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.
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References
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 15:20–26
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 15:38–42
Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112
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 18:1254–1260
Melton LJ III (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141
Melton LJ III (1997) Epidemiology of spinal osteoporosis. Spine 22:2S–11S
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 14:69–76
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 8:364–372
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 10:66–72
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 32:718–724
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 14:821–828
Melton LJ III, Atkinson EJ, Cooper C, O’Fallon WM, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221
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 12:85–90
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 11:1010–1018
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 11:680–687
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 113:220–228
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 10:259–264
Anonymous (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8 [Suppl 4]:S7–80
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 182:297–300
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 15:113–119
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 128:793–800
Silverman SL, Cranney A (1997) Quality of life measurement in osteoporosis. J Rheumatol 24:1218–1221
Huang C, Ross PD, Wasnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475
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 10:26–33
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
Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483
Ioannidis G, Gordon M, Adachi JD (2001) Quality of life in osteoporosis. Nurs Clin North Am 36:481–489, ix
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 10:207–213
Anonymous (1997) Measuring quality of life in women with osteoporosis. Osteoporosis Quality of Life Study Group. Osteoporos Int 7:478–487
Thompson DR, Yu CM (2003) Quality of life in patients with coronary heart disease-I: assessment tools. Health Qual Life Outcomes 1:42
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 15:1384–1392
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 9:508–515
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 14:895–904
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 3:11
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 12:903–908
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 30:1579–1583
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 12:1042–1049
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 44:2611–2619
Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841
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 25:1171–1179
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
Guyatt G, Walter S, Norman G (1987) Measuring change over time: assessing the usefulness of evaluative instruments. J Chronic Dis 40:171–178
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 47:81–87
Rubin D (1976) Inference and missing data. Biometrika 63:581–590
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 21:711–730
Rapado A (1996) General management of vertebral fractures. Bone 18:191S–196S
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 288:3027–3034
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 14:677–682
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
Fogari R, Zoppi A (2004) Effect of antihypertensive agents on quality of life in the elderly. Drugs Aging 21:377–393
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 154:2154–2160
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 18:239–245
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 20:2069–2079
Fletcher A (1999) Quality of life in the management of hypertension. Clin Exp Hypertens 21:961–972
Anonymous (1999) 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. Guidelines subcommittee. J Hypertens 17:151–183
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 27:258–260
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 15:615–624
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 18:95–103
Martinez JA, Mota GA, Vianna ES, Filho JT, Silva GA, Rodrigues AL Jr (2004) Impaired quality of life of healthy young smokers. Chest 125:425–428
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 13:156–164
Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR (2003) Obesity and quality of life: mediating effects of pain and comorbidities. Obes Res 11:209–216
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 27:1227–1232
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 5:85–88
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Papaioannou, A., Kennedy, C.C., Ioannidis, G. et al. Determinants of health-related quality of life in women with vertebral fractures. Osteoporos Int 17, 355–363 (2006). https://doi.org/10.1007/s00198-005-2020-3
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DOI: https://doi.org/10.1007/s00198-005-2020-3