutoff values proposed by the Asian Working Group for Sarcopenia (AWGS). Results The mean age of women was 71.2 years, and the mean SMI in 196 women was 5.94 kg/m(2). The average HGS was 20.3 kg, and the mean gait speed was 1.08 m/sec. In 41 out of the 196 women (20.9%), the SMI was reduced to less than 5.4 kg/m(2). Fifty-nine women (30.1%) had HGS of less than 18 kg, and gait speed was less than 0.8 m/sec in 12 women (6.1%). Twenty-six women (13.3%) were classified into the presarcopenia stage, and 15 women (7.6%) were classified into the sarcopenia stage. There was no case of severe sarcopenia. Conclusions One out of five relatively healthy women aged more than 65 years showed a decrease in muscle mass, and 7.6% of women showed a decrease in muscle mass and strength. The sarcopenia stage was also intensified with aging.

BACKGROUND: The purpose of this study is to investigate 1) whether equol has the direct modulation on vascular tone of endothelium-denuded human uterine artery, and 2) if present, whether this equol-induced modulation of vascular tone is mediated by intracellular calcium modulation through Ca(2+) & K(+) channels on vascular smooth muscle cell membrane. METHODS: The uterine arteries were obtained at the time of hysterectomy from 15 women. The uterine smooth muscles were pretreated with phenylephrine, 10(-5) M & high KCl solution 70 mM. The equol at 6 different concentrations from 10(-11) to 10(-6) M were used for the evaluation of modulatory action of equol on precontracted vascular smooth. The cumulative concentration-response for equol were determined on phenylephrine-induced contractions and compared with the results without pretreatment. RESULTS: Equol 10(-11) to 10(-6) M in concentration showed relaxation effect on vascular smooth muscle contraction which was induced by phenylephrine 10(-5) M. This relaxation effect of equol was dose-dependent. Equol in same concentrations showed no significant effects on vascular smooth muscle contraction induced by high KCI solution. Phenylephrine-induced contraction was markedly reduced from 10(-7) to 10(-4) M in concentration by pretreatment of equol, but high KCI-induced contraction was not affected by pretreatment of equol. CONCLUSIONS: This vasodilatation effect of equol may be induced by calcium antagonistic action, which was mediated through antagonistic action for receptor-dependent Ca(2+) channel, but not for voltage-dependent Ca(2+) channel. As far as we know, this is the first report of phytoestrogen equol on vascular reactivity of human vessels.

Objective To assess the attitudes of Korean physicians toward hormone therapy (HT) after publication of the Women's Health Initiative (WHI) study. Design Self-administered questionnaires, consisting of 22 items, were sent by mail to the members of the Korean Society of Menopause. Results More than 95% of Korean physicians were aware of the WHI study. The HT prescription rate decreased by 16% after publication of the WHI report; approximately half of the physicians who continued prescribing HT changed their prescriptions. The largest decreases occurred in regimens using conjugated equine estrogens and medroxyprogesterone acetate, for which prescriptions of sequential and continuous-combined regimens decreased by 20.7% and 22.7%, respectively. In contrast, the prescription rate for tibolone increased by 3.6%. Approximately 30% of physicians changed from standard to low doses, and 67.8% shortened the duration of HT. After publication of the WHI report, the main reasons for not prescribing or discontinuing HT were patient refusal and increased risk of cardiovascular disease, rather than breast cancer risk. After publication of the WHI report, the number of physicians who prescribed alternative or complementary medicines increased, the rate of HT prescription for the prevention of osteoporosis decreased, and the number of postmenopausal outpatients decreased. Conclusions Despite the results of the WHI report, most Korean physicians who participated in this study continued prescribing HT; however, approximately half of those who continued prescribing HT changed their prescriptions. The greatest change occurred in regimens using conjugated equine estrogens and medroxyprogesterone acetate.

