Abstract
Summary
This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months.
Introduction
The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture.
Methods
Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture.
Results
Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types.
Conclusions
Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
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References
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936. https://doi.org/10.1016/S0140-6736(02)08761-5
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, Fragility Fracture Network Rehabilitation Research Special Interest G (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16(1):158. https://doi.org/10.1186/s12877-016-0332-0
Fischer S, Kapinos KA, Mulcahy A, Pinto L, Hayden O, Barron R (2017) Estimating the long-term functional burden of osteoporosis-related fractures. Osteoporos Int 28(10):2843–51
Hallberg I, Rosenqvist AM, Kartous L, Lofman O, Wahlstrom O, Toss G (2004) Health-related quality of life after osteoporotic fractures. Osteoporos Int 15:834–841
Klop C, Welsing PM, Cooper C, Harvey NC, Elders PJ, Bijlsma JW, Leufkens HG, de Vries F (2014) Mortality in British hip fracture patients, 2000-2010: a population-based retrospective cohort study. Bone 66:171–177. https://doi.org/10.1016/j.bone.2014.06.011
Tran T, Bliuc D, van Geel T, et al (2017) Population-wide impact of non-hip non-vertebral fractures on mortality. J Bone Miner Res. https://doi.org/10.1002/jbmr.3118
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. https://doi.org/10.1016/S0140-6736(02)08657-9
Papadimitriou N, Tsilidis KK, Orfanos P et al (2017) Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium. Lancet Public Health 2:239–246
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1-2):136. https://doi.org/10.1007/s11657-013-0136-1
Blume SW, Curtis JR (2011) Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int 22(6):1835–1844. https://doi.org/10.1007/s00198-010-1419-7
Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW (2015) Methods for the economic evaluation of health care programmes. Oxford University Press, Oxford
Oppe M, Devlin NJ, Szende A (2007) EQ-5D value sets: inventory, comparative review and user guide. Springer, Berlin
Si L, Winzenberg TM, de Graaff B, Palmer AJ (2014) A systematic review and meta-analysis of utility-based quality of life for osteoporosis-related conditions. Osteoporos Int 25:1987–1997
Borgstrom F, Lekander I, Ivergard M et al (2013) The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)—quality of life during the first 4 months after fracture. Osteoporos Int 24(3):811–823. https://doi.org/10.1007/s00198-012-2240-2
Borgstrom F, Zethraeus N, Johnell O et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17(5):637–650. https://doi.org/10.1007/s00198-005-0015-8
Olerud P, Tidermark J, Ponzer S, Ahrengart L, Bergstrom G (2011) Responsiveness of the EQ-5D in patients with proximal humeral fractures. J Shoulder Elb Surg 20(8):1200–1206. https://doi.org/10.1016/j.jse.2011.06.010
Tidermark J, Bergstrom G (2007) Responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) in elderly patients with femoral neck fractures. Qual Life Res Int J Qual Life Asp Treat Care Rehab 16(2):321–330. https://doi.org/10.1007/s11136-006-9004-4
Haywood KL, Griffin XL, Achten J, Costa ML (2014) Developing a core outcome set for hip fracture trials. Bone Joint J 96-B(8):1016–1023. https://doi.org/10.1302/0301-620X.96B8.33766
Dolan P (1997) Modeling valuations for EuroQol health states. Med Care 35(11):1095–1108. https://doi.org/10.1097/00005650-199711000-00002
Coretti S, Ruggeri M, McNamee P (2014) The minimum clinically important difference for EQ-5D index: a critical review. Expert Rev Pharmacoecon Outcomes Res 14(2):221–233. https://doi.org/10.1586/14737167.2014.894462
