Impact of Prevalent Fractures on Quality of Life: Baseline Results From the Global Longitudinal Study of Osteoporosis in Women

Abstract

F ractures are a major clinical concern in older women and men. The most commonly considered sites of fracture are the hip, spine, and wrist.1-4 About 40% of white women aged 50 years and older will experience at least 1 clinically recognized fracture at one of these skeletal sites and be subjected to increased risks of morbidity and mortality. 5,6 However, other less recognized fractures, such as those of the pelvis, ribs, shoulder, distal femur, and proximal tibia, may also lead to reductions in quality of life. 7-10OBJECTIVE: To examine several dimensions of health-related quality of life (HRQL) in postmenopausal women who report previous fractures, and to provide perspective by comparing these findings with those in other chronic conditions (diabetes, arthritis, lung disease). PATIENTS AND METHODS:Fractures are a major cause of morbidity among older women. Few studies have examined HRQL in women who have had prior fractures and the effect of prior fracture location on HRQL. In this observational study of 57,141 postmenopausal women aged 55 years and older (enrollment from December 2007 to March 2009) from 17 study sites in 10 countries, HRQL was measured using the European Quality of Life 5 Dimensions Index (EQ-5D) and the health status, physical function, and vitality questions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS:Reductions in EQ-5D health-utility scores and SF-36-measured health status, physical function, and vitality were seen in association with 9 of 10 fracture locations. Spine, hip, and upper leg fractures resulted in the greatest reductions in quality of life (EQ-5D scores, 0.62, 0.64, and 0.61, respectively, vs 0.79 without prior fracture). Women with fractures at any of these 3 locations, as well as women with a history of multiple fractures (EQ-5D scores, 0.74 for 1 prior fracture, 0.68 for 2, and 0.58 for ≥3), had reductions in HRQL that were similar to or worse than those in women with other chronic diseases (0.67 for diabetes, 0.69 for arthritis, and 0.71 for lung disease).CONCLUSION: Previous fractures at a variety of bone locations, particularly spine, hip, and upper leg, or involving more than 1 location are associated with significant reductions in quality of life. If their full health impact is to be appreciated, fractures at a range of sites need to be examined to determine their effects on health-related quality of life (HRQL). Mayo Clin

Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence

“…(5,7) In addition to health care costs, osteoporotic fractures significantly impact mortality and patient quality of life by inducing pain, physical limitations, and psychological symptoms, including depression and loss of self-esteem, resulting in institutionalization and long-term care. (2,4,(8)(9)(10)(11)(12)(13)(14) Pharmacotherapies currently available for the prevention and treatment of osteoporosis include oral bisphosphonates (OBP), calcitonin, estrogen/hormone therapy, the estrogen agonist/ antagonist raloxifene, and the recombinant parathyroid hormone teriparatide. Among these, bisphosphonates are the most commonly used treatment for established osteoporosis with a market share of 35% in the US.…”

Kwas zoledronowy stosowany przez dwa lata u Chinek z osteoporozą pomenopauzalną zwiększa gęstość mineralną tkanki kostnej i poprawia jakość życia związaną ze stanem zdrowia

“…Furthermore, we didn't try to find the relationships among the changes of BMD, FI and SF-36 score, and further studies are required. Finally, as many studies show, previous fractures have an impact on HRQL, and HRQL will decrease with each subsequent fracture [25,26]. Some patients in our study had previous fractures, but we didn't have these patients divided into two groups (fracture or no).…”

“…Many studies have noted that osteoporotic patients have impaired HRQL, especially in the physical aspects, and fracture is an important determinant of HRQL impairment in these patients [25][26][27]. One study showed that lower femoral neck BMD was associated with poorer PF [3].…”

Genetic Studies of Endophenotypes From Spine CT Scans Provide Novel Insights Into the Contribution of Mechanosensory Pathways to Vertebral Fractures and Spinal Curvature

“…This focus on spinal endophenotypes is important given the burden of disease associated with kyphosis and vertebral fractures, as exemplified by associations between vertebral fractures and reduced quality of life (6) , increased risk of hospitalization (7) , functional limitation (8) , mortality (7,9) , and chronic back pain (8) . Yau et al examined genetic influences on spinal curvature, and its potentially associated endophenotypes, as ascertained on thoracic CT scans.…”