Health-related quality of life of patients with a recent fracture attending a fracture liaison service: a 3-year follow-up study

Abstract

This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. Introduction To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). Methods Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. Results A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: − 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. Conclusion The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV.

A head-to-head comparison of EQ-5D-5L and SF-6D in Dutch patients with fractures visiting a Fracture Liaison Service

“…During 3-year follow-up, five patients died, and the contribution of these patients to the data on responsiveness is limited. In addition, based on our previous longitudinal study 6 , the change of both EQ-5D-5L and SF-6D HSUV over 3 years was not statistically significant, as was not unexpected given patients were included upon 3 months after the fracture. Therefore, recovery following a fracture would not be a situation eligible to assess responsiveness.…”

“…Besides, bone mineral density (BMD) was measured by DXA, and prevalent vertebral fracture (VF) by VFA. The definition and classification of BMD and prevalent VF has been described in detail in previous studies 6,18 . In addition, laboratory tests were performed to detect contributors to secondary osteoporosis and metabolic bone diseases.…”

“…Patients' missing utilities at six time-points were drawn using predictive mean matching. The details of MI can be found in our previous study 6 .…”

“…To capture the maximum impact of a subsequent fracture, the HSUV just before and immediately after the subsequent fracture was treated as pre-and post-HSUV, respectively (i.e. if one patient had a subsequent fracture at 6 months, the HSUV at 3 months was treated as pre-HSUV and the HSUV at 6 months as post-HSUV) 6 .…”

“…Fracture Liaison Services (FLSs) as a coordinated, multi-disciplinary model of care, are advocated as the best practice for secondary fracture prevention. We recently reported significant improvements in HRQoL within 12 months following the initial fracture of patients attending FLS in the Netherlands 6 .…”