The Influence of Osteoporotic Fractures on Health-Related Quality of Life in Community-Dwelling Men and Women across Canada

Abstract

Health-related quality of life (HRQL) was examined in relation to prevalent fractures in 4816 community-dwelling Canadian men and women 50 years and older participating in the Canadian Multicentre Osteoporosis Study (CaMos). Fractures were of three categories: clinically recognized main fractures, subclinical vertebral fractures and fractures at other sites. Main fractures were divided and analyzed at the hip, spine, wrist/forearm, pelvis and rib sites. Baseline assessments of anthropometric data, medical history, therapeutic drug use, spinal radiographs and prevalent fractures were obtained from all participants. The SF-36 instrument was used as a tool to measure HRQL. A total of 652 (13.5%) main fractures were reported. Results indicated that hip, spine, wrist/forearm, pelvis and rib fractures had occurred in 78 (1.6%), 40 (0.8%), 390 (8.1%), 19 (0.4%) and 125 (2.6%) individuals, respectively (subjects may have had more than one main fracture). Subjects who had experienced a main prevalent fracture had lower HRQL scores compared with non-fractured participants. The largest differences were observed in the physical functioning (-4.0; 95% confidence intervals (CI): -6.0, -2.0) and role-physical functioning domains (-5.8; 95% CI: -9.5, -2.2). In women, the physical functioning domain was most influenced by hip (-14.9%; 95% CI: -20.9, -9.0) and pelvis (-18.1; 95% CI: -27.6, -8.6) fractures. In men, the role-physical domain was most affected by hip fractures (-35.7; 95% CI: -60.4, -11.1). Subjects who experienced subclinical vertebral fractures had lower HRQL scores than those without prevalent fractures. In conclusion, HRQL was lower in the physical functioning domain in women and the role-physical domain in men who sustained main fractures at the hip. Subclinical vertebral fractures exerted a moderate effect on HRQL.

Osteoporosis management among residents living in long-term care

“…Not only do fragility fractures impose an economic burden but there are also important human costs. Fragility fractures can reduce quality of life, increase fear of falling, and often result in impaired mobility and a loss of independence [5][6][7]. The 1-year mortality rate after hip fracture has been reported to be up to 25% for individuals returning to the community and 40% for those living in LTC [8].…”

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].…”

Glucocorticoids predict 10-year fragility fracture risk in a population-based ambulatory cohort of men and women: Canadian Multicentre Osteoporosis Study (CaMos)

“…Although current guidelines indicate that those taking glucocorticoids should be concurrently treated with bisphosphonates, they do not indicate that osteoporosis treatment is needed for previous GC use. The higher observed absolute fracture rate in those who had previously been GC treated is important given that osteoporotic fractures cause deterioration in patients' quality of life and increase health care costs [15,16]. Furthermore, vertebral fractures and hip fractures are associated with an increased risk of death in those over the age of 50 years [17].…”

“…The doses and durations of GC therapy in our participants are not known and both amount and time on GC therapy relate to fracture risk [15][16][17][18]. Our study also included participants who only were treated with oral GC and did not use parenteral and higher dose forms of GC.…”