Osteoporosis that is associated with estrogen deficiency in menopause is by far the most common cause of age-related bone loss. Since isoflavone had been reported as a natural substance that minimizes bone loss, we have begun this study to examine the effect of the substance on bone metabolism in ovariectomized rats. Five week-old (n

The Osteoporosis Self-assessment Tool for Asians (OSTA) was developed to help physicians focus their efforts on patients at increased risk, and encourage appropriate use of bone mineral density (BMD) measurements. Previously, OSTA performed well in a sample of women from eight countries in Asia, and in a validation group of Japanese women. In this study, we evaluate the performance of OSTA using a sample of 1101 postmenopausal women from a clinic in Korea who had femoral neck BMD measurements by dual-energy X-ray absorptiometry (DXA). The OSTA had a high sensitivity (87%), and good specificity (67%) for identifying osteoporosis (BMD T-scores ≤ –2.5); the corresponding values were 80% and 72% for identifying T-scores ≤ –2.0. The prevalence of osteoporosis ranged from 2% among women classified as low risk (OSTA > –1) to 64% among those classified as high risk (OSTA

This study evaluated the effects of combination treatment with alendronate (ALEN) and hormone therapy (HT) on bone mineral density (BMD) in postmenopausal Korean women. This multicenter, randomized, controlled clinical trial enrolled 344 postmenopausal women with low BMD. The women received HT (0.625 mg/day of conjugated equine estrogen and 2.5 mg/day of medroxyprogesterone acetate) alone or in combination with ALEN (10 mg/day) for 1 year. Changes in BMD and biochemical markers of bone turnover were evaluated. Data from 203 women (HT alone, 99; combination treatment, 104) who completed this study were analyzed. BMD at the lumbar spine and total hip increased significantly in both treatment groups after 1 year. There were no significant differences between HT alone vs. the combination of ALEN and HT in mean BMD increase at the lumbar spine (6.9% vs. 7.9%) and total hip (3.7% vs. 3.8%). Combined therapy suppressed serum osteocalcin and urinary deoxypyridinoline to a greater extent than HT alone. In conclusion, compared to HT alone, combination treatment with ALEN and HT for 1 year did not offer a benefit in BMD in postmenopausal Korean women with low BMD., Graphical Abstract

The aims of this study are to estimate the hysterectomy rate for benign disease and determine recent trends in laparoscopic surgery for hysterectomies, including subtotal, total, and radical hysterectomy, in Korea.Computerized discharge summaries from private and public hospitals for 2007-2009 were obtained from the Health Insurance ReviewAssessment Service. All records listing subtotal and total hysterectomies for benign disease and radical hysterectomies in women aged ≥ 16 years in each period were selected (n = 99,388). All women living in Korea aged ≥ 16 years were the denominator population. Laparoscopic surgery was identified when the code for laparoscopic materials was used. Statistical analysis included a trend test.The hysterectomy rates for benign disease were 1.48, 1.49, and 1.52/1000 women aged ≥ 16 years in 2007, 2008, and 2009, respectively, and the overall rate was 1.49/1000 women. The trend increased (P for trend0.001). The use of laparoscopy for subtotal and total hysterectomies accounted for 43.1% in 2007, 47.7% in 2008, and 52.0% in 2009, which showed a clear increasing trend (P for trend0.001). The use of laparoscopy for radical hysterectomies comprised 26.7%, 28.7%, and 38.2% of cases in 2007, 2008, and 2009, respectively, an increased trend (P for trend0.001).The hysterectomy rate for benign disease increased between 2007 and 2009 in Korea. Application of laparoscopy during subtotal, total, and radical hysterectomies has increased significantly.

