Osteoporosis International

, Volume 16, Issue 12, pp 2175–2179 | Cite as

The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women

  • J. Fechtenbaum
  • C. Cropet
  • S. Kolta
  • S. Horlait
  • P. Orcel
  • C. Roux
Original Article


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 assess QOL, using QUALEFFO, in osteoporotic postmenopausal women, according to the number and the severity of the vertebral fractures. A group of 629 osteoporotic postmenopausal women (60–80 years) with symptoms that, according to a rheumatologist, could be related to a vertebral fracture, had spine X-rays with standardized procedures. All the X-rays were assessed in a central facility. The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical function ( P =0.001), social function ( P =0.002) and total score ( P =0.027). Patients with higher grades of vertebral deformities, i.e., more severe fractures, had low QOL in these three domains, too ( P <0.0001, P <0.0001 and P =0.005, respectively). There was no difference in QOL according to the thoracic or lumbar location of the fractures. Both anterior and middle deformities of the vertebral bodies had a negative impact on QOL. In none of the analyses were the pain and mental function domains of QUALEFFO discriminant among the patients. QOL, assessed by an osteoporosis-specific instrument, is decreased in osteoporotic 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.


Osteoporosis QUALEFFO Quality of life Vertebral fractures 


  1. 1.
    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215PubMedGoogle Scholar
  2. 2.
    O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018PubMedGoogle Scholar
  3. 3.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedGoogle Scholar
  4. 4.
    Kotowicz MA, Melton LJ III, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605PubMedGoogle Scholar
  5. 5.
    Burger H, van Daele PLA, Algra D, Hofman A, Grobbee DE, Schütte HE, et al (1994) Vertebral deformities as predictor of non-vertebral fractures. BMJ 309:991–992PubMedGoogle Scholar
  6. 6.
    Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:302–323CrossRefGoogle Scholar
  7. 7.
    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 33:522–532CrossRefPubMedGoogle Scholar
  8. 8.
    Cauley JA, Thompson DE, Ensrud KC et al (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefGoogle Scholar
  9. 9.
    Johnell O, Kanis J, Oden A, Sernbo I, Reslund-Johnell I, Petterson C et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42CrossRefPubMedGoogle Scholar
  10. 10.
    Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–43SCrossRefPubMedGoogle Scholar
  11. 11.
    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 128:793–800PubMedGoogle Scholar
  12. 12.
    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 7:449–456Google Scholar
  13. 13.
    Burger H, van Daele PLA, Grashuis K, Hofman A, Grobbee DE, Shütte HE et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157PubMedGoogle Scholar
  14. 14.
    Leidig G, Minne HW, Sauer P, Wüster C, Wüster J, Lojen M et al (1990) A study of complaints and their relation to vertebral destruction in patients with osteoporosis. Bone Miner 8:217–229CrossRefPubMedGoogle Scholar
  15. 15.
    Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601CrossRefPubMedGoogle Scholar
  16. 16.
    Huang C, Ross PD, Wasnich RD (1996) Vertebral fracture and other predictors of physical impairment and health care utilization. Arch Intern Med 156:2469–2475CrossRefPubMedGoogle Scholar
  17. 17.
    Kanis JA, Minne HW, Meunier PJ, Ziegler R, Allender E (1992) Quality of life and vertebral osteoporosis. Osteoporos Int 2:161–163CrossRefPubMedGoogle Scholar
  18. 18.
    Lips R, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O et al (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38CrossRefPubMedGoogle Scholar
  19. 19.
    Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O et al on behalf of the Working Party of the European Foundation for Osteoporosis (1999) Quality of life in patients with vertebral fractures: validation of the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporos Int 10:150–160CrossRefPubMedGoogle Scholar
  20. 20.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedGoogle Scholar
  21. 21.
    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 10:283–296CrossRefPubMedGoogle Scholar
  22. 22.
    Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, Juniper EF (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756PubMedGoogle Scholar
  23. 23.
    Ross PD, Davis JW, Epstein RS, Wasnich RD (1994) Pain and disability associated with new vertebral fractures and other spinal conditions. J Clin Epidemiol 47:231–239CrossRefPubMedGoogle Scholar
  24. 24.
    Huang C, Ross PD, Wasnich RD (1996) Vertebral fractures and other predictors of back pain among older women. J Bone Miner Res 11:1026–1032PubMedGoogle Scholar
  25. 25.
    Begerow B, Pferfer M, Pospeschill M, Scholz M, Schlotthauer T, Lazarescu A et al (1999) Time since vertebral fracture: an important variable concerning quality of life in patients with post menopausal osteoporosis. Osteoporos Int 10:26–33CrossRefPubMedGoogle Scholar
  26. 26.
    Cockerill W, Lunt M, Silman AJ, Cooper C, Lips P, Bhalla AK et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119CrossRefPubMedGoogle Scholar
  27. 27.
    Kovacs FM, Abraira V, Zamora J, Gil del Real MT, Llobera J, Fernandez C and the Koracs-Atencion Primaria Group (2004) Correlation between pain, disability and quality of life in patients with common low back pain. Spine 29:206–210CrossRefPubMedGoogle Scholar
  28. 28.
    Van Schoor et al (2005) Impact of vertebral deformities and osteoarthritis. Osteoporos Int 16:749–756CrossRefPubMedGoogle Scholar
  29. 29.
    Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C et al (2000) Health related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15:1384–1392PubMedGoogle Scholar
  30. 30.
    Silverman SL, Minshall ME, Shen W, Harper KD, Xie S, on behalf of the Health-related Quality of Life Subgroup of the Multiple Outcomes of Raloxifen Evaluation Study. Arthritis Rheum 2001; 44:2611–2619Google Scholar
  31. 31.
    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 14:69–76CrossRefPubMedGoogle Scholar
  32. 32.
    Ensrud K, Black DM, Harris F, Ettinger B, Cummings SR (1997) Correlates of kyphosis in older women. J Am Geriatr Soc 45:682–687PubMedGoogle Scholar
  33. 33.
    Puche RC, Morosano M, Masoni A, Perez Jimeno N, Bertoluzzo SM, Podadera JC et al (1995) The natural history of kyphosis in post menopausal women. Bone 17:239–246CrossRefPubMedGoogle Scholar
  34. 34.
    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 12:663–675PubMedGoogle Scholar
  35. 35.
    Lydick E, Martin A, Yawn B (1996) Impact of fears on quality of life in patients with a silent disease: osteoporosis. Clin Ther 18:1307–1315CrossRefPubMedGoogle Scholar
  36. 36.
    Kessenich CR, Guyatt GH, Rosen CJ (1988) Health-related quality of life and participation in osteoporosis clinical trials. Calcif Tissue Int 62:189–192CrossRefGoogle Scholar
  37. 37.
    Picavet HSJ, Hoeymans N (2004) Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 63:723–729CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • J. Fechtenbaum
    • 1
  • C. Cropet
    • 2
  • S. Kolta
    • 1
  • S. Horlait
    • 3
  • P. Orcel
    • 4
  • C. Roux
    • 1
  1. 1.Department of RheumatologyDescartes University of Paris Faculty of Medicine, Hôpital CochinParisFrance
  2. 2.MAPILyonFrance
  3. 3.Procter and Gamble PharmaceuticalsParisFrance
  4. 4.Department of RheumatologyUniversité Paris 7, Assistance Publique-Hôpitaux de Paris Hôpital LariboisièreParisFrance

Personalised recommendations