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



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.


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.


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.


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.


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.


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



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.


  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  2. 2.
    Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427PubMedCrossRefGoogle Scholar
  3. 3.
    Cuddihy MT, Gabriel SE, Crowson CS, O’Fallon WM, Melton LJ 3rd (1999) Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int 9:469–475PubMedGoogle Scholar
  4. 4.
    Huntjens KM, Kosar S, van Geel TA, Geusens PP, Willems P, Kessels A, Winkens B, Brink P, van Helden S (2010) Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int 21:2075–2082PubMedCrossRefGoogle Scholar
  5. 5.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, 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 15:721–739PubMedCrossRefGoogle Scholar
  6. 6.
    Lauritzen JB, Schwarz P, McNair P, Lund B, Transbol I (1993) Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation. Osteoporos Int 3:133–137PubMedCrossRefGoogle Scholar
  7. 7.
    Finigan J, Greenfield DM, Blumsohn A, Hannon RA, Peel NF, Jiang G, Eastell R (2008) Risk factors for vertebral and nonvertebral fracture over 10 years: a population-based study in women. J Bone Miner Res 23:75–85PubMedCrossRefGoogle Scholar
  8. 8.
    Graafmans WC, Ooms ME, Bezemer PD, Bouter LM, Lips P (1996) Different risk profiles for hip fractures and distal forearm fractures: a prospective study. Osteoporos Int 6:427–431PubMedCrossRefGoogle Scholar
  9. 9.
    Honkanen R, Tuppurainen M, Kroger H, Alhava E, Saarikoski S (1998) Relationships between risk factors and fractures differ by type of fracture: a population-based study of 12,192 perimenopausal women. Osteoporos Int 8:25–31PubMedCrossRefGoogle Scholar
  10. 10.
    Nguyen TV, Center JR, Sambrook PN, Eisman JA (2001) Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: the Dubbo Osteoporosis Epidemiology Study. Am J Epidemiol 153:587–595PubMedCrossRefGoogle Scholar
  11. 11.
    Pike C, Birnbaum HG, Schiller M, Swallow E, Burge RT, Edgell ET (2011) Economic burden of privately insured non-vertebral fracture patients with osteoporosis over a 2-year period in the US. Osteoporos Int 22:47–56PubMedCrossRefGoogle Scholar
  12. 12.
    Ray NF, Chan JK, Thamer M, Melton LJ 3rd (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35PubMedCrossRefGoogle Scholar
  13. 13.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRefGoogle Scholar
  14. 14.
    Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908PubMedCrossRefGoogle Scholar
  15. 15.
    Dennison EM, Jameson KA, Syddall HE, Martin HJ, Cushnaghan J, Aihie Sayer A, Cooper C (2010) Bone health and deterioration in quality of life among participants from the Hertfordshire cohort study. Osteoporos Int 21:1817–1824PubMedCrossRefGoogle Scholar
  16. 16.
    Fechtenbaum J, Cropet C, Kolta S, Horlait S, Orcel P, Roux C (2005) The severity of vertebral fractures and health-related quality of life in osteoporotic postmenopausal women. Osteoporos Int 16:2175–2179PubMedCrossRefGoogle Scholar
  17. 17.
    Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841PubMedCrossRefGoogle Scholar
  18. 18.
    Dolan P, Torgerson D, Kakarlapudi TK (1999) Health-related quality of life of Colles’ fracture patients. Osteoporos Int 9:196–199PubMedCrossRefGoogle Scholar
  19. 19.
    Hooven FH, Adachi JD, Adami S, Boonen S, Compston J, Cooper C, Delmas P, Diez-Perez A, Gehlbach S, Greenspan SL, LaCroix A, Lindsay R, Netelenbos JC, Pfeilschifter J, Roux C, Saag KG, Sambrook P, Silverman S, Siris E, Watts NB, Anderson FA Jr (2009) The Global Longitudinal Study of Osteoporosis in Women (GLOW): rationale and study design. Osteoporos Int 20:1107–1116PubMedCrossRefGoogle Scholar
  20. 20.
    (1990) EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16:199–208Google Scholar
  21. 21.
    Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160–164PubMedCrossRefGoogle Scholar
  22. 22.
    Sullivan PW, Lawrence WF, Ghushchyan V (2005) A national catalog of preference-based scores for chronic conditions in the United States. Med Care 43:736–749PubMedCrossRefGoogle Scholar
  23. 23.
    Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L, Hanley DA, Olszynski WP, Murray TM, Anastassiades T, Hopman W, Brown JP, Kirkland S, Joyce C, Papaioannou A, Poliquin S, Tenenhouse A, Papadimitropoulos EA (2003) The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 14:895–904PubMedCrossRefGoogle Scholar
  24. 24.
    Adachi JD, Adami S, Gehlbach S, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Delmas P, Diez-Perez A, Greenspan SL, Hooven FH, LaCroix AZ, Lindsay R, Netelenbos JC, Wu O, Pfeilschifter J, Roux C, Saag KG, Sambrook PN, Silverman S, Siris ES, Nika G, Watts NB (2010) Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc 85:806–813PubMedCrossRefGoogle Scholar
  25. 25.
    Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366:1885–1893PubMedCrossRefGoogle Scholar
  26. 26.
    Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int 9:29–37PubMedCrossRefGoogle Scholar
  27. 27.
    Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16(Suppl 2):S8–S17PubMedCrossRefGoogle Scholar
  28. 28.
    Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954PubMedCrossRefGoogle Scholar
  29. 29.
    Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995PubMedCrossRefGoogle Scholar
  30. 30.
    Fink HA, Ensrud KE, Nelson DB, Kerani RP, Schreiner PJ, Zhao Y, Cummings SR, Nevitt MC (2003) Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 14:69–76PubMedCrossRefGoogle Scholar
  31. 31.
    Roux C, Briot K, Horlait S, Varbanov A, Watts NB, Boonen S (2007) Assessment of non-vertebral fracture risk in postmenopausal women. Ann Rheum Dis 66:931–935PubMedCrossRefGoogle Scholar
  32. 32.
    Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES (2006) Impact of recent fracture on health-related quality of life in postmenopausal women. J Bone Miner Res 21:809–816PubMedCrossRefGoogle Scholar
  33. 33.
    Edwards BJ, Song J, Dunlop DD, Fink HA, Cauley JA (2010) Functional decline after incident wrist fractures—study of osteoporotic fractures: prospective cohort study. BMJ 341:c3324PubMedCrossRefGoogle Scholar
  34. 34.
    Greendale GA, Barrett-Connor E, Ingles S, Haile R (1995) Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 43:955–961PubMedGoogle Scholar
  35. 35.
    Kaukonen JP, Karaharju EO, Porras M, Luthje P, Jakobsson A (1988) Functonal recovery after fractures of the distal forearm. Analysis of radiographic and other factors affecting the outcome. Ann Chir Gynaecol 77:27–31PubMedGoogle Scholar
  36. 36.
    Ivers RQ, Cumming RG, Mitchell P, Peduto AJ (2002) The accuracy of self-reported fractures in older people. J Clin Epidemiol 55:452–457PubMedCrossRefGoogle Scholar
  37. 37.
    Ismail AA, O’Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K et al (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group. European Prospective Osteoporosis Study Group. Osteoporos Int 11:248–254PubMedCrossRefGoogle Scholar

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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