Ho Yeon Chung,1 Jawon Koo,1 Su Kyoung Kwon,2 Moo-IL Kang,3 Seong-Hwan Moon,4 Jin-Young Park,5 Chan Soo Shin,6 Byung-Koo Yoon,7 Hyun-Koo Yoon,8 Jae-Suk Chang,9 Yoon-Sok Chung,10 Hyoung-Moo Park111Department of Internal Medicine, Kyung Hee University, 2Department of Statistics, 3Department of Internal Medicine, Catholic University of Korea, 4Department of Orthopedics, Yonsei University, 5Department of Orthopedics, Konkuk University, 6Department of Internal Medicine, Seoul National University, 7Department of Obstetrics and Gynecology, Sungkyunkwan University, 8Department of Internal Medicine, Kwandong University, 9Department of Orthopedics, University of Ulsan, Seoul, South Korea; 10Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea; 11Department of Obstetrics and Gynecology, Chung-Ang University, Seoul, South KoreaPurpose: This study investigated the efficacy and safety of monthly risedronate, with and without cholecalciferol, on 25-hydroxyvitamin D (25[OH]D) levels and bone markers in Korean patients with osteoporosis.Methods: A randomized, double-blinded, prospective, 16-week clinical trial was conducted in ten hospitals. A total of 150 subjects with osteoporosis were randomized to one of the two treatment groups: RSDM+ (monthly risedronate 150 mg and cholecalciferol 30,000 IU combined in a single pill, n = 74) or RSDM (monthly risedronate 150 mg alone, n = 76). We measured serum levels of 25-hydroxyvitamin D (25[OH]D), parathyroid hormone (PTH), and bone markers, as well as performing muscle-function tests at baseline and after 16 weeks of treatment.Results: After 16 weeks, serum 25(OH)D levels significantly increased from 17.8 to 26.8 ng/mL in the RSDM+ group, but did not change in the RSDM group. The RSDM+ group exhibited significantly decreased serum PTH from 46 to 36.7 pg/mL, while the RSDM group showed a tendency for PTH to increase from 38 to 40.6 pg/mL. In both groups, serum bone-specific alkaline phosphatase and C-terminal telopeptide rapidly declined, with significance at 16 weeks; there were no significant differences between the groups.Conclusion: A once-monthly pill of risedronate and cholecalciferol provided equivalent antiresorptive efficacy to risedronate alone in terms of bone turnover and improved 25(OH)D levels over the 16-week treatment period without significant adverse events in Korean patients with osteoporosis. Keywords: bisphosphonate, cholecalciferol, bone markers, 25(OH)D

(InAs)m(GaAs)m (1 ≤ m ≤ 12) short period superlattices (SPSs) have been grown on semi-insulated InP substrates with a 200 nm InP cap layer using low pressure metalorganic chemical vapor deposition (MOCVD). According to double crystal x-ray diffraction and transmission electron microscopy results, the critical layer thickness of (InAs)m(GaAs)m SPS was observed to be ∼30A (m = 5). For the SPS below the critical layer thickness, mirror-like surface morphology was found without defects, and strong intensity Fourier transformed photoluminescence (FT-PL) spectra were also obtained at room temperature. The SPS with m = 4 showed a drastic improvement in photoluminescence intensity of order of two compared to an InGaAs ternary layer. However, the SPS with a large value of m (m ≥ 6), rough surface was observed with defects, with broad and weak FT-PL spectra. The surface morphology of SPS was greatly affected by the substrate orientation. The SPS with m = 5 was grown on two degree tilted substrate from (100) direction and showed poor surface morphology as compared to the one grown on (100) exact substrate Moreover, the SPS grown on a (111)B substrate showed a rough triangular pattern with Nomarski optical microscopy. In-situ thermal annealed SPS with m = 4 showed a 18 meV increase in PL peak energy compared to the as-grown sample due to phase separation resulting from thermal interdiffusion.

BACKGROUND The criteria for defining sarcopenia vary among studies and confusion has arisen when defining the cutoff value. As a result, the prevalence of sarcopenia differs markedly depending on the definition. This study used the Asian Working Group for Sarcopenia (AWGS) definition to determine the prevalence of sarcopenia among Korean women. METHODS This study was based on data obtained from the 2008 to 2011 Korean National Health and Nutrition Examination Surveys IV and V. We used the AWGS recommended cutoff value of 5.4 kg/m(2) to determine the prevalence of sarcopenia in Korean women. RESULTS The prevalence rates of sarcopenia using a cutoff value of 5.4 kg/m(2) were 385 (19.5%) in women in their 50s, 286 (16.6%) in women in their 60s, 293 (23.7%) in women in their 70s, and 91 (30.8%) in women ≥80 years. The prevalence rates of sarcopenia were 307 (19.0%) in women 65 to 74 years, 194 (27.4%) in women 75 to 84 years, and 32 (40.5%) in women ≥85 years. The overall prevalence among women >50 years was 20.2%. The prevalence of sarcopenia in women >65 years was 22.1%. CONCLUSIONS The prevalence of sarcopenia among Korean women was within the range of values of previous research about sarcopenia. Furthermore, using 5.4 kg/m(2) as the cutoff value was useful to compare various studies about sarcopenia in Koreans.

