Abstract
Health-related quality of life in osteoporotic patients with vertebral fracture is of increasing interest, but relevant studies have yielded debatable results. This systematic review and meta-analysis of 16 observational studies demonstrate a clear association between physical health status and presence of vertebral fracture after accounting for age. This meta-analysis was conducted to identify if there are any differences between physical and/or mental health-related quality of life (HRQoL) in older people with osteoporosis based on conventional T-score definitions and the presence or absence of vertebral fracture. A comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the “grey” literature from 1950 to the end of April 2015. Search terms for vertebral fracture (VF) included VF, osteoporotic fracture, fragility fracture, and spinal fracture. Quality of life was searched using the following terms: quality of life, health-related quality of life, HRQoL, and QoL. Strict inclusion and exclusion criteria were used. The standardized mean difference (SMD) was calculated for each HRQoL domain by the difference in means between case and control groups divided by the pooled SD of participants. Sixteen eