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Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study

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Abstract

Summary

We studied 7,897 women with postmenopausal osteoporosis to assess factors that influence health-related quality of life (HRQoL). An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL. Understanding the factors that affect HRQoL may improve management of these patients.

Introduction

HRQoL is impaired in women treated for postmenopausal osteoporosis (PMO). The objective of this study was to examine the relationship between clinical characteristics, comorbidities, medical history, patient demographics, and HRQoL in women with PMO.

Methods

Baseline data were obtained and combined from two large and similar multinational observational studies: Prospective Observational Scientific Study Investigating Bone Loss Experience in Europe (POSSIBLE EU®) and in the US (POSSIBLE US™) including postmenopausal women in primary care settings initiating or switching bone loss treatment, or who had been on bone loss treatment for some time. HRQoL measured by health utility scores (EQ-5D™) were available for 7,897 women (94 % of study participants). The relationship between HRQoL and baseline clinical characteristics, medical history and patient demographics was assessed using parsimonious, multivariable, mixed-model analyses.

Results

Median health utility score was 0.80 (interquartile range 0.69–1.00). In multivariable analyses, young age, low body mass index, previous vertebral fracture, increased number of comorbidities, high fear of falling, and depression were associated with reduced HRQoL. Regression-based model estimates showed that previous vertebral fracture was associated with lower health utility scores by 0.08 (10.3 %) and demonstrated the impact of multiple comorbidities and of fear of falling on HRQoL.

Conclusions

In this large observational study of women with PMO, there was substantial interindividual variability in HRQoL. An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL.

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Notes

  1. The EQ-5D-3 L version was used in this study.

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Funding/support

F. Guillemin has received funding for travel and consultancy from Amgen and GlaxoSmithKline, and research grants from Merck, Pfizer, sanofi-aventis, and Expanscience. M. Calvert has received funding for travel and consultancy from Amgen. L. Martinez has received consulting fees or other remuneration from Amgen, sanofi-aventis, Pfizer, Roche, Novo Nordisk, Ipsen, and Mayoly Spindler. T.G. Ganiats has received funding for consultancy from Amgen. R. Horne has received research funding from Amgen. J. Pfeilschifter has received research grants from Roche Diagnostics and Merck Sharp & Dohme; is on the speaker's bureau for Amgen, GlaxoSmithKline, Lilly Deutschland, Novartis, and Roche and Merck Sharp & Dohme; and is an advisory board member for Amgen, Novartis, and Roche. A. Tosteson has received funding for consultancy from Amgen. S. Wade has received funding for consultancy from Amgen. N. Freemantle has received funding for research, travel, and consulting from Amgen and for research and consulting from Pfizer and Eli Lilly.

Role of the sponsor

Both the POSSIBLE EU® and POSSIBLE US™ studies were sponsored by Amgen Inc. Amgen (Europe) GmbH and GlaxoSmithKline sponsored the joint analysis for this paper. Editing support was provided by Bioscript Stirling Ltd. and Oxford Pharmagenesis, funded by Amgen (Europe) GmbH and GlaxoSmithKline, and by Lucy Hyatt of Amgen (Europe) GmbH. Amgen and GlaxoSmithKline were given the opportunity to review the manuscript, but inclusion of their comments was at the discretion of the authors.

Conflicts of interest

M. Gitlin, S. Shepherd, and D. Macarios are employees of and may hold stock in Amgen; A. Marciniak was an employee of Amgen during the conduct of the study and manuscript preparation, and may hold stock in Amgen. S. Wade is an independent consultant contracted to Amgen.

Author information

Author notes

  1. A. Marciniak

    Present address: Daichii-Sankyo Europe, Gerrards Cross, UK

Authors and Affiliations

  1. Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France

    F. Guillemin

  2. Department of General Practice, Pierre et Marie Curie University, Paris, France

    L. Martinez

  3. University of Birmingham, Edgbaston, Birmingham, UK

    M. Calvert

  4. MRC Epidemiology Resource Centre, University of Southampton, Southampton, UK

    C. Cooper

  5. Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK

    C. Cooper

  6. University of California, San Diego, CA, USA

    T. Ganiats

  7. Health Economics, Amgen (Europe) GmbH, Zug, Switzerland

    M. Gitlin

  8. Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK

    R. Horne

  9. Health Economics, Amgen Ltd., Uxbridge, UK

    A. Marciniak

  10. Alfried Krupp Krankenhaus, Essen, Germany

    J. Pfeilschifter

  11. Biostatistics, Amgen Ltd., Uxbridge, UK

    S. Shepherd

  12. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Lebanon, Lebanon, NH, USA

    A. Tosteson

  13. Wade Outcomes Research and Consulting, Salt Lake City, UT, USA

    S. Wade

  14. Health Economics, Amgen Inc., Thousand Oaks, CA, USA

    M. Gitlin & D. Macarios

  15. Department of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK

    N. Freemantle

Authors
  1. F. Guillemin
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  2. L. Martinez
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  3. M. Calvert
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Corresponding author

Correspondence to F. Guillemin.

Appendix

Appendix

Items in the OPAQ-SV fear of falling domain [21].

Questions

  1. 20.

    How often were you afraid that you would fall?

  2. 21.

    How often were you afraid that you would accidentally break or fracture a bone?

  3. 22.

    How often did you feel that you were losing balance?

  4. 23.

    How often did you use a hand rail or other support when walking up or down stairs?

  5. 24.

    How often did your fear of falling keep you from doing what you want to do?

Answer options

Always, very often, sometimes, almost never, and never.

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Guillemin, F., Martinez, L., Calvert, M. et al. Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study. Osteoporos Int 24, 3001–3010 (2013). https://doi.org/10.1007/s00198-013-2408-4

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  • DOI: https://doi.org/10.1007/s00198-013-2408-4

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