Background The purpose of this study was to determine cut-off point of appendicular skeletal muscle mass (ASM) adjusted body mass index (BMI) for sarcopenia in the Korean women and evaluate the prevalence of sarcopenia in postmenopausal women. Methods This study was based on the data obtained from 2008 to 2011 Korean National Health and Nutrition Examination Survey (KNHANES) IV and V. A whole body dual energy X-ray absorptiometry (DXA) scan and measurement of BMI were performed on individuals of ≥10 years old. Five thousand, two hundred and fifteen women older than 50 years were included in the study. ASM was obtained by adding the muscle masses of the four limbs. To determine the young reference group, mean and standard deviation of ASM and ASM/BMI by ages was measured. We calculated the prevalence rate of sarcopenia by each age group according to the cut-off point based on ASM and ASM/BMI. Results In determining the cut-off values related ASM/BMI, using the value that is two standard deviations below mean values for young reference group (20's and 30's) thus recommends 0.50 m2 in women. The overall prevalence among women older than 50 years was 15.6%. Among women older than 65 years prevalence of sarcopenia was 22.9%. Conclusions The prevalence of sarcopenia among Korean women obtained in this study is within the proper range of value to research about sarcopenia. Furthermore, using 0.50 m2 as the cut-off value can help compare various studies about sarcopenia in Korea.

The International Society for Clinical Densitometry (lSCD) is a nonprofit multidisciplinary international professional organization. The ISCD mission is to advance excellence in the assessment of skeletal health. To achieve this mission, the ISCD has conducted a number of Position Development Conferences over the past 10 yr, bringing together international experts to review and create evidence-based position statements guiding clinicians involved in the area. The Asia-Pacific (AP) Panel of the ISCD was formed to give regional input to the ISCD from the AP Region and to oversee ISCD education and certification programs in the region. An AP Panel consensus meeting recently reviewed the most current Official Positions of the ISCD in view of the different population characteristics and health standards in the region. The reviewed position statements included those for bone testing by central and peripheral devices but did not include ISCD Official Positions on Vertebral Fracture Assessment or pediatric bone mineral density.

Cardiovascular disease and osteoporosis are thought to share common risk factors, and metabolic syndrome (MS) is composed of major risk factors for cardiovascular disease. This study was performed to investigate the relationships between specific MS components and bone mineral density (BMD). BMD was measured at the femoral neck of Korean men aged 40 years or more (n = 1,780) and postmenopausal women (n = 1,108) using dual-energy X-ray absorptiometry. We identified subjects with MS as defined by two criteria, International Diabetes Federation (IDF) and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Body fat and lean mass were measured via bioimpedance analysis. The prevalence of MS was 19.8% and 7.7% in men and 20.8% and 11.6% in postmenopausal women according to the AHA/NHLBI definition and the IDF definition, respectively. After multivariate adjustment, femoral neck BMD was significantly lower in subjects with MS regardless of diagnostic criteria. BMD decreased as the number of MS components increased (P < 0.001 for trends in both sexes). Among MS components, waist circumference was the most important factor in this negative association. When multiple linear regression models were applied to each 5-kg weight stratum to test for a linear trend, waist circumference and fat mass were negatively associated with BMD and lean mass was positively associated with BMD in men but not in women. MS was associated with a lower BMD in Korean men and postmenopausal women, suggesting that visceral fat may lead to bone loss, especially in men.

