Top

Osteoporosis International

Published in:

01-01-2021 | Original Article

Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study

Authors: G. Valentin, K. Friis, C. P. Nielsen, F. B. Larsen, B. L. Langdahl

Published in: Osteoporosis International | Issue 1/2021

Abstract

Summary

Studying 12,839 fracture cases and 91,426 controls, we found that fractures of the spine and hip are associated with clinically important HRQoL deficits up to 5 years post-fracture. Fracture cases with a low educational attainment are more likely to report very low HRQoL due to a low pre-fracture HRQoL.

Introduction

The aim of this study was to explore the short-term and long-term impact of fractures on health-related quality of life (HRQoL) and to study the effect of educational attainment as a proxy for socio-economic status (SES) on post-fracture HRQoL.

Methods

In a population-based survey including 12,839 fracture cases and 91,426 controls, HRQoL was measured using the physical component score (PCS) and the mental component score (MCS) of the 12-Item Short Form Health Survey (SF-12). Information about fractures, age, sex, ethnicity, comorbidity and SES was obtained from national registers. Multiple regression analysis was conducted to measure the mean HRQoL difference, termed deficit, between non-fracture controls and fracture cases (all fractures combined and fractures at six different skeletal sites).

Results

PCS and MCS were significantly lower among fracture cases than among controls. Statistically and clinically important PCS deficits (≥ 5 points) were observed among people with fractures of the spine and hip up to 5 years post-fracture and among people with upper arm fractures up to 1 year post-fracture. Greater deficits were observed for MCS but not for PCS in post-fracture HRQoL in the low than in the high SES group.

Conclusion

Fractures of the spine and hip are associated with clinically important deficits in physical HRQoL up to 5 years post-fracture. Low educational attainment widened the gap in mental but not in physical post-fracture HRQoL. However, due to low pre-fracture PCS and MCS, people with a low educational attainment and fractures were more likely to report very low HRQoL post-fracture.

Available only for authorised users

Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos 8(1):136. https://doi.org/10.1007/s11657-013-0136-1CrossRefPubMedPubMedCentral

Kanis J, Johnell O, De Laet C, Johansson H, Odén A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382CrossRefPubMed

Alexiou KI, Roushias A, Varitimidis SE, Malizos KN (2018) Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging 13:143–150. https://doi.org/10.2147/cia.S150067CrossRefPubMedPubMedCentral

Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J (2016) Quality of life after hip fracture in the elderly: a systematic literature review. Injury 47(7):1369–1382. https://doi.org/10.1016/j.injury.2016.04.018CrossRefPubMed

Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25(8):1987–1997. https://doi.org/10.1007/s00198-014-2636-2CrossRefPubMed

Diderichsen F, Hallqvist J (1998) Social inequalities in health: some methodological considerations for the study of social position and social context. Inequality in health—a Swedish perspective Stockholm: Swedish Council for Social Research:25–39

Valentin G, Pedersen SE, Christensen R, Friis K, Nielsen CP, Bhimjiyani A, Gregson CL, Langdahl BL (2020) Socio-economic inequalities in fragility fracture outcomes: a systematic review and meta-analysis of prognostic observational studies. Osteoporos Int 31(1):31–42. https://doi.org/10.1007/s00198-019-05143-yCrossRefPubMed

Christensen AI, Ekholm O, Glumer C, Andreasen AH, Hvidberg MF, Kristensen PL, Larsen FB, Ortiz B, Juel K (2012) The Danish National Health Survey 2010. Study design and respondent characteristics. Scand J Public Health 40(4):391–397. https://doi.org/10.1177/1403494812451412CrossRefPubMed

Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490. https://doi.org/10.2147/clep.S91125CrossRefPubMedPubMedCentral

10.

Brennan SL, Pasco JA, Urquhart DM, Oldenburg B, Hanna F, Wluka AE (2009) The association between socioeconomic status and osteoporotic fracture in population-based adults: a systematic review. Osteoporos Int 20(9):1487–1497CrossRefPubMed

11.

