Abstract
Vertebral fractures are the hallmark of osteoporosis, responsible for increased back pain, impairment of mobility and functional limitations. These factors have an impact on patients’ health-related quality of life (QOL). The aim of this study was to evaluate the prevalence of vertebral fractures in Moroccan postmenopausal women and to assess their QOL, using an Arabic validated version of QUALEFFO. The study recruited 347 postmenopausal women in obvious good health. We excluded women who had used a drug or who had chronic diseases affecting bone metabolism. All patients had density measurements and spinal radiography. Each vertebral body (T4–L5) was graded using the semiquantitative method of Genant. The mean age was 60 years. Forty-six percent of patients had at least one vertebral fracture. The prevalence ranged from 31% in patients 50–55 years to 69% in patients 65 years and older. Patients with vertebral fractures were older (61.6 ± 8 vs 57 ± 7 years, P < 0.001), had more frequent history of nonvertebral fractures, and had spine and hip BMD values significantly lower (P < 0.001) than patients without vertebral fractures. In multivariate analysis, older age and a history of nonvertebral fractures were the two independent clinical factors of vertebral fractures. The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical function, social function, mental function, and general health [for all (P < 0.05)]. Patients with higher grades of vertebral deformities, i.e., more severe fractures, had low QOL in these four domains. Patient with thoracolumbar fractures had a worse general health than patients with thoracic or lumbar fractures. We found a high prevalence of vertebral fractures probably explained by socioeconomic factors in Morocco. QOL, assessed by an osteoporosis-specific instrument, is decreased in postmenopausal women as a function of both the number and the severity of the vertebral fractures. Treating women with prevalent fractures may avoid a further decrease in their quality of life.
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References
Lips P, Cooper C, Agnusdei D, Caulin F, Egger P et al (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int 10(2):150–160
Kiel D (1995) National osteoporosis foundation working group on vertebral fractures. Report assessing vertebral fractures. J Bone Miner Res 10:518–523
O’Neill TW, Felsenberg D, Varlow J, Cooper C et al (1996) The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11(7):1010–1018
Härmä M, Heliövaara M, Aromaa A, Knekt P (1986) Thoracic spine compression fractures in Finland. Clin Orthop 205:188–194
Koçyigit H, Gülseren S, Erol A, Hizli N, Memis A (2003) The reliability and validity of the Turkish version of Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Clin Rheumatol 22(1):18–23
Cooper C, Shah S, Hand DJ, Adams J, Compston J, Davie M et al (1991) Screening for vertebral osteoporosis using individual risk factors. Osteoporos Int 2:48–53
Spector TD, McCloskey EV, Dogle DV, Kanis JA (1993) Prevalence of vertebral fracture in women and the relationship with bone density and symptoms: the Chingford Study. J Bone Miner Res 8:817–822
Szulc P, Marchand F, Felsenberg D, Delmas PD (1998) Prevalence of vertebral deformities according to the diagnostic method. Rev Rhum Engl Ed 65:245–256
Grados F, Marcelli C, Dargent-Molina P, Roux C et al (2004) Prevalence of vertebral fractures in French women older than 75 years from the EPIDOS study. Bone 34(2):362–367
Hansen MA, Overgaard K, Nielsen VAH, Jensen GF et al (1992) No secular increase in the prevalence of vertebral fractures due to postmenopausal osteoporosis. Osteoporos Int 2:241–246
Jensen GF, Christiansen C, Boesen J, Hegedus V et al (1982) Epidemiology of postmenopausal spinal and long bone fractures: a unifying approach to postmenopausal osteoporosis. Clin Orthop 166:75–81
Bengnér U, Johnell O, Redlund-Johnell I (1988) Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif Tissue Int 42:293–296
Hasserius R, Redlund-Johnell I, Mellström D, Johansson C et al (2001) Vertebral deformation in urban Swedish men and women. Acta Orthop Scand 72:273–278
Johansson C, Mellström D, Rosengren K, Rundgren A (1993) Prevalence of vertebral fractures in 85-years old. Acta Orthop Scand 64:25–27
Pluijm SMF, Tromp AM, Smit JH, Deeg DJH, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572
Clark P, Cons-Molina F, Deleze M, Ragi S et al (2008) The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 26. [Epub ahead of print]
Baddoura R, Okais J, Awada H (2001) Incidence of fractures after the age of 50 years in the Lebanese population and implications in terms of osteoporosis. Rev Epidemiol Sante Publique 49(1):27–32
Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:302–323