To determine the vitamin D status of Korean postmenopausal women during the winter months according to the intake of vitamin D supplements.Cross sectional study of serum 25(OH)D levels according to the intake of vitamin D supplements in postmenopausal women.Between November 2006 and February 2007, 254 postmenopausal women who visited our menopausal clinic for hormone therapy or osteoporosis medication were recruited. Serum 25(OH)D levels were measured with a radioimmunoassay kit and the results were compared among groups that were classified according to the intake amount of vitamin D supplements.The mean serum 25(OH)D level was 83.3 +/- 32.8 nmol/L and it increased as the intake amount of vitamin D supplements increased. The mean serum 25(OH)D level was not significantly different between groups 1 (no vitamin D supplements) and 2 (daily 100-300 IU supplements). However, the mean serum 25(OH)D level was significantly higher in group 3 (daily 400 IU supplements) than in group 1. While the mean value of group 4 (daily 600 IU) was not significantly different from that of group 3, it was significantly lower than that of group 5 (daily 800-900 IU).Vitamin D supplementation is highly effective in improving vitamin D status and the vitamin D status in this study population was improved considerably when compared to previous studies. Therefore, it is concluded that the prevalence of vitamin D insufficiency should be re-evaluated in postmenopausal women in most countries including Korea.

BACKGROUND Sarcopenia is considering important disease entity in elderly. Several study groups define the sum of the muscle masses of the four limbs as appendicular skeletal mass (ASM) to calculate skeletal muscle index (SMI). The purpose of this study was to determine cut point of SMI for sarcopenia in Korean women. METHODS This study was based on data obtained from the 2008 to 2011 Korean National Health and Nutrition Examination Survey (KNHANES) IV and V. A whole body dual energy X-ray absorptiometry scan were performed on individuals of ≥10 years old from July 2008 to May 2011. In the analysis, 11,633 women were included. ASM was calculated and SMI was obtained as ASM/height(2). Cutoff value was defined two standard deviations below mean values for young reference group. RESULTS Of 11,633 women aged 10 to 97 years, mean and standard deviation of year was 46.73±18.54 years. The highest level of height was noted in 20's and the highest total sum of skeletal mass was seen 14.87 kg in 40's. The highest value of SMI was noted in 60's in Korean women. Cutoff value as mean value of young women was decided with SMI of 30's and 40's that have peak ASM. Mean and standard deviation of SMI in those ages was 5.9±0.7 kg/m(2). A SMI of two standard deviations below the mean SMI of reference groups was 4.4 kg/m(2) as cutoff value. CONCLUSIONS This study shows that 4.4 kg/m(2) of SMI in Korean women was cutoff value of sarcopenia. Further study is clearly required to decide cutoff value of SMI for sarcopenia, especially for Korean women.

Background Osteoporosis and resultant fracture seems to be the most common skeletal disease, affecting female exclusively. Osteoporosis increases exponentially with menopause and age. Therefore the demographic data seems to be the most important & fundamental for the study of osteoporosis epidemiology. Methods This study was to analyzed population projection from 1960 to 2060. We evaluated the demographic change of female, postmenopausal and elderly geripausal population in South Korea using Korean statistical information service database as basic fundamental data for osteoporosis epidemiology. Results According to population projection, the total female population will be exceeds the total male population since 2015 and maximize up to 2030. In 2030, nearly half of female will become postmenopausal and one fourth of women elderly will be geripausal. Of total female population in 2060, the proportion of postmenopausal women will be increased up to 59.8%. Conclusions According to population projection in South Korea, six of ten women in 2060 will be postmenopausal and seven of ten postmenopausal women geripausal. As expected to increase proportion of elderly women, dramatic rise of osteoporosis and osteoporotic fracture also expected. Health providers pay more attention to postmenopausal and geripausal women health care.

