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Osteoporosis International

, Volume 23, Issue 12, pp 2863–2871 | Cite as

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women

The Global Longitudinal study of Osteoporosis in Women (GLOW)
  • C. Roux
  • A. Wyman
  • F. H. Hooven
  • S. H. Gehlbach
  • J. D. Adachi
  • R. D. Chapurlat
  • J. E. Compston
  • C. Cooper
  • A. Díez-Pérez
  • S. L. Greenspan
  • A. Z. LaCroix
  • J. C. Netelenbos
  • J. Pfeilschifter
  • M. Rossini
  • K. G. Saag
  • P. N. Sambrook
  • S. Silverman
  • E. S. Siris
  • N. B. Watts
  • S. Boonen
  • for the GLOW investigators
Original Article

Abstract

Summary

Among 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures.

Introduction

There is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life.

Methods

We analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey.

Results

Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures.

Conclusion

This prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.

Keywords

Non-hip, non-vertebral fractures Postmenopausal women Quality of life 

Notes

Acknowledgements

We thank the physicians and study coordinators participating in GLOW, the staff at the Center for Outcomes Research, including Linda Chase and Sophie Rushton-Smith, PhD. Financial support for the GLOW study is provided by Warner Chilcott Company, LLC and sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School.

Conflicts of interest

Christian Roux—honoraria/consultant/advisory board and research grants: Alliance, Amgen, Lilly, Merck, Novartis, Nycomed, Roche, GlaxoSmithKline, Servier, Wyeth.

Allison Wyman—none.

Fred H Hooven—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Stephen Gehlbach—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Jonathan D Adachi—consultant/speaker and research grants: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Servier, Warner Chilcott, Wyeth; clinical trials: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Warner Chilcott, Wyeth, Bristol-Myers Squibb.

Roland Chapurlat—funding and research grants: French Ministry of Health, French Ministry of Research, Merck, Servier, Lilly; honoraria: Amgen, Servier, Novartis, Lilly, Roche; consultant/advisory board: Amgen, Merck, Servier, Novartis.

Juliet E Compston—paid consultancy work and research grants: Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gamble, Wyeth, Pfizer, The Alliance for Better Bone Health, Roche, and GlaxoSmithKline; paid speaker and received reimbursement, travel and accommodation: Servier, Procter & Gamble, and Lilly; research grants: Servier R&D and Procter & Gamble.

Cyrus Cooper—consulting fees/lecturer and research grants: Amgen, The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott), Lilly, Merck, Servier, Novartis, Roche-GSK.

Adolfo Díez-Pérez—consulting fees/lecturer and research grants: Eli Lilly, Amgen, Procter & Gamble, Servier, Daiichi-Sankyo; expert witness: Merck; consultant/advisory board: Novartis, Eli Lilly, Amgen, Procter & Gamble.

Susan L Greenspan—consultant/advisory board and research grants: Amgen, Lilly, Merck; research grants: The Alliance for Better Bone Health (sanofi-aventis and Procter & Gamble), Lilly.

Andrea LaCroix—funding and research grants: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott); advisory board: Amgen.

J Coen Netelenbos—consultant and research grants: Roche Diagnostics, Daiichi-Sankyo, Procter & Gamble, Nycomed; speaker/reimbursement, travel and accommodation: Roche Diagnostics, Novartis, Daiichi-Sankyo, Procter & Gamble; research grants: The Alliance for Better Bone Health, Amgen.

Johannes Pfeilschifter—research grants: Amgen, Kyphon, Novartis, Roche; other research support (equipment): GE Lunar; Speakers’ bureau: Amgen, sanofi-aventis, GlaxoSmithKline, Roche, Lilly Deutschland, Orion Pharma, Merck, Merckle, Nycomed, Procter & Gamble; advisory board: Novartis, Roche, Procter & Gamble, Teva.

Maurizio Rossini—Speakers’ bureau and research grants: Roche, Merck Sharp & Dohme, GlaxoSmithKline.

