A Case-Control Study of Quality of Life and Functional Impairment in Women with Long-Standing Vertebral Osteoporotic Fracture

Abstract

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.

Impact of prevalent and incident vertebral fractures on utility: results from a patient-based and a population-based sample

“…This study was continued as the European Prospective Osteoporosis Study (EPOS), in which the age-standardized incidence of VFX was estimated at 10.7/1,000 person years in women and 5.7/1,000 person years in men [9]. Both clinical and subclinical VFX are associated with back pain, impaired physical functioning, and decreased quality of life [1,3,4,7,[10][11][12][13][14][15][16][17][18][19].…”

“…Only few studies have assessed the association between VFX and utility [1,11,14,[16][17][18][19]. The utility after VFX varied between 0.20 and 0.85, depending on the time frame, definition of VFX, and population used.…”

Health economics of osteoporosis

“…Quality of life in subsequent years after a hip fracture was assumed to be 90% of that of a healthy individual [49]. In line with evidence indicating a long-term reduction in quality of life after vertebral fractures, quality of life loss related to clinical vertebral fractures in the second and following years was conservatively assumed to be 0.05 [20,80,81,139].…”

Vertebroplasty and kyphoplasty: complementary tecniques for the treatment of painful osteoporotic vertebral compression fractures

“…Open surgical treatment is reserved to the rare cases of progressive deformity and neurological deterioration or to the more frequent cases of persistent intractable pain. Vertebroplasty (VP) and Kyphoplasty (KP) are well known percutaneous vertebral body augmentation procedures that provide good pain relief when used to treat osteoporotic VCFs 1,5,6 . VP involves percutaneous injection of bone cement into the fractured vertebra/e in order to stabilise the fracture.…”

“…KP involves an initial step of expansion of a balloon into the vertebral body, which creates a cavity to be filled with bone cement and allows for reduction of the fracture. VP and KP have so far been proposed as alternative 1,5,6 techniques because of the supposed possibility of KP to reduce vertebral body deformity. In fact, VP has also been reported to be able to provide some fracture reduction 7 .…”