Sequential change in quality of life for patients with incident clinical fractures: a prospective study

Hagino, Hiroshi; Nakamura, Toshio; Fujiwara, Saeko; Oeki, Miki; Okano, T.; Teshima, Ryota

doi:10.1007/s00198-008-0761-5

Cited by 102 publications

(85 citation statements)

References 27 publications

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“…The results presented here support previous research demonstrating that hip fractures are associated with a substantial decrement in HrQoL [11,[22][23][24]. In a systematic review, hip fractures were associated with a HrQoL decrement of approximately 50 % shortly after fracture and 20 % 4 months after fracture [23].…”

Section: Discussionsupporting

confidence: 79%

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

2015

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Summary The study rationale was to provide a detailed overview of the costs, quality of life and mortality of hip fractures in Portugal. Mean individual fracture-related costs were estimated at €13, 434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. Introduction Osteoporotic fractures represent a remarkable burden to health care systems and societies worldwide, which will tend to increase as life expectancy expands and lifestyle changes favour osteoporosis. The cost-effectiveness evaluation of intervention strategies demands accurate data on the epidemiological and economical reality to be addressed. Methods Information was collected retrospectively on consumption of resources and changes in quality of life attributable to fracture as well as mortality, regarding 186 patients randomly selected to represent the distribution of hip fractures in the Portuguese population, in terms of gender, age and geographical provenience. Data were cross-tabulated with socio-demographic variables and individual resource consumption to estimate the burden of disease. A societal perspective was adopted, including direct and indirect costs.Multivariate analyses were carried out to assess the main determinants of health-related quality of life (HrQoL). Results Mean individual fracture-related costs were estimated at €13, 434 [12,290; 14,576] for the first year and €5985 [4982; 7045] for the second year following the fracture. In 2011 the economic burden attributable to osteoporotic hip fractures in Portugal could be estimated at €216 million. Mean reduction in HrQoL 12 months after fracture was estimated at 0.34. Regression analysis showed that age was associated with a higher loss of HrQoL, whereas education had the opposing effect. We observed 12 % excess mortality in the first year after hip fracture, when compared to the gender and age-matched general population. Conclusions Results of this study indicate that osteoporotic hip fractures are, also in Portugal, despite its low incidence of fractures and cost per event, associated with a high societal burden, in terms of costs, loss in HrQoL and mortality. These data provide valuable input to the design and selection of fracture prevention strategies.

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Section: Discussionsupporting

confidence: 79%

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

2015

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“…Our model may underestimate the true cost-effectiveness of alendronate treatment in osteopenic menopausal women because it may have underestimated the total risk of osteoporotic fractures. Although the impact of other osteoporotic fractures on health outcomes seems to be relatively small compared to that of hip fracture and clinical vertebral fracture, (35) the results of our analysis should be interpreted with caution. Another limitation is that we estimated the efficacy of alendronate using the meta-analysis of randomized clinical trials that were conducted in countries other than Japan.…”

Section: Discussionmentioning

confidence: 81%

“…(34) The utilities of patients who experienced fracture events were calculated by multiplying the event-free utility value by the percent reduction in utility associated with various fracture events. (35) Given the lack of data on utility values for bedridden patients, we used data for patients provided with nursing care level 5.…”