Kenneth G Saag—consulting fees/other remuneration and research grants: Eli Lilly & Co, Merck, Novartis, Amgen; paid research: Eli Lilly & Co, Merck, Novartis, Amgen.

Philip N Sambrook—honoraria/consultant/advisory board and research grants: Merck, sanofi-aventis, Roche, Servier.

Stuart Silverman—research grants: Wyeth, Lilly, Novartis, Alliance; Speakers’ bureau: Lilly, Novartis, Pfizer, Procter & Gamble; honoraria: Procter & Gamble; consultant/advisory board: Lilly, Argen, Wyeth, Merck, Roche, Novartis.

Ethel S Siris—consultant and research grants: Amgen, Lilly, Novartis, The Alliance for Better Bone Health; Speakers’ bureau: Amgen, Lilly.

Nelson B Watts—honoraria and research grants: Amgen, Novartis, Warner Chilcott; consultant: Amgen, Arena, Baxter, InteKrin, Johnson & Johnson, Lilly, Medpace, Merck, NPS, Orexigen, Pfizer/Wyeth, Takeda, Vivus, Warner Chilcott; research support: Amgen, Merck, NPS; co-founder/stock options/director: OsteoDynamics.

Steven Boonen—research grants: Amgen, Lilly, Novartis, Pfizer, Procter & Gamble, sanofi-aventis, Roche, GlaxoSmithKline; honoraria/Speakers’ bureau/consultant/advisory board: Amgen, Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier. Dr Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • C. Roux
    • 1
  • A. Wyman
    • 2
  • F. H. Hooven
    • 2
  • S. H. Gehlbach
    • 2
  • J. D. Adachi
    • 3
  • R. D. Chapurlat
    • 4
  • J. E. Compston
    • 5
  • C. Cooper
    • 6
  • A. Díez-Pérez
    • 7
    • 8
  • S. L. Greenspan
    • 9
  • A. Z. LaCroix
    • 10
  • J. C. Netelenbos
    • 11
  • J. Pfeilschifter
    • 12
  • M. Rossini
    • 13
  • K. G. Saag
    • 14
  • P. N. Sambrook
    • 15
  • S. Silverman
    • 16
  • E. S. Siris
    • 17
  • N. B. Watts
    • 18
  • S. Boonen
    • 19
  • for the GLOW investigators
  1. 1.Department of Rheumatology, Cochin HospitalParis Descartes UniversityParis Cedex 14France
  2. 2.Center for Outcomes ResearchUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.St. Joseph’s HospitalMcMaster UniversityHamiltonCanada
  4. 4.Division of Rheumatology, INSERM UMR 1033Université de LyonLyonFrance
  5. 5.School of Clinical Medicine, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK
  6. 6.MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
  7. 7.Department of Medicine, Hospital del Mar–IMIM-AutonomousUniversity of BarcelonaBarcelonaSpain
  8. 8.RETICEF, ISCIIIMadridSpain
  9. 9.University of PittsburghPittsburghUSA
  10. 10.Fred Hutchinson Cancer Research CenterSeattleUSA
  11. 11.Department of EndocrinologyVU University Medical CenterAmsterdamThe Netherlands
  12. 12.Department of Internal Medicine IIIEssenGermany
  13. 13.Department of RheumatologyUniversity of VeronaVeronaItaly
  14. 14.University of Alabama–BirminghamBirminghamUSA
  15. 15.University of Sydney–Royal North Shore Hospital, St. LeonardsSydneyAustralia
  16. 16.Department of RheumatologyCedars-Sinai/UCLALos AngelesUSA
  17. 17.Department of MedicineColumbia University Medical CenterNew YorkUSA
  18. 18.Bone Health and Osteoporosis CenterUniversity of CincinnatiCincinnatiUSA
  19. 19.Leuven University Center for Metabolic Bone Diseases, Division of Geriatric MedicineKatholieke Universiteit LeuvenLouvainBelgium

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