Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial

Silverman, Stuart L.; Viswanathan, Hema N.; Yang, YC; Wang, A; Boonen, Steven; Ragi-Eis, Sergio; Fardellone, Patrice; Gilchrist, Nigel; Lips, Paul; Nevitt, Michael C.; Gil‐Antuñano, Santiago Palacios; Pavelka, Karel; Revicki, Dennis A.; Simon, Jean‐Pierre; Macarios, David; Siris, Ethel S.

doi:10.1007/s00198-011-1720-0

Cited by 25 publications

(17 citation statements)

References 13 publications

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“…Women with incident fractures (vertebral and non-vertebral) had a worse HRQoL (physical function, symptoms and emotional status dimensions) during the study than women without incident fractures, regardless of treatment group [38]. Another large RCT evaluating denosumab treatment also demonstrated that incident clinical fractures have an adverse impact on HRQoL in postmenopausal women with osteoporosis [39]. …”

Section: Discussionmentioning

confidence: 99%

Effective osteoporosis treatment with teriparatide is associated with enhanced quality of life in postmenopausal women with osteoporosis: the European Forsteo Observational Study

Ljunggren

Barrett²,

Stoykov³

et al. 2013

BMC Musculoskelet Disord

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BackgroundTo describe changes in health-related quality of life (HRQoL) of postmenopausal women with osteoporosis treated with teriparatide for up to 18 months and followed-up for a further 18 months, and to assess the influence of recent prior and incident fractures.MethodsThe European Forsteo Observational Study (EFOS) is an observational, prospective, multinational study measuring HRQoL using the EQ-5D. The primary objective was to assess changes in HRQoL during 36 months in the whole study population. A secondary post-hoc analysis examined fracture impact on HRQoL in four subgroups classified based on recent prior fracture 12 months before baseline and incident clinical fractures during the study. Changes from baseline were analysed using a repeated measures model.ResultsOf the 1581 patients, 48.4% had a recent prior fracture and 15.6% of these patients had an incident fracture during follow-up. 10.9% of the 816 patients with no recent prior fracture had an incident fracture. Baseline mean EQ-VAS scores were similar across the subgroups. In the total study cohort (n = 1581), HRQoL (EQ-VAS and EQ-5D index scores) improved significantly from baseline to 18 months and this improvement was maintained over the 18-month post-teriparatide period. Improvements were seen across all five EQ-5D domains during teriparatide treatment that were maintained after teriparatide was discontinued. Subjects with incident clinical fractures had significantly less improvement in EQ-VAS than those without incident fractures. Recent prior fracture did not influence the change in EQ-VAS during treatment.ConclusionsEFOS is the first longitudinal study in women with severe postmenopausal osteoporosis in the real world setting to show a substantial improvement in HRQoL during teriparatide treatment that was sustained during subsequent treatment with other medications. The increase in HRQoL was lower in the subgroups with incident fracture but was not influenced by recent prior fracture. The results should be interpreted in the context of the design of an observational study.

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Section: Discussionmentioning

confidence: 99%

Effective osteoporosis treatment with teriparatide is associated with enhanced quality of life in postmenopausal women with osteoporosis: the European Forsteo Observational Study

Ljunggren

Barrett²,

Stoykov³

et al. 2013

BMC Musculoskelet Disord

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“…As quality of life was found to be dependent on comorbidities, mobility, independence of activities of daily life and fracture complaints [10], it is central to optimize treatment modalities, pain management, rehabilitation strategies and overall patients' medical management to improve outcomes as evaluated by quality of life future science group Improving patients' outcomes after osteoporotic fractures Review questionnaires. Recently, it has been demonstrated that osteoporotic fractures also have an impact on quality of life over time [120], implying that evaluation and management of patients with fragility fractures should be c ontinuing for a better outcome.…”

Section: Rehabilitation Long-term Pain Management and Improving Qualitmentioning

confidence: 99%

Improving patients’ outcomes after osteoporotic fractures

Dimitriou¹,

Calori²,

Giannoudis³

2012

International Journal of Clinical Rheumatology

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“…46 Other bene fits, based on low-quality evidence, may include a small reduction in back pain related to past and future vertebral fractures for teriparatide, 47 but there was little to no effect on quality of life for other therapies. [48][49][50][51] There was low to very low quality evidence for very small risks of serious events such as osteonecrosis of the jaw and atypical fractures or delayed healing (estimated at < 1 per 10 000 communitydwelling older people). [52][53][54] It is unclear whether these risks would be higher among long-term care residents.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Recommendations for preventing fracture in long-term care

Παπαϊωάννου

Santesso

Morin

et al. 2015

CMAJ

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• In older adults living in long-term care (residents), fractures cause pain, agitation, immobility and transfers to hospital.• Residents identified as being at high risk of fracture include those with prior fracture of the hip or spine, those with more than one prior fracture and those with one prior fracture and recent use of glucocorticoids.• Recommendations for preventing fracture in long-term care were developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with consideration of the quality of the available evidence, the balance between benefits and harms, the preferences of residents and their care providers, and the resources required to implement the recommendations.• Strategies to prevent fractures, including vitamin D and calcium supplementation, use of hip protectors, exercise, multifactorial interventions to prevent falls and pharmacologic therapies, should be tailored to each resident's level of fracture risk, mobility, life expectancy, renal function and ability to swallow.

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Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial

Abstract: These findings not only demonstrate that incident clinical fractures impact HRQoL but also contribute new information regarding the impact of these fracture events on HRQoL over time.

Cited by 25 publications

References 13 publications

Effective osteoporosis treatment with teriparatide is associated with enhanced quality of life in postmenopausal women with osteoporosis: the European Forsteo Observational Study

Effective osteoporosis treatment with teriparatide is associated with enhanced quality of life in postmenopausal women with osteoporosis: the European Forsteo Observational Study

Improving patients’ outcomes after osteoporotic fractures

Recommendations for preventing fracture in long-term care

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