Rubin DB (2004) Multiple imputation for nonresponse in surveys. Wiley, Hoboken
Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19(23):3219–3236. https://doi.org/10.1002/1097-0258(20001215)19:23<3219::AID-SIM623>3.0.CO;2-P
Peasgood T, Herrmann K, Kanis JA, Brazier JE (2009) An updated systematic review of Health State Utility Values for osteoporosis related conditions. Osteoporos Int 20(6):853–868. https://doi.org/10.1007/s00198-009-0844-y
Adachi J, Ioannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos E, Hopman W, Poliquin S, Prior J (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12(11):903–908. https://doi.org/10.1007/s001980170017
Papaioannou A, Kennedy C, Ioannidis G, Sawka A, Hopman W, Pickard L, Brown J, Josse R, Kaiser S, Anastassiades T (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20(5):703–714. https://doi.org/10.1007/s00198-008-0743-7
Marsh J, Bryant D, MacDonald SJ (2009) Older patients can accurately recall their preoperative health status six weeks following total hip arthroplasty. J Bone Joint Surg Am 91(12):2827–2837. https://doi.org/10.2106/JBJS.H.01415
Rohde G, Haugeberg G, Mengshoel AM, Moum T, Wahl AK (2009) No long-term impact of low-energy distal radius fracture on health-related quality of life and global quality of life: a case-control study. BMC Musculoskelet Disord 10(1):106. https://doi.org/10.1186/1471-2474-10-106
Herman A, Botser IB, Tenenbaum S, Chechick A (2009) Intention-to-treat analysis and accounting for missing data in orthopaedic randomized clinical trials. J Bone Joint Surg Am 91(9):2137–2143. https://doi.org/10.2106/JBJS.H.01481
Dimai HP, Svedbom A, Fahrleitner-Pammer A, Resch H, Muschitz C, Thaler H, Szivak M, Amrein K, Borgstrom F (2014) Epidemiology of distal forearm fractures in Austria between 1989 and 2010. Osteoporos Int 25(9):2297–2306. https://doi.org/10.1007/s00198-014-2766-6
Tarantino U, Capone A, Planta M, D'Arienzo M, Letizia Mauro G, Impagliazzo A, Formica A, Pallotta F, Patella V, Spinarelli A, Pazzaglia U, Zarattini G, Roselli M, Montanari G, Sessa G, Privitera M, Verdoia C, Corradini C, Feola M, Padolino A, Saturnino L, Scialdoni A, Rao C, Iolascon G, Brandi ML, Piscitelli P (2010) The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study. Arthritis Res Ther 12(6):R226. https://doi.org/10.1186/ar3213
Lesnyak O, Ershova O, Belova K, Gladkova E, Sinitsina O, Ganert O, Romanova M, Khodirev V, Johansson H, McCloskey E, Kanis JA (2012) Epidemiology of fracture in the Russian Federation and the development of a FRAX model. Arch Osteoporos 7(1-2):67–73. https://doi.org/10.1007/s11657-012-0082-3
Acknowledgements
We are grateful to the Quality of Life and Epidemiology Working Group of the Committee of Scientific Advisors for the International Osteoporosis Foundation under whose supervision this study was undertaken. On its international level, the ICUROS is sponsored by Amgen, Eli Lilly, Medtronic, Novartis, Sanofi-Aventis, Servier, and Pfizer. In Australia, the study is supported by project grant no. 628422 from the National Health and Medical Research Council. In Austria, the study is sponsored by Central Association of Austrian Social Security Institution (Hauptverband der österreichischen Sozialversicherungsträger), Austrian Society for Bone and Mineral Research (AuSBMR), Merck Sharp & Dohme, Servier GmbH, Medtronic GmbH, Amgen GmbH, Novartis GmbH, Nycomed GmbH, Roche GmbH, Sanofi-Aventis GmbH, and Daiichi-Sankyo GmbH. In France, we would like to thank Prs Bernard Cortet, Roland Chapurlat, Patrice Fardellone, Philippe Orcel, and Christian Roux for their work. In Mexico, the study was supported by CONACyT grant no. El 2008-01-87106, and we are grateful to Gabriela