Health-related quality of life and radiographic vertebral fracture

Abstract

Background: Vertebral fractures are associated with back pain and disability; however, relatively little is known about the impact of radiographic vertebral fractures on quality of life in population samples. The aim of this study was to determine the impact of a recent radiographic vertebral fracture on health-related quality of life (HRQoL). Methods: Men and women aged 50 years and over were recruited from population registers in 12 European centers. Subjects completed an interviewer-administered questionnaire and had lateral spine radiographs performed. Subjects in these centers were followed prospectively and had repeat spinal radiographs performed a mean of 3.8 years later. Prevalent deformities were defined using established morphometric criteria, and incident vertebral fractures by both morphometric criteria and qualitative assessment. For each incident fracture case, three controls matched for age, gender, and center were selected: one with a prevalent deformity (at baseline) and two without prevalent deformities. All subjects were interviewed or completed a postal questionnaire instrument which included Short Form 12 (SF-12), the EQ-5D (former EuroQol), and the quality of life questionnaire of the International Osteoporosis Foundation (QUALEFFO). The median time from the second spinal radiograph until the quality of life survey was 1.9 years. Comparison between cases and their matched controls was undertaken using the signed rank test. Results: 73 subjects with incident vertebral fracture (cases), mean age 64.8 years (of whom 23 had a baseline deformity), and 196 controls, mean age 63.9 years (of whom 60 had a baseline deformity), were studied. There were strong correlations between the domain scores for each of the three instruments. There was no statistically significant difference in any of the domain scores between cases and those controls with a prevalent deformity. However, compared with the controls without a prevalent deformity the cases had significantly impaired quality of life as determined using the total QUALEFFO score (38.2 vs 33.7), the physical component score of the SF-12 (39.9 vs 43.7) and the health status score of the EQ-5D (62.3 vs 69.9). When the analysis was repeated after stratification of the cases by baseline deformity status (i.e., cases with and without a prevalent deformity at baseline), cases with a prevalent deformity had impaired quality of life compared with their matched controls, both with and without a prevalent deformity. In contrast there was no significant difference in quality of life among the cases without a prevalent deformity and either control group. Conclusion: In this population-based study a recent vertebral fracture was associated with impairment in quality of life, though this was mainly among those who had sustained a previous vertebral deformity.

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Acknowledgements

The study was financially supported by European Union Concerted Action Grants under Biomed-1 (BMH 1CT 931448 and 920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 & 940229. The central coordination was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536), and the European Foundation for Osteoporosis and Bone Disease. Also a grant from Eli Lilly and Company. The EU’s PECO program linked to Biomed-1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin, and Moscow centers. Data collection in Cambridge was supported by a HSR grant from the Anglia and Oxford region. The central X-ray evaluation was generously sponsored by the Bundesministerium fur Forschung and Technologie, Germany. Individual centers acknowledge the receipt of locally acquired support for their data collection. We would like to thank the following individuals: Rita Smith, Aberdeen, UK; Uday Bhonsle, Anna Martin, Judith Walton, and Bridget Wardley-Smith, Cambridge and Harrow, UK; Mrs Joanna Parsons, Truro, UK; and J. Bernardino Diaz Lopez and Ana Rodriguez Rebollar, Oviedo, Spain. We would also like to thank the individuals who took part in the study and the many individuals who helped access our population samples.

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Correspondence to T. W. O’Neill.

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Cockerill, W., Lunt, M., Silman, A.J. et al. Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15, 113–119 (2004). https://doi.org/10.1007/s00198-003-1547-4

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Keywords

  • Health impact
  • Osteoporosis
  • Quality of life
  • Vertebral fracture