Top

Published in:

01-03-2006 | Original Article

Determinants of health-related quality of life in women with vertebral fractures

Authors: Alexandra Papaioannou, Courtney C. Kennedy, George Ioannidis, Jacques P. Brown, Anjali Pathak, David A. Hanley, Robert G. Josse, Rolf J. Sebaldt, Wojciech P. Olszynski, Alan Tenenhouse, Timothy M. Murray, Annie Petrie, Charles H. Goldsmith, Jonathan D. Adachi

Published in: Osteoporosis International | Issue 3/2006

Abstract

Health-related quality of life (HRQL) is an important consideration in the management of patients with vertebral fractures. The purpose of this study was to examine patient-related factors that contribute to HRQL after vertebral fractures, including co-morbidities, medications, fracture history, family disease history, demographics, exercise, education and living environment. A total of 1,129 post-menopausal women (mean age 67.2, SD 11.9 years) was studied from the Canadian Database of Osteoporosis and Osteopenia (CANDOO). HRQL was measured using the mini-osteoporosis quality of life questionnaire (mini-OQLQ). Separate multivariable linear regression analyses [parameter estimates and corresponding 95% confidence intervals (CI)] were performed for each of the five mini-OQLQ domains: symptoms, physical functioning, emotional functioning, activities of daily living and leisure domains. A strong positive association was found between HRQL and post-secondary education, a family history of osteoporosis, working and thiazide therapy. Exercise improved HRQL; however, several hours a week were required to be meaningful. Living in long-term care had the most marked negative effect on HRQL. Smoking, past surgery of the hip or spine, sedatives, anticonvulsants, atherosclerotic disease and hypertension were also associated with a substantially decreased HRQL across several domains. Calcium channel-blockers, chemotherapy, corticosteroids, diabetes, migraines, the number of non-vertebral fractures and falls had a negative impact on selected domains. We demonstrated that several modifiable factors influence HRQL in patients with vertebral fractures, and physicians should be aware of these and other markers of reduced HRQL to enhance patient care.

Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26PubMedCrossRef

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42CrossRefPubMed

Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112PubMedCrossRef

Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260PubMedCrossRef

Melton LJ III (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141PubMedCrossRef

Melton LJ III (1997) Epidemiology of spinal osteoporosis. Spine 22:2S–11SCrossRefPubMed

Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreiner PJ, Zhao Y, Cummings SR, Nevitt MC (2003) Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 14:69–76PubMedCrossRef

Matthis C, Weber U, O’Neill TW, Raspe H (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372PubMedCrossRef

De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72PubMedCrossRef

10.

Ethgen O, Tellier V, Sedrine WB, De Maeseneer J, Gosset C, Reginster JY (2003) Health-related quality of life and cost of ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers? Bone 32:718–724PubMedCrossRef

11.

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828PubMedCrossRef

12.

Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221CrossRefPubMed

13.

Ismail AA, Cockerill W, Cooper C, Finn JD, Abendroth K, Parisi G, Banzer D, Benevolenskaya LI, Bhalla AK, Armas JB, Cannata JB, Delmas PD, Dequeker J, Dilsen G, Eastell R, Ershova O, Falch JA, Felsch B, Havelka S, Hoszowski K, Jajic I, Kragl U, Johnell O, Lopez VA, Lorenc R, Lyritis G, Marchand F, Masaryk P, Matthis C, Miazgowski T, Pols HA, Poor G, Rapado A, Raspe HH, Reid DM, Reisinger W, Janott J, Scheidt-Nave C, Stepan J, Todd C, Weber K, Woolf AD, Ambrecht G, Gowin W, Felsenberg D, Lunt M, Kanis JA, Reeve J, Silman AJ, O’Neill TW (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12:85–90PubMedCrossRef

14.

O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018PubMedCrossRef

15.

Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687PubMedCrossRef

16.

Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228CrossRefPubMed

17.

Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi ES, Gennari C, Johnell O, Johnston CC Jr, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N (1999) Interim report and recommendations of the World Health Organization Task Force for Osteoporosis. Osteoporos Int 10:259–264CrossRefPubMed

18.

Anonymous (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8 [Suppl 4]:S7–80

19.

Kim N, Rowe BH, Raymond G, Jen H, Colman I, Jackson SA, Siminoski KG, Chahal AM, Folk D, Majumdar SR (2004) Underreporting of vertebral fractures on routine chest radiography. AJR Am J Roentgenol 182:297–300PubMed

20.

Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK, Cannata JB, Eastell R, Felsenberg D, Gennari C, Johnell O, Kanis JA, Kiss C, Masaryk P, Naves M, Poor G, Raspe H, Reid DM, Reeve J, Stepan J, Todd C, Woolf AD, O’Neill TW (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119CrossRefPubMed

21.

Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800PubMed

22.

Silverman SL, Cranney A (1997) Quality of life measurement in osteoporosis. J Rheumatol 24:1218–1221PubMed

23.

Huang C, Ross PD, Wasnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475PubMedCrossRef

24.

Begerow B, Pfeifer M, Pospeschill M, Scholz M, Schlotthauer T, Lazarescu A, Pollaehne W, Minne HW (1999) Time since vertebral fracture: an important variable concerning quality of life in patients with postmenopausal osteoporosis. Osteoporos Int 10:26–33CrossRefPubMed

25.

National Center for Chronic Disease Prevention and Health Promotion (2004) Health-related quality of life. http://www.cdc.gov/hrqol/index.htm. 5–13–2004. 7–5-0004

26.

Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef

27.

Ioannidis G, Gordon M, Adachi JD (2001) Quality of life in osteoporosis. Nurs Clin North Am 36:481–489, ixPubMed

28.

Cook DJ, Guyatt GH, Adachi JD, Epstein RS, Juniper EF, Austin PA, Clifton J, Rosen CJ, Kessenich CR, Stock JL, Overdorf J, Miller PD, Erickson AL, McCLung MR, McClung BL, Griffith LE, Ioannidis G (1999) Development and validation of the mini-osteoporosis quality of life questionnaire (OQLQ) in osteoporotic women with back pain due to vertebral fractures. Osteoporosis Quality of Life Study Group. Osteoporos Int 10:207–213CrossRefPubMed

29.

Anonymous (1997) Measuring quality of life in women with osteoporosis. Osteoporosis Quality of Life Study Group. Osteoporos Int 7:478–487PubMedCrossRef

30.

Thompson DR, Yu CM (2003) Quality of life in patients with coronary heart disease-I: assessment tools. Health Qual Life Outcomes 1:42PubMedCrossRef

31.

Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392PubMedCrossRef

32.

Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515CrossRefPubMed

33.

Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA, Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S, Joyce C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA (2003) The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 14:895–904CrossRefPubMed

34.

Adachi JD, Ioannidis G, Olszynski WP, Brown JP, Hanley DA, Sebaldt RJ, Petrie A, Tenenhouse A, Stephenson GF, Papaioannou A, Guyatt GH, Goldsmith CH (2002) The impact of incident vertebral and non-vertebral fractures on health related quality of life in postmenopausal women. BMC Musculoskelet Disord 3:11CrossRefPubMed

35.

Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, AnastassiadesT, Brown JP, Murray T, Jackson SA, Tenenhouse A (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908PubMedCrossRef

36.

Oglesby AK, Minshall ME, Shen W, Xie S, Silverman SL (2003) The impact of incident vertebral and non-vertebral fragility fractures on health-related quality of life in established postmenopausal osteoporosis: results from the teriparatide randomized, placebo-controlled trial in postmenopausal women. J Rheumatol 30:1579–1583PubMed

37.

Tosteson AN, Gabriel SE, Grove MR, Moncur MM, Kneeland TS, Melton LJ III (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 12:1042–1049PubMedCrossRef

38.

Silverman SL, Minshall ME, Shen W, Harper KD, Xie S (2001) The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum 44:2611–2619CrossRefPubMed

39.

Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841CrossRefPubMed

40.

Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire. J Rheumatol 25:1171–1179PubMed

41.

Sebaldt RJ, Adachi JD (1996) Canadian database of osteoporosis and osteopenia patients (CANDOO). Canadian Organization for the Advancement of Computers in Healthcare Proceedings 21:41–44

42.

Guyatt G, Walter S, Norman G (1987) Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:171–178CrossRefPubMed

43.

Juniper EF, Guyatt GH, Willan A, Griffith LE (1994) Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol 47:81–87CrossRefPubMed

44.

Rubin D (1976) Inference and missing data. Biometrika 63:581–590CrossRef

45.

Xenodemetropoulos T, Davison S, Ioannidis G, Adachi JD (2004) The impact of fragility fracture on health-related quality of life: the importance of antifracture therapy. Drugs Aging 21:711–730CrossRefPubMed

46.

Rapado A (1996) General management of vertebral fractures. Bone 18:191S–196SCrossRefPubMed

47.

Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK (2002) Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA 288:3027–3034CrossRefPubMed

48.

Papaioannou A, Adachi JD, Winegard K, Ferko N, Parkinson W, Cook RJ, Webber C, McCartney N (2003) Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures. Osteoporos Int 14:677–682CrossRefPubMed

49.