Youn-Jee Chung, M.D., Mee-Ran Kim, M.D., Ph.D., Hye-Won Jeong, M.D., Ph.D., Byung Koo Yoon, M.D., Ph.D., Byung Suk Lee, M.D., Ph.D., Byung Moon Kang, M.D., Ph.D., Hoon Choi, M.D., Ph.D., Hyoung Moo Park, M.D., Ph.D., Jung Gu Kim, M.D., Ph.D. Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Ewha Womans University School of Medicine, Sungkyunkwan University School of Medicine, College of Medicine, College of Medicine, University of Ulsan, College of Medicine, College of Medicine, Chung-ang University Hospital, College of Medicine, Seoul, Korea; The Study Group of Menopause

Objectives: This study was performed to identify nurses’ knowledge and attitudes on hormone replacement therapy (HRT) of menopausal women. Methods: Data were collected from 221 nurses who were working at maternity hospitals in the whole country using questionnaires consisting of 9 questions related to menopause-related knowledge and HRT-related attitudes and knowledge. Results: According to the nurses’s responses, the diseases of concern in menopausal women were osteoporosis (78%), and depression (69%). Most nurses replied that the most effective treatment of menopausal symptoms is HRT, and nurses were very knowledgeable about its strengths (59%) and weaknesses (44%). Cancer was regarded as the major complication of HRT (71%), and its side effects were breast pain (77%) and vaginal bleeding (77%). Forty-six percent of nurses thought that the appropriate treatment duration of HRT is not necessary to limit the period. The most important considerations when conducting HRT were drug stability (59%) and improving the quality of life (36%). Ninety-fi ve percent of nurses responded that they personally would use HRT for menopausal treatment or would recommend their family. HRT for menopausal symptoms was being utilized before seeking medical treatment (40%) and after drug prescription (42%). Conclusion: Nurses have very positive attitudes about HRT but appeared to lack critical knowledge about HRT. Therefore, more educational programs for nurses about HRT should be required.

Sun Kyoung Yum, M.D., Byung-Koo Yoon, M.D., Ph.D., Byoung Ick Lee, M.D., Hyoung Moo Park, M.D., Ph.D., Tak Kim, M.D., Ph.D. Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine; Department of Obstetrics and Gynecology, Sungkyunkwan University School of Medicine, Seoul; Department of Obstetrics and Gynecology, Inha University College of Medicine, Incheon; Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea

Objectives: The relationship between subclinical hypothyroidism and cardiovascular disease has not yet been clearly defined. This study will investigate whether or not there is a difference in the prevalence of subclinical hypothyroidism in menopausal women with respect to cardiovascular risk factors, and will furthermore analyze the relationship between cardiovascular diseases and subclinical hypothyroidism, in order to establish a foundation for subclinical hypothyroidism research. Methods: The study subjects consisted of 713 post-menopausal women, who visited the hospital for a health check-up in 20062010. They were divided into a subclinical hypothyroidism group and a normal group. This study analyzed the difference in blood pressure, serum lipid, body mass index (BMI) and blood glucose level between the two groups. The data was analyzed using a two-sample t-test. Results: The prevalence of subclinical hypothyroidism for menopausal women was 6.7%. The results showed no significant differences between the normal and subclinical hypothyroidism patient groups, in regards to blood pressure, BMI, and blood glucose levels (P > 0.05). However the triglyceride of serum lipid was significantly higher in the subclinical hypothyroidism group (P = 0.003). Conclusion: It has been confirmed that the triglyceride of the subclinical hypothyroidism group was higher than that of the normal group, and so serum lipid maintenance and caution towards cardiovascular disease is necessary for the subclinical hypothyroidism group. (J Korean Soc Menopause 2012;18:193-198)

Hye Won Chung, M.D., Byung Moon Kang, M.D., Ph.D., Mee Ran Kim, M.D., Ph.D., Byung Koo Yoon, M.D., Ph.D., Byung Seok Lee, M.D., Ph.D., Hoon Choi, M.D., Ph.D., Hyoung Moo Park, M.D., Ph.D., Jung Gu Kim, M.D., Ph.D. Department of Obstetrics and Gynecology, College of Medicine, Ewha Woman’s University, College of Medicine, University of Ulsan, College of Medicine, The Catholic University of Korea, College of Medicine, Sungkyunkwan University, College of Medicine, Yonsei University, College of Medicine, Inje University, College of Medicine, Chungang University, College of Medicine, Seoul National University, Seoul, Korea; The Study Group of Menopause

