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Health-related quality of life after osteoporotic fractures
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
Department of Geriatrics, Ryhovs Hospital, Jönköping, Sweden.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
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2004 (English)In: Osteoporosis International, ISSN 0937-941X, Vol. 15, no 10, 834-841 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To estimate the impact of osteoporosis fractures on health-related quality of life (HRQOL) in postmenopausal women. Methods: To compare the impact on HRQOL of different osteoporotic fractures, 600 consecutive women 55-75 years old with a new fracture (inclusion fracture) were invited by mail. After exclusions by preset criteria (high-energy fractures, ongoing osteoporosis treatment, or unwillingness to participate), 303 women were included, 171 (56%) of whom had a forearm, 37 (12%) proximal humerus, 40 (13%) hip, and 55 (18%) vertebral fracture, respectively, and all were investigated and treated according to the current local consensus program for osteoporosis. In addition, HRQOL was evaluated by the SF-36 questionnaire and compared with local, age-matched reference material. Examinations were performed 82 days (median) after the fracture and 2 years later. Results: HRQOL was significantly reduced at baseline regarding all SF-36 domains after vertebral fractures and most after hip fractures, but only regarding some domains after forearm and humerus fracture. After 2 years, improvements had occurred after all types of fractures, and after forearm or humerus fracture, HRQOL was completely normalized in all domains. However, 2 years after hip fracture, HRQOL was still below normal regarding physical function, role-physical and social function, while after vertebral fracture, scores were still significantly lower for all domains, physical as well as mental. Patients with one or more previous fractures before the inclusion fracture had lower HRQOL at baseline and after 2 years, compared with those with no previous fracture. Patients with osteoporosis (T-score < - 2.5 in hip or spine) had lower HRQOL than those with normal BMD. Conclusion: Vertebral and hip fractures have a considerably greater and more prolonged impact on HRQOL than forearm and humerus fractures. The number of fractures was inversely correlated to HRQOL. These differences should be taken into account when making priorities in health care programs.

Place, publisher, year, edition, pages
2004. Vol. 15, no 10, 834-841 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-24150DOI: 10.1007/s00198-004-1622-5Local ID: 3733OAI: diva2:244467
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2009-11-09Bibliographically approved
In thesis
1. Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures
Open this publication in new window or tab >>Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The global burden of osteoporosis includes considerable numbers of fractures, morbidity, mortality and expenses, due mainly to vertebral, hip and forearm fractures. Underdiagnosis and undertreatment are common. Several studies have shown decreased health-related quality of life (HRQOL) after osteoporotic fracture, but there is a lack of data from long-term follow-up studies, particularly regarding vertebral fractures, which are often overlooked despite patients reporting symptoms.

Aim: The overall aim of this thesis was to evaluate the usefulness of a recent low-energy fracture as index event in a case-finding strategy for osteoporosis and to describe and analyse long-term HRQOL in postmenopausal women with osteoporotic fracture. The specific aims were to describe bone mineral density and risk factors in women 55-75 years of age with a recent low-energy fracture (I), estimate the impact of osteoporotic fractures on HRQOL in women three months and two years after a forearm, proximal humerus, vertebral or hip fracture (II), investigate the changes and long-term impact of vertebral or hip fracture on HRQOL in women prospectively between two and seven years after the inclusion fracture (III), and describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis (IV).

Design and methods: Data were collected from southern Sweden between 1998 and 2008. A total of 303 women were included in Study I, and this group served as the basis for Studies II (n=303), III (n=67), and IV (n=10). A cross-sectional observational, case-control design (I), and a prospective longitudinal observational design (II-III) were used. In Study IV a qualitative inductive approach with interviews was used and data were analysed using a qualitative conventional content analysis.

Results: The type of recent fracture and number of previous fractures are important information for finding the most osteoporotic women in terms of severity (I). Hip and vertebral fractures in particular have a significantly larger impact on HRQOL evaluated using the SF-36 than do humerus and forearm fractures, both during the three months after fracture and two years later, compared between the different fracture groups and the reference population (II). Women who had a vertebral fracture as inclusion fracture had remaining pronounced reduction of HRQOL at seven years. At the mean age of 75.5 years (±4.6 SD), the prevalence of vertebral fracture suggests more negative long-term impact on HRQOL, more severe osteoporosis and a poorer prognosis than a hip fracture does, and this effect may have been underestimated in the past (III). Study IV demonstrates that the women’s HRQOL and daily life have been strongly affected by the long-term impact of the vertebral fracture several years after diagnosis. The women strive to maintain their independence by trying to manage different types of symptoms and consequences in different ways.

Conclusions and implications: Type and number of fractures should be taken into account in the case-finding strategy for osteoporosis in postmenopausal women between 55 and 75 years of age. The long-term reduction of HRQOL in postmenopausal women (age span 55-75 yr) with vertebral fracture emerged clearly, compared to women with other types of osteoporotic fractures and references in this thesis. The results ought to be taken into consideration when developing guidelines for more effective fracture prevention and treatment, including non-pharmacological intervention for women with osteoporotic fractures, with highest priority placed on vertebral fractures and multiple fractures, to increase or maintain HRQOL.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 84 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1155
Bone Mineral Density, Hip Fracture, Osteoporosis, Spinal Deformity Index, Vertebral fracture
National Category
urn:nbn:se:liu:diva-51524 (URN)978-91-7393-508-1 (ISBN)
Public defence
2009-11-20, Hälsans hus, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Available from: 2009-11-09 Created: 2009-11-05 Last updated: 2009-11-09Bibliographically approved

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Hallberg, IngerLöfman, OweWahlström, OlaToss, Göran
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Nursing ScienceFaculty of Health SciencesDepartment of Department of Health and SocietyCentre for Public Health SciencesOrthopaedics and Sports MedicineDepartment of Orthopaedics LinköpingInternal MedicineDepartment of Endocrinology and Gastroenterology UHL
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