Kosinski M, Ware JE, Turner-Bowker DM, Gandek B (2007) User’s manual for the SF-12v2 health survey : with a supplement documenting the SF-12® health survey. QualityMetric Incorporated, Lincoln, RI

12.

Frost MH, Bonomi AE, Cappelleri JC, Schünemann HJ, Moynihan TJ, Aaronson NK, Group CSCM (2007) Applying quality-of-life data formally and systematically into clinical practice. In: Mayo Clinic Proceedings. vol 10. Elsevier, pp 1214–1228

13.

Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care:582–592

14.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8CrossRefPubMed

15.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83CrossRefPubMed

16.

Kjøller M, Juel K, Kamper-Jørgensen F (2007) Folkesundhedsrapporten, Danmark 2007. Statens Institut for Folkesundhed & Syddansk Universitet, Kbh

17.

UNESCO Institute for Statistics (2012) International Standard Classification of Education: ISCED 2011

18.

Williams R (2012) Using the margins command to estimate and interpret adjusted predictions and marginal effects. Stata J 12:12–331. https://doi.org/10.1177/1536867X1201200209CrossRef

19.

Valliant R, Dever JA, Kreuter F (2013) Practical tools for designing and weighting survey samples. Statistics for Social and Behavioral Sciences. Springer-Verlag New York

20.

Liu H, Hays RD, Adams JL, Chen WP, Tisnado D, Mangione CM, Damberg CL, Kahn KL (2005) Imputation of SF-12 health scores for respondents with partially missing data. Health Serv Res 40(3):905–921. https://doi.org/10.1111/j.1475-6773.2005.00391.xCrossRefPubMedPubMedCentral

21.

Al-Sari U, Tobias J, Clark E (2016) Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 27(10):2891–2900CrossRefPubMed

22.

Tarride J-E, Burke N, Leslie WD, Morin SN, Adachi JD, Papaioannou A, Bessette L, Brown JP, Pericleous L, Muratov S (2016) Loss of health related quality of life following low-trauma fractures in the elderly. BMC Geriatr 16(1):84CrossRefPubMedPubMedCentral

23.

Borhan S, Papaioannou A, Gajic-Veljanoski O, Kennedy C, Ioannidis G, Berger C, Goltzman D, Josse R, Kovacs CS, Hanley DA (2019) Incident fragility fractures have a long-term negative impact on health-related quality of life of older people: the Canadian multicentre osteoporosis study. J Bone Miner Res 34(5):838–848CrossRefPubMed

24.

Ware J, Kosinski M, Turner-Bowker D (2005) How to score version 2 of the SF-12 health survey (with a supplement documenting version 1). Lincoln, RI; Boston, MA: QualityMetric Inc. Health Assessment Lab[Google Scholar]

25.

Diderichsen F, Hallqvist J, Whitehead M (2019) Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. Int J Epidemiol 48(1):268–274. https://doi.org/10.1093/ije/dyy167CrossRefPubMed

26.

Stafford M, Soljak M, Pledge V, Mindell J (2012) Socio-economic differences in the health-related quality of life impact of cardiovascular conditions. Eur J Pub Health 22(3):301–305. https://doi.org/10.1093/eurpub/ckr007CrossRef

27.

Leslie W, Schousboe J, Morin S, Martineau P, Lix L, Johansson H, McCloskey E, Harvey N, Kanis J (2020) Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study. Osteoporos Int:1–9

Title: Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study
Authors: G. Valentin
K. Friis
C. P. Nielsen
F. B. Larsen
B. L. Langdahl
Publication date: 01-01-2021
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2021
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05540-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Disruption of bone densitometry practice in a Northern Italy Orthopedic Hospital during the COVID-19 pandemic

Randomized, controlled trial to assess the safety and efficacy of odanacatib in the treatment of men with osteoporosis

The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density

Loss of bone density and bone strength following premenopausal risk–reducing bilateral salpingo-oophorectomy: a prospective controlled study (WHAM Study)

Upper gastrointestinal safety of oral bisphosphonate in hospitalized patients

The use of 2-, 5-, and 10-year probabilities to characterize fracture risk after a recent sentinel fracture