Osteoporosis International

, Volume 23, Issue 4, pp 1361–1369 | Cite as

Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial

  • S. SilvermanEmail author
  • H. N. Viswanathan
  • Y.-C. Yang
  • A. Wang
  • S. Boonen
  • S. Ragi-Eis
  • P. Fardellone
  • N. Gilchrist
  • P. Lips
  • M. Nevitt
  • S. Palacios Gil-Antuñano
  • K. Pavelka
  • D. Revicki
  • J. Simon
  • D. Macarios
  • E. S. Siris
Original Article



In the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) study, women with incident clinical fractures reported significant declines in health-related quality of life (HRQoL). The largest declines were observed when the assessment was <3 months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain.


In the FREEDOM trial, denosumab significantly reduced the risk of new vertebral, hip, and nonvertebral fractures. We evaluated the effect of denosumab on HRQoL and the association between incident clinical fractures and HRQoL.


The FREEDOM trial enrolled 7,868 women aged 60–90 years with a total hip and/or lumbar spine BMD T-score <−2.5 and not <−4.0 at either site. Women were randomized to receive denosumab 60 mg or placebo every 6 months, in addition to daily calcium and vitamin D. HRQoL was assessed with the Osteoporosis Assessment Questionnaire-Short Version (OPAQ-SV) at baseline and every 6 months for 36 months. The OPAQ-SV assesses physical function, emotional status, and back pain. Higher scores indicate better health status.


No statistically significant differences in mean change in HRQoL from baseline to end of study were found when comparing treatment groups. Compared with women without any incident fractures during the study, women with incident clinical fractures reported significant declines in physical function (−4.0 vs. −0.5) and emotional status (−5.0 vs. −0.8) at month 36 (P < 0.001 for both). Importantly, time-dependent covariate analyses demonstrated that the largest declines were observed when the assessment was <3 months post fracture. The largest impact of incident clinical fractures was on physical function, and that of incident clinical vertebral fractures was on back pain.


These findings not only demonstrate that incident clinical fractures impact HRQoL but also contribute new information regarding the impact of these fracture events on HRQoL over time.


Health-related quality of life Incident clinical fracture OPAQ-SV Osteoporosis 



Amgen Inc. sponsored this study. The authors would like to thank Michelle Geller, MD; Andreas Grauer, MD; Luanda Grazette, MD; and Cesar Libanati, MD, for their contribution toward the development of the comorbidity index, and Michelle N. Bradley, PhD, who provided medical writing support on behalf of Amgen Inc.

Conflicts of interest

This study was funded by Amgen Inc. S. Silverman is a consultant, speaker, and/or research investigator for Amgen Inc., Eli Lilly, Merck, Novartis, Procter & Gamble, Roche Diagnostics, Roche Pharmaceuticals, and Wyeth. H. N. Viswanathan, Y-C Yang, A. Wang, and D. Macarios are employees and shareholders of Amgen Inc. S. Boonen is a consultant for Amgen Inc. S. Ragi-Eis is a consultant, advisory board member, speaker, and/or research investigator for Amgen Inc., Merck, Novartis, Pfizer, Roche, and Sanofi–Aventis. P. Fardellone, N. Gilchrist, S. Palacios, and K. Pavelka are investigators for Amgen Inc. P. Lips is a speaker and/or research investigator for Amgen Inc., Eli Lilly, Merck, Servier, and Wyeth. M. Nevitt and D. Revicki are consultants and investigators for Amgen Inc. J. Simon is a consultant, advisory board member, speaker, and/or research investigator for Allergan, The Alliance for Better Bone Health, Amgen Inc., Ascend Therapeutics, Barr, Bayer, BioSante, Boehringer Ingelheim, Corcept Therapeutics, FemmePharma, GSK, KV Pharmaceutical, Meditrina Pharmaceuticals, Merck, Merrion Pharmaceuticals, Nanma/Tripharma/Trinity, Novartis, Novo Nordisk, Novogyne, Pear Tree Pharmaceuticals, Procter & Gamble, QuatRx Pharmaceuticals, Roche, Schering-Plough, Sciele, Solvay, Warner Chilcott, and Wyeth. E. Siris is a consultant, advisory board member, and/or speaker for Amgen, Eli Lilly, Merck, Novartis, and Pfizer.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • S. Silverman
    • 1
    Email author
  • H. N. Viswanathan
    • 2
  • Y.-C. Yang
    • 2
  • A. Wang
    • 2
  • S. Boonen
    • 3
  • S. Ragi-Eis
    • 4
  • P. Fardellone
    • 5
  • N. Gilchrist
    • 6
  • P. Lips
    • 7
  • M. Nevitt
    • 8
  • S. Palacios Gil-Antuñano
    • 9
  • K. Pavelka
    • 10
  • D. Revicki
    • 11
  • J. Simon
    • 12
  • D. Macarios
    • 2
  • E. S. Siris
    • 13
  1. 1.Cedars-Sinai/UCLA and OMC Clinical Research CenterBeverly HillsUSA
  2. 2.Amgen IncThousand OaksUSA
  3. 3.Leuven UniversityLeuvenBelgium
  4. 4.CEDOES Diagnóstico e PesquisaVitóriaBrazil
  5. 5.CHU Amiens, INSERM ERI 12AmiensFrance
  6. 6.CGM Research Trust and Canterbury District Health BoardChristchurchNew Zealand
  7. 7.VU University Medical CenterAmsterdamThe Netherlands
  8. 8.University of California San FranciscoSan FranciscoUSA
  9. 9.Palacios Institute of Woman’s HealthMadridSpain
  10. 10.Charles UniversityPragueCzech Republic
  11. 11.United BioSource CorporationBethesdaUSA
  12. 12.Women’s Health & Research Consultants®WashingtonUSA
  13. 13.Columbia University Medical CenterNew YorkUSA

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