Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures—results from the ICUROS

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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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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Correspondence to A. Svedbom.

Ethics declarations

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.

Conflicts of interest

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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Keywords

  • EQ-5D
  • Fracture
  • Health-related quality of life
  • Osteoporosis