Mo F, Choi BC, Li FC, Merrick J (2004) Using the Health Utility Index (HUI) for measuring the impact on health-related quality of life (HRQL) among individuals with chronic diseases. Sci World J 4:746–757

50.

Fogari R, Zoppi A (2004) Effect of antihypertensive agents on quality of life in the elderly. Drugs Aging 21:377–393CrossRefPubMed

51.

Applegate WB, Pressel S, Wittes J, Luhr J, Shekelle RB, Camel GH, Greenlick MR, Hadley E, Moye L, Perry HM Jr (1994) Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Arch Intern Med 154:2154–2160CrossRefPubMed

52.

Degl’Innocenti A, Elmfeldt D, Hofman A, Lithell H, Olofsson B, Skoog I, Trenkwalder P, Zanchetti A, Wiklund I (2004) Health-related quality of life during treatment of elderly patients with hypertension: results from the Study on Cognition and Prognosis in the Elderly (SCOPE). J HumHypertens 18:239–245CrossRef

53.

Fletcher AE, Bulpitt CJ, Thijs L, Tuomilehto J, Antikainen R, Bossini A, Browne J, Duggan J, Kawecka-Jaszcz K, Kivinen P, Sarti C, Terzoli L, Staessen JA (2002) Quality of life on randomized treatment for isolated systolic hypertension: results from the Syst-Eur Trial. J Hypertens 20:2069–2079CrossRefPubMed

54.

Fletcher A (1999) Quality of life in the management of hypertension. Clin Exp Hypertens 21:961–972PubMedCrossRef

55.

Anonymous (1999) 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. Guidelines subcommittee. J Hypertens 17:151–183PubMed

56.

Mitra M, Chung MC, Wilber N, Klein WD (2004) Smoking status and quality of life: a longitudinal study among adults with disabilities. Am J Prev Med 27:258–260PubMed

57.

Turner J, Page-Shafer K, Chin DP, Osmond D, Mossar M, Markstein L, Huitsing J, Barnes S, Clemente V, Chesney M (2001) Adverse impact of cigarette smoking on dimensions of health-related quality of life in persons with HIV infection. AIDS Patient Care STDS 15:615–624CrossRefPubMed

58.

Oldridge N, Gottlieb M, Guyatt G, Jones N, Streiner D, Feeny D (1998) Predictors of health-related quality of life with cardiac rehabilitation after acute myocardial infarction. J Cardiopulm Rehabil 18:95–103CrossRefPubMed

59.

Martinez JA, Mota GA, Vianna ES, Filho JT, Silva GA, Rodrigues AL Jr (2004) Impaired quality of life of healthy young smokers. Chest 125:425–428CrossRefPubMed

60.

Marchesini G, Solaroli E, Baraldi L, Natale S, Migliorini S, Visani F, Forlani G, Melchionda N (2000) Health-related quality of life in obesity: the role of eating behaviour. Diabetes Nutr Metab 13:156–164PubMed

61.

Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR (2003) Obesity and quality of life: mediating effects of pain and comorbidities. Obes Res 11:209–216PubMed

62.

Hassan MK, Joshi AV, Madhavan SS, Amonkar MM (2003) Obesity and health-related quality of life: a cross-sectional analysis of the US population. Int J Obes Relat Metab Disord 27:1227–1232CrossRefPubMed

63.

Fontaine KR, Barofsky I, Bartlett SJ, Franckowiak SC, Andersen RE (2004) Weight loss and health-related quality of life: results at 1-year follow-up. Eat Behav 5:85–88CrossRefPubMed

Title: Determinants of health-related quality of life in women with vertebral fractures
Authors: Alexandra Papaioannou
Courtney C. Kennedy
George Ioannidis
Jacques P. Brown
Anjali Pathak
David A. Hanley
Robert G. Josse
Rolf J. Sebaldt
Wojciech P. Olszynski
Alan Tenenhouse
Timothy M. Murray
Annie Petrie
Charles H. Goldsmith
Jonathan D. Adachi
Publication date: 01-03-2006
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 3/2006
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-005-2020-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Determinants of health-related quality of life in women with vertebral fractures

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2006

The long-term predictive value of bone mineral density measurements for fracture risk is independent of the site of measurement and the age at diagnosis: results from the Prospective Epidemiological Risk Factors study

Intensity of exercise is associated with bone density change in premenopausal women

Racial variations in antiresorptive medication use: results from the 2000 Medical Expenditure Panel Survey (MEPS)

Teriparatide vs. calcitonin in the treatment of Asian postmenopausal women with established osteoporosis

The role of collagen in bone strength

Trend in hip fracture epidemiology over a 14-year period in a Spanish population