Chico, Master Student, Mexico City and Fernando Carlos, MHE, Mexico City. In Lithuania, the work was supported by National Osteoporosis Center, and gratitude is extended to Dr. Violeta Sinkeviciene and Inga Tamulaityte-Morozoviene (Faculty of Medicine of Vilnius University) for skillful technical assistance. In Russia, the following team members provided valuable contributions to the study: Dr. Oxana Nikitinskaya, Dr. Olga Dobrovolskaya (Institute of Rheumatology, RAS, Moscow), Prof. Larissa Menshikova, Dr. Julia Varavko (Medical Institute of Postgraduate Training, Irkutsk), Prof. Olga Ershova, Dr. Ksenia Belova (Yaroslavl State Medical University, Yaroslavl), Dr. Ksenia Usenko (Ural State Medical University, Yekaterinburg), Prof. Georgij Golubev, Dr. Vyacheslav Grebenshikov (Rostov-on-Don State Medical University, Rostov-on-Don), Prof. Eugenij Zotkin, Dr. Irina Zubkova (North-West Mechnikov State Medical University, Saint-Petersburg), Prof. Alexander Kochish, Dr. Sergej Ivanov (Vreden Institute of Traumatology and Orthopedics, Saint-Petersburg), and Dr. Radik Nurligayanov (City Clinical Hospital # 21, Ufa). In the USA, Amgen Inc., Ingenix Pharmaceutical Services, Eli Lilly and Company, Medtronic Spine LLC, and Pfizer Inc. sponsored the study. Hoffmann La Roche and Amgen provided support. In Estonia, the study was supported by Estonian Science Foundation grant no. 9368. The global study team would like to thank Ingrid Lekander, Erik Landfeldt, Martin Kleman, Moa Ivergård, and Viktor Wintzell for contributing to the study. The following investigators provided valuable contributions to the Australian substudy: Prof JJ Watts and Professors GC Nicholson, E Seeman, R Prince, G Duque, T Winzenberg, L March, and PR Ebeling.
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The study adhered to the declaration of Helsinki and was approved by the relevant research ethics committees in each participating country. All patients provided their informed consent to participate and the patients could withdraw from the study at any time on their own request.
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On its international level, the ICUROS is sponsored by Amgen, Eli Lilly, Medtronic, Novartis, Sanofi-Aventis, Servier, and Pfizer. In Australia, the study was supported by project grant no. 628422 from the National Health and Medical Research Council with supplementary funding from Merck Pty Ltd. In Austria, the study was sponsored by Central Association of Austrian Social Security Institution (Hauptverband der österreichischen Sozialversicherungsträger), Austrian Society for Bone and Mineral Research (AuSBMR), Merck Sharp & Dohme, Servier GmbH, Medtronic GmbH, Amgen GmbH, Novartis GmbH, Nycomed GmbH, Roche GmbH, Sanofi-Aventis GmbH, and Daiichi-Sankyo GmbH. In Mexico, the study was supported by CONACyT grant no. El 2008-01-87106. In Lithuania, the work was supported by the National Osteoporosis Center. In the USA, Amgen Inc., Ingenix Pharmaceutical Services, Eli Lilly and Company, Medtronic Spine LLC, and Pfizer (formerly Wyeth) sponsored the study, and Hoffmann La Roche and Amgen provided support. In Estonia, the study was supported by the Estonian Science Foundation [grant no. 9368] and the Estonian Ministry of Education and Research [grant no. IUT 34-17, IUT 2-8]. In Russia, the study was supported by Hoffmann La Roche, Amgen, and the Russian Osteoporosis Association.
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Svedbom, A., Borgstöm, F., Hernlund, E. et al. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures—results from the ICUROS. Osteoporos Int 29, 557–566 (2018). https://doi.org/10.1007/s00198-017-4317-4
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DOI: https://doi.org/10.1007/s00198-017-4317-4