Objectives: Overactive bladder (OAB) is characterized by urinary urgency, usually accompanied with frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection (UTI) or other obvious pathology. This study was performed to investigate the prevalence of OAB and the effect of hormone therapy (HT) on the OAB prevalence in healthy Korean postmenopausal women. Methods: The frequency, nocturia, urgency, and urgency incontinence were investigated by using questionnaire in 350 healthy postmenopausal women over 45 years old among patients who visited the Department of Obstetrics and Gynecology, Chung-Ang University Hospital, between November 2010 and February 2011. Results: In our study, the prevalence of OAB was 14.3% and OAB with urgency incontinence was present in 8.0% of the investigated participants. There was no difference in OAB related to older age or the presence of HT, but signifi cant difference was found in the duration of menopause (odds ratio [OR] 3.451, 95% confi dence interval [CI] 1.422-8.377, P = 0.004). Higher risks for both frequency (OR 2.921, 95% CI 1.587-5.375, P = 0.001) and nocturia (OR 2.469, 95% CI 1.069-5.702, P = 0.037) were observed in OAB subjects compared to postmenopausal women without OAB. Conclusion: To the best of our knowledge, this is the fi rst study investigating the prevalence of overactive bladder in Korean postmenopausal women. Older age or HT did not affect the prevalence of OAB, and HT was not effective in treating the symptoms of OAB. However, the prevalence of OAB was increased with the age, duration of menopause.

Objectives: To analyze the domestic consumption of postmenopausal hormonal medicine in the year 2010 and compare it with those since 2002. Methods: Data from Intercontinental Marketing Services were used to analyze the consumption of hormonal medicine in the year 2010. Total hormonal medicines consisted of estrogen (ET), estrogen+progestogen (EPT), and Tibolone. We compared the respective consumption of hormonal medicines in the year 2010 with those since 2002. The percentage and frequency of usage of ET, ET/EPT, and tibolone in the year 2010 were also estimated. Results: We found that 4.5% of women over 50 years of age had taken the postmenopausal hormonal medicine in the year 2010. The usage rate of each medicine showed 60% for ET/EPT compound, and 40% for Tibolone. The usage of postmenopausal hormonal medicine in 2010 increased by 7% compared to the previous year reaching 3.81 billion Korean won. There was 9% increase in the use of ET/EPT compound, and 4% increase in Tibolone. Conclusion: The total consumption of postmenopausal hormonal medicine was markedly decreased between 2002 and 2007. Since 2007, however, it has been steadily increasing from 3.01 billion to more than 3.81 billion Korea won in 2010, which maybe due to the reappraisal of the WHI study results, the change of doctor's recognition, and the increased consumption of Tibolone. When initiating postmenopausal hormone replacement therapy, the risk-benefit of hormonal therapy should be thoroughly explored. (J Korean Soc Menopause 2011;17:150-154)

목적 본 연구는 한국 폐경여성에서 혈중 비타민D 영양상태 및 골건강 상태와의 상관관계를 알아보고자 하였다. 연구방법 본 연구는 2008년 10월부터 2009년 3월까지 서울시내 거주하는 322명의 거동 가능한 폐경여성을 대상으로 시행하였다. 혈중 비타민D 농도, 혈중 부갑상선호르몬 농도, 골밀도 등을 측정하였다. 결과 평균 혈중 비타민D 농도는 16.0±7.1ng/mL이었으며 평균 혈중 부갑상선호르몬 농도는 34.0±13.7pg/mL으로 전체 대상군의 약 90%에서 비타민D 불충분 상태이었다. 골밀도가 정상인 경우나 골감소증 여성보다 골다공증 여성에서 혈중 비타민D 농도가 낮았으나 유의한 차이를 보이지 않았다(P=0.4689). 또한 65세 이상인 고령 폐경여성에서 혈중 비타민D 농도가 유의하게 낮았다(P=0.0011). 그러나 조기 폐경여성과 후기 폐경여성 사이의 혈중 비타민D 농도의 유의한 차이는 보이지 않았다(P=0.9882). 혈중 비타민D 농도는 겨울과 봄에 유의하게 낮았으며(P

