There have been several studies of the impact of vertebral osteoporotic fracture on the quality of life and functionality of individual subjects. To date, however, no direct comparisons with age-matched normal subjects without vertebral fracture have been made. The radiographs of 145 female clinic patients with vertebral fractures were reviewed by the study physicians. The controls were recruited from the electoral role and by media appeal. One hundred and sixty-seven women had radiographs taken to determine those without vertebral fracture. Fracture subjects and controls had to be ambulant and were excluded if they had significant radiologic evidence of degenerative disk or joint disease of the spine. One hundred cases and one hundred controls were matched by 5-year age groups. The number, position and severity of the vertebral fracture on the lateral radiographs of the cases was recorded. Quality of life was measured using the Short Form-36 (SF-36) (maximum score 100) and a utility score calculated from these results (maximum score 1). Two measurements of functionality were employed: the Modified Barthel Index (MBI) to assess the activities of daily living (maximum score 100) and the Timed 'Up & Go' (TUG) that measured the time taken for the subject to rise from sitting in a chair, walk 3 m along a line, return to the chair and sit down. The fracture subjects had 2.9 +/- 1.6 (mean +/- SD) vertebral fractures and the time since last fracture was 5.1 +/- 4.8 years. The SF-36 physical function component summary index results were: fracture subjects 36 +/- 11, controls 48 +/- 9 (p < 0.001). The SF-36 mental health component summary index results were: fracture subjects 50 +/- 11, controls 54 +/- 8 (p < 0.05). The utility scores were: fracture subjects 0.64 +/- 0.08, controls 0.72 +/- 0.07 (p < 0.001). The MBI results were: fracture subjects 97 +/- 5, controls 99 +/- 1 (p < 0.01). The TUG results were: fracture subjects 13.8 +/- 7.3 s, controls 10.1 +/- 4.1 s (p < 0.01). TUG and MBI scores correlated well with SF-36 scores; however, no domain of the SF-36 or functional measure correlated with either the number of vertebral fractures or the time since last vertebral fracture. Thus, clinically reported vertebral fractures impair both the quality of life and functionality of these subjects. The adverse impact of vertebral fracture on quality of life and functionality needs to be recognized by medical practitioners, subjects and the community, so that adequate health resources can be devoted to the prevention and treatment of this debilitating condition condition.

OBJECTIVE To examine the effects of demographic, geographical and socio‐economic factors, and the influence of private health insurance, on patterns of prostate cancer care and 3‐year survival in Western Australia (WA). PATIENTS AND METHODS The WA Record Linkage Project was used to extract all hospital morbidity, cancer and death records of men diagnosed with prostate cancer between 1982 and 2001. The likelihood of having a radical prostatectomy (RP) was estimated using logistic regression, and the likelihood of death 3 years after diagnosis was estimated using Cox regression. RESULTS The proportion of men undergoing RP increased six‐fold, from 3.1% to 20.1%, over the 20 years, whilst non‐radical surgery (transurethral, open or closed prostatectomy) simultaneously halved to 29%. Men who had RP were typically younger, married and with less comorbidity. Patients with a first admission to a rural hospital were much less likely to have RP (odds ratio 0.15; 95% confidence interval, CI, 0.11–0.21), whereas residence alone in a rural area had less effect (0.54, 0.29–1.03). A first admission to a private hospital increased the likelihood of having RP (2.40, 2.11–2.72), as did having private health insurance (1.77, 1.56–2.00); being more socio‐economically disadvantaged reduced RP (0.63, 0.47–0.83). The 3‐year mortality rate was greater with a first admission to a rural hospital (relative risk 1.22; 95% CI 1.09–1.36) and in more socio‐economically disadvantaged groups (1.34, 1.10–1.64), whereas those admitted to a private hospital (0.77, 0.71–0.84) or with private health insurance (0.82, 0.76–0.89) fared better. Men who had RP had better survival than those who had non‐radical surgery (4.85, 3.52–6.68) or no surgery (6.42, 4.65–8.84), although this may be an artefact of a screening effect. CONCLUSION The 3‐year survival was poorer and the use of RP less frequent in men from socio‐economically and geographically disadvantaged backgrounds, particularly those admitted to rural or public hospitals, and those with no private health insurance.

The aim of this study was to determine the health system costs associated with falls in older adults who had attended an emergency department (ED) in Western Australia. The data relating to the ED presentations and hospital admissions were obtained from population-based hospital administrative records for [2001][2002]. The type of other health services (eg, outpatient, medical, community, ancillary and residential care), the quantity, and their cost were estimated from the literature.In adults aged 65 years and above, there were 18 706 ED presentations and 6222 hospital admissions for fall-related injuries. The estimated cost of falls to the health system was $86.4 million, with more than half of this attributable to hospital inpatient treatment. Assuming the current rate of falls remains constant for each age group and gender, the projected health system costs of falls in older adults will increase to $181 million in 2021 (expressed in 2001-02 Australian dollars).The economic burden to the health services imposed by falls in older adults is substantial, and a long-term strategic approach to falls prevention needs to be adopted. Policy in this area should be targeted at both reducing the current rate of falls through preventing injury in people from high-risk groups and reducing the future rate of falls

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The effects of impaired balance and mobility along with reduced functional and social independence are reflected in the diminished QOL perceived by the fracture group. This indicates that many do not return to their pre-fracture lifestyle.