Delmas PD, Genant HK, Crans GG, Stock JL, Wong M, Siris E et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and non vertebral fractures: results from the MORE trial. Bone 33:522–532
Nevitt MC, Ettinger B, Black DM et al (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800
Lyles KW, Gold DT, Shipp KM, Pieper CF et al (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601
Kanis JA, Minne HW, Meunier PJ, Ziegler R et al (1992) Quality of life and vertebral osteoporosis. Osteoporos Int 2:161–163
Lips P, Cooper C, Agnusdei D, Caulin F, Egger P et al (1997) Quality of life as outcome in the treatment of osteoporosis; the development of questionnaire for Quality of Life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38
Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46(12):1417–1432 Review
Genant HK, Wu CY, Van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148
Worls Health Organisation Study Group (1994) Assessment of fracture risk and its application to screening for post-menopausal osteoporosis. WHO Technical Report Series, No. 843. WHO, Geneva
Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334
Leplège A, Coste J (2001) Mesure de la santé perceptuelle et de la qualité de vie: méthodes et applications. Estem, Paris
Grados F, Roux C, de Vernejoul MC, Utard G et al (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722
Wu CY, Li J, Jergas M, Genant HK (1995) Comparison of semiquantitative and quantitative techniques for the assessment of prevalent and incident vertebral fractures. Osteoporos Int 5:354–370
Davies KM, Stegman MR, Heaney RP, Recker RR (1996) Prevalence and severity of vertebral fractures: the Saunders County Bone Quality Study. Osteoporos Int 6:160–165
Melton LJ III, Kan SH, Frye MA, Wahner H (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011
Melton LJ III, Lane AW, Cooper C, Eastell R et al (1993) Prevalence and incidence of vertebral deformities. Osteoporos Int 3:113–119
Jackson SA, Tenenhouse A, Robertson L (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian multicenter osteoporosis study. Osteoporos Int 11:680–687
Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ et al (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6:233–239
Lau EMC, Chan HHL, Woo J et al (1996) Normal ranges for vertebral height ratios and prevalence of vertebral fracture in Hong Kong Chinese: a comparison with American Caucasians. J Bone Miner Res 11:1364–1368
Tsai KS, Twu SJ, Chieng PU, Yang RS, Lee TK (1996) Prevalence of vertebral fractures in Chinese men and women in urban Taiwanese communities. Calcif Tissue Int 59:249–253
Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR et al (1992) The Study of Osteoporotic Fractures Research Group. Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner 7:449–456
Ettinger B, Block JE, Smith R, Cummings SR, Harris ST et al (1988) An examination of the association between vertebral deformities, physical disabilities and psychosocial problems. Maturitas 10:283–296
Adachi JD, Loannidis G, Berger C, Joseph L et al (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
Oleksik A, Lips P, Dawson A et al (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15(7):1384–1392
Burger H, van Daele PLA, Grashuis K, Hofman A, Grobbee DE, Schütte HE et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157
Silverman SL (2000) The Osteoporosis Assessment Questionnaire (OPAQ): a reliable and valid disease-targeted measure of health-related quality of life in osteoporosis. Qual Life Res 9:764–774
Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic post menopausal women. Osteoporos Int 16:2175–2179
Cook DJ, Guyatt GH, Adachi JD et al (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756
Leidig-Bruckner G, Minne HW, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T et al (1997) Clinical grading of spinal osteoporosis. Quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 12:663–675
Lydick E, Martin A, Yawn B (1996) Impact of fears on quality of life in patients with a silent disease: osteoporosis. Clin Ther 18:1307–1315
Silverman SL, Minshall ME, Shen W, Harper KD, Xie S (2001) On behalf of the health-related quality of life subgroup of the multiple outcomes of raloxifen evaluation study. Arthritis Rheum 44:2611–2619
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
Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreimer PJ, Zhao Y et al (2003) Disability after clinical fracture in post menopausal women with low bone density: the Fracture Intervention Trial. Osteoporos Int 14:69–76
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Rostom, S., Allali, F., Bennani, L. et al. The prevalence of vertebral fractures and health-related quality of life in postmenopausal women. Rheumatol Int 32, 971–980 (2012). https://doi.org/10.1007/s00296-010-1734-5
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DOI: https://doi.org/10.1007/s00296-010-1734-5