Objective: Postmenopausal osteoporosis is a common skeletal disease with serious consequences due to fracture, leading to increased morbidity and mortality. This study was carried out to evaluate the changes of national osteoporosis markets during the last 5 years and to estimate the trends of national osteoporosis market in the future. Methods: The use of the medications for osteoporosis treatment was evaluated in terms of sales of drugs for osteoporosis treatment. The sales audit of drugs for osteoporosis treatment from Intercontinental Marketing Services (IMS) were used to analyse the sales of specific drugs. Results: The total national osteoporosis market has been increased progressively and markedly during the last 5 years and was valued at 167.4 billion Korean won (KRW) in 2008. The use of hormone therapy was decreased markedly by 40% after reporting of WHI results and the reduction of hormone therapy has been continuing during the recent 5 years. The market size of the non-hormonal osteoporosis drugs has been grown by 73% during the last 5 years and was valued at 134.5 billion KRW in 2008. This non-hormonal drug market was dominated by bisphosphonates. which account for over 80% of total sales. The use of bisphosphonates and active vitamin D metabolites has been increasing but raloxifene and calcitonin, decreasing. Conclusion: The survery of recent national osteoporosis market using IMS sales audit showed that the use of drugs for osteoporosis treatment has been markedlly increasing during last 5 years from 2004 to 2008. This has been attributed to non-horomonal pharmacological drugs, especially bisphosphonate.

목적: 본 연구의 목적은 Women`s Health Initiative Study (WHI) 발표 전후 2000년부터 2009년까지 10년 동안의 폐경 여성에서 호르몬 사용의 변화와 WHI의 결과가 우리나라의 호르몬 요법 사용에 어떠한 영향을 보였는지 알아보고 이를 통해 앞으로의 폐경 후 호르몬 요법의 전망을 알아보고자 한다. 연구 방법: 이 연구는 International Medical Service HEALTH 회사에서 발표된 약제 통계자료에 기초하였다. 우리나라에서 판매된 호르몬 제제들에 대한 통계자료들은 2000년부터의 자료를 이용하였다. 폐경여성들의 호르몬 제제들의 사용은 연간 호르몬 제제들의 판매액으로 표시하였으며 총 호르몬 제제는 에스트로겐, 에스트로겐/프로게스토겐, 티볼론 제제들의 합으로 표시하였다. 호르몬 제제의 사용 변화를 알기 위해 전년 대비 성장률과 2000년을 기준으로 한 축적성장률을 산출하였다. WHI발표 이후의 사용 변화를 알기 해서 2002년부터 2009년까지 2002년을 기준으로 한 변화를 확인하였다. 결과: 2002년 WHI 발표 이후 우리나라의 총 호르몬 요법 사용은 2002년도의 511억에 비해 2006년에 39%의 감소를 보여 314억까지 감소하였다. 이후 조금씩 상승하여 2009년에는 356억이었다. 반면 티볼론의 사용은 WHI 이후 2년간은 감소하여 2002년 134억에 비해 2004년에는 100억으로 25.4% 감소하였으나 이후 지속적으로 상승하여 2007년에는 134억으로 2002년의 사용량보다 증가하였고, 2009년에는 145억으로 2002년 대비 8.2% 증가하였다. 저용량 호르몬 제제 또한 WHI 이후 지속적으로 증가하여 2002년 8억 대비 2009년에는 71억으로 787.5% 증가하였다. 결론: WHI의 발표 후 폐경 여성들의 호르몬 사용은 2002년에 비해 2003년에 23.9% 감소하였고 저용량 호르몬과 티볼론 사용이 확연히 증가하였다. 앞으로 우리나라 폐경 여성에서 호르몬 사용은 저용량의 호르몬과 티볼론이 대세를 이룰 것으로 생각된다. 또한 호르몬 요법을 시작할 때 환자의 병력, 신체검사를 통한 이득과 위험을 판단한 후 각 개인에 맞는 호르몬 요법을 시행하여야 할 것이다.