Section: Costsmentioning

confidence: 99%

Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan

Moriwaki

Komaba

Noto

et al. 2012

Journal of Bone and Mineral Research

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Many postmenopausal women have osteopenia, a condition characterized by loss of bone mineral density (BMD) that is not as severe as in osteoporosis. The objective of this study was to estimate the cost-effectiveness of alendronate to prevent fractures in osteopenic postmenopausal women without a history of fracture in Japan. An individual simulation model was developed to predict lifetime costs and quality-adjusted life years (QALYs) of 5 years of preventive alendronate therapy versus no preventive therapy. The risk of hip and vertebral fracture associated with age and BMD was derived from epidemiologic studies in Japan. We ran the model with different combinations of age (65, 70, and 75 years), BMD (70%, 75%, and 80% of young adult mean [YAM]), and additional clinical risk factors. For 70-year-old women with a BMD of 70% of the YAM having one of the following risk factors: a family history of hip fracture, high alcohol intake, or current smoking, the incremental cost-effectiveness ratio (ICER) of alendronate was $92,937, $126,251, and $129,067 per QALY, respectively. These results were sensitive to age, BMD, and number of clinical risk factors. Probabilistic sensitivity analysis for the base case showed that in the presence of one, two, and three risk factors, alendronate was cost-effective in 0.2% to 2.6%, 13.1% to 56.1%, and 99.1% of the simulations, respectively, if society is willing to pay $50,000 per QALY. Additional analysis indicated that alendronate can be a good value in osteopenic women if the 10-year probability for a osteoporotic hip or vertebral fracture is more than 26.2%. Our results indicate that whether to treat osteopenia with alendronate should be determined on the basis of age, BMD, and number of clinical risk factors in terms of cost-effectiveness. ß

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“…9 O longo período durante o qual o paciente deve ficar acamado para consolidação da fratura sem cirurgia eleva o risco de desenvolvimento de complicações sistêmicas (tais como tromboembolismo pulmonar, pneumonias e descompensações de doenças clínicas preexistentes), o que já demonstrou que o tratamento não cirúrgico tem prognóstico sombrio. 10 A fixação interna é útil em pacientes jovens, independentemente do desvio da fratura, a fim de preservar a articulação nativa do quadril. [11][12][13] No entanto, em pacientes idosos, há vários estudos que mostram a superioridade da artroplastia sobre a fixação interna.…”

Section: -7unclassified

A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastias

Sansanovicz

Baras

Silva

et al. 2016

Rev. Fac. Ciênc. Méd. Sorocaba

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A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastiasThe quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties RESUMOIntrodução: A fratura do colo femoral é uma patologia frequente na população idosa, com cerca de 100 mil casos por ano no Brasil. O tratamento cirúrgico por meio da fixação interna ou da substituição artroplástica do quadril é preconizado atualmente. O tratamento não cirúrgico é reservado aos casos de exceção. Objetivo: Comparar a qualidade de vida pós-operatória de pacientes tratados por fratura do colo femoral por meio de duas técnicas distintas: artroplastia do quadril e fixação interna. Métodos: Por meio do questionário SF-36, estudamos a qualidade de vida de 60 pacientes com mais de 65 anos, tratados entre 2004 e 2012 em nosso serviço. Metade dos pacientes foi submetida à fixação interna e a outra metade à substituição artroplástica da articulação do quadril. Resultados: Médias mais altas na ampla maioria dos parâmetros do questionário foram obtidas pelo grupo que realizou fixação interna, porém sem significância estatística na maioria dessas diferenças. Alguns relatos internacionais sinalizam que pacientes que sofreram uma fratura do colo femoral e foram tratados com fixação interna podem retornar à qualidade de vida anterior à fratura. Paradoxalmente, na atualidade, há uma crescente tendência entre os ortopedistas em optar pela substituição articular protética da articulação do quadril nesses casos. Conclusão: Mais estudos são necessários para definir qual a melhor opção cirúrgica de tratamento. Palavras-chave: fraturas do quadril; artroplastia de quadril; fixação interna de fraturas; qualidade de vida. ABSTRACT Introduction:The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surger...

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Sequential change in quality of life for patients with incident clinical fractures: a prospective study

Abstract: Loss of QOL was more severe in patients after hip or vertebral fractures than in patients with wrist fracture. HR-QOL was not completely restored in patients suffering from hip fracture.

Cited by 102 publications

References 27 publications

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

The burden of osteoporotic hip fractures in Portugal: costs, health related quality of life and mortality

Cost-effectiveness of alendronate for the treatment of osteopenic postmenopausal women in Japan

A qualidade de vida após a fratura do colo femoral nos idosos: um estudo comparativo entre fixação interna e artroplastias

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