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Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women

The Global Longitudinal study of Osteoporosis in Women (GLOW)

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Abstract

Summary

Among 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures.

Introduction

There is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life.

Methods

We analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey.

Results

Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures.

Conclusion

This prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.

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Acknowledgements

We thank the physicians and study coordinators participating in GLOW, the staff at the Center for Outcomes Research, including Linda Chase and Sophie Rushton-Smith, PhD. Financial support for the GLOW study is provided by Warner Chilcott Company, LLC and sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School.

Conflicts of interest

Christian Roux—honoraria/consultant/advisory board and research grants: Alliance, Amgen, Lilly, Merck, Novartis, Nycomed, Roche, GlaxoSmithKline, Servier, Wyeth.

Allison Wyman—none.

Fred H Hooven—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Stephen Gehlbach—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Jonathan D Adachi—consultant/speaker and research grants: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Servier, Warner Chilcott, Wyeth; clinical trials: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Warner Chilcott, Wyeth, Bristol-Myers Squibb.

Roland Chapurlat—funding and research grants: French Ministry of Health, French Ministry of Research, Merck, Servier, Lilly; honoraria: Amgen, Servier, Novartis, Lilly, Roche; consultant/advisory board: Amgen, Merck, Servier, Novartis.

Juliet E Compston—paid consultancy work and research grants: Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gamble, Wyeth, Pfizer, The Alliance for Better Bone Health, Roche, and GlaxoSmithKline; paid speaker and received reimbursement, travel and accommodation: Servier, Procter & Gamble, and Lilly; research grants: Servier R&D and Procter & Gamble.

Cyrus Cooper—consulting fees/lecturer and research grants: Amgen, The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott), Lilly, Merck, Servier, Novartis, Roche-GSK.

Adolfo Díez-Pérez—consulting fees/lecturer and research grants: Eli Lilly, Amgen, Procter & Gamble, Servier, Daiichi-Sankyo; expert witness: Merck; consultant/advisory board: Novartis, Eli Lilly, Amgen, Procter & Gamble.

Susan L Greenspan—consultant/advisory board and research grants: Amgen, Lilly, Merck; research grants: The Alliance for Better Bone Health (sanofi-aventis and Procter & Gamble), Lilly.

Andrea LaCroix—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott); advisory board: Amgen.

J Coen Netelenbos—consultant and research grants: Roche Diagnostics, Daiichi-Sankyo, Procter & Gamble, Nycomed; speaker/reimbursement, travel and accommodation: Roche Diagnostics, Novartis, Daiichi-Sankyo, Procter & Gamble; research grants: The Alliance for Better Bone Health, Amgen.

Johannes Pfeilschifter—research grants: Amgen, Kyphon, Novartis, Roche; other research support (equipment): GE Lunar; Speakers’ bureau: Amgen, sanofi-aventis, GlaxoSmithKline, Roche, Lilly Deutschland, Orion Pharma, Merck, Merckle, Nycomed, Procter & Gamble; advisory board: Novartis, Roche, Procter & Gamble, Teva.

Maurizio Rossini—Speakers’ bureau and research grants: Roche, Merck Sharp & Dohme, GlaxoSmithKline.

Kenneth G Saag—consulting fees/other remuneration and research grants: Eli Lilly & Co, Merck, Novartis, Amgen; paid research: Eli Lilly & Co, Merck, Novartis, Amgen.

Philip N Sambrook—honoraria/consultant/advisory board and research grants: Merck, sanofi-aventis, Roche, Servier.

Stuart Silverman—research grants: Wyeth, Lilly, Novartis, Alliance; Speakers’ bureau: Lilly, Novartis, Pfizer, Procter & Gamble; honoraria: Procter & Gamble; consultant/advisory board: Lilly, Argen, Wyeth, Merck, Roche, Novartis.

Ethel S Siris—consultant and research grants: Amgen, Lilly, Novartis, The Alliance for Better Bone Health; Speakers’ bureau: Amgen, Lilly.

Nelson B Watts—honoraria and research grants: Amgen, Novartis, Warner Chilcott; consultant: Amgen, Arena, Baxter, InteKrin, Johnson & Johnson, Lilly, Medpace, Merck, NPS, Orexigen, Pfizer/Wyeth, Takeda, Vivus, Warner Chilcott; research support: Amgen, Merck, NPS; co-founder/stock options/director: OsteoDynamics.

Steven Boonen—research grants: Amgen, Lilly, Novartis, Pfizer, Procter & Gamble, sanofi-aventis, Roche, GlaxoSmithKline; honoraria/Speakers’ bureau/consultant/advisory board: Amgen, Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier. Dr Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases.

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Authors and Affiliations

  1. Department of Rheumatology, Cochin Hospital, Paris Descartes University, 27 rue du Faubourg St. Jacques, 75659, Paris Cedex 14, France

    C. Roux

  2. Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA

    A. Wyman, F. H. Hooven & S. H. Gehlbach

  3. St. Joseph’s Hospital, McMaster University, Hamilton, ON, Canada

    J. D. Adachi

  4. Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France

    R. D. Chapurlat

  5. School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    J. E. Compston

  6. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    C. Cooper

  7. Department of Medicine, Hospital del Mar–IMIM-Autonomous, University of Barcelona, Barcelona, Spain

    A. Díez-Pérez

  8. RETICEF, ISCIII, Madrid, Spain

    A. Díez-Pérez

  9. University of Pittsburgh, Pittsburgh, PA, USA

    S. L. Greenspan

  10. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    A. Z. LaCroix

  11. Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

    J. C. Netelenbos

  12. Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany

    J. Pfeilschifter

  13. Department of Rheumatology, University of Verona, Verona, Italy

    M. Rossini

  14. University of Alabama–Birmingham, Birmingham, AL, USA

    K. G. Saag

  15. University of Sydney–Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia

    P. N. Sambrook

  16. Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA

    S. Silverman

  17. Department of Medicine, Columbia University Medical Center, New York, NY, USA

    E. S. Siris

  18. Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA

    N. B. Watts

  19. Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Katholieke Universiteit Leuven, Louvain, Belgium

    S. Boonen

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  1. C. Roux
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  2. A. Wyman
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  3. F. H. Hooven
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  9. A. Díez-Pérez
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  12. J. C. Netelenbos
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  13. J. Pfeilschifter
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  14. M. Rossini
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  16. P. N. Sambrook
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  17. S. Silverman
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  18. E. S. Siris
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  19. N. B. Watts
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  20. S. Boonen
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Correspondence to C. Roux.

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Roux, C., Wyman, A., Hooven, F.H. et al. Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women. Osteoporos Int 23, 2863–2871 (2012). https://doi.org/10.1007/s00198-012-1935-8

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  • DOI: https://doi.org/10.1007/s00198-012-1935-8

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