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Health-Related Quality of Life in Postmenopausal Women with Osteoporotic Fractures
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
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.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1155
Keyword [en]
Bone Mineral Density, Hip Fracture, Osteoporosis, Spinal Deformity Index, Vertebral fracture
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-51524ISBN: 978-91-7393-508-1 (print)OAI: oai:DiVA.org:liu-51524DiVA: diva2:275441
Public defence
2009-11-20, Hälsans hus, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-09 Created: 2009-11-05 Last updated: 2009-11-09Bibliographically approved
List of papers
1. Women with low-energy fracture should be investigated for osteoporosis
Open this publication in new window or tab >>Women with low-energy fracture should be investigated for osteoporosis
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2007 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 78, no 6, 813-821 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: Treatment of osteoporosis is becoming more effective, but methods to identify patients who are most suitable for investigation and treatment are still being debated. Should any type of fracture have higher priority for investigation of osteoporosis than any other? Is the number of previous fractures useful information? Material and methods: We investigated 303 consecutive women patients between 55 and 75 years of age who had a newly diagnosed low-energy fracture. They answered a questionnaire on previous fractures which also dealt with risk factors. Bone mineral density (BMD) was measured at the hip, lumbar spine, and forearm. Results: The distribution of fracture location was: distal forearm 56%, proximal humerus 12%, vertebra 18%, and hip 13%, all with similar age. Half of the subjects had had at least one previous fracture before the index fracture, 19% had had two previous fractures, and 6% had had three or more previous fractures. Patients with vertebral or hip fracture had lower BMD and had had more previous fractures than patients with forearm or humerus fractures. There was an inverse correlation between number of fractures and BMD. Osteoporosis was present in one-third of patients with forearm fracture, in one-half of those with hip or humerus fracture, and in two-thirds of those with vertebral fracture. Interpretation: Vertebral fractures were the strongest marker of low BMD and forearm fractures the weakest. The number of previous fractures is helpful information for finding the most osteoporotic patient in terms of severity. Investigation of osteoporosis therefore seems warranted in every woman between the ages of 55 and 75 with a recent low-energy fracture, with highest priority being given to those with vertebral, hip, or multiple fractures. Copyright© Taylor & Francis 2007. all rights reserved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-41402 (URN)10.1080/17453670710014608 (DOI)56296 (Local ID)56296 (Archive number)56296 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
2. Health-related quality of life after osteoporotic fractures
Open this publication in new window or tab >>Health-related quality of life after osteoporotic fractures
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2004 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24150 (URN)10.1007/s00198-004-1622-5 (DOI)3733 (Local ID)3733 (Archive number)3733 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
3. Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study
Open this publication in new window or tab >>Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study
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2009 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, no 135Article in journal (Refereed) Published
Abstract [en]

Background

The negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.

Methods

Ninety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student’s t-tests, ANCOVA, and partial correlation.

Results

Sixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p<0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.

Conclusions

The long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-51527 (URN)10.1186/1471-2474-10-135 (DOI)
Note
Original Publication: Inger Hallberg, Margareta Bachrach-Lindström, Staffan Hammerby, Göran Toss and Anna-Christina Ek, Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study, 2009, BMC Musculoskeletal Disorders, (10), 135, . http://dx.doi.org/10.1186/1471-2474-10-135 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2017-12-12Bibliographically approved
4. A striving for independence: a qualitative study of women living with vertebral fracture
Open this publication in new window or tab >>A striving for independence: a qualitative study of women living with vertebral fracture
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.

Methods: The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.

Results: The findings of this study revealed three themes related to the influence on HRQOL and daily life: A threatened independence, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; Strategies for maintaining independence, i.e. coping, self-care and support; and The importance of maintaining independence, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. As a result of how their HRQOL and daily life have been affected by their vertebral fractures, the women in this study are striving for independence or maintaining their independence by trying to manage the different types of symptoms and consequences in different ways.

Conclusion: HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. One possible effective intervention for the future may be to support women in using self-management strategies so that they can be in charge of their situation and positively influence their HRQOL and daily life to achieve independence, but further evaluation is still needed. Information from this study may provide a foundation for guidelines for health care professionals to offer empathic and supportive care to women living with prevalent vertebral fracture.

National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-51531 (URN)
Available from: 2009-11-05 Created: 2009-11-05 Last updated: 2010-01-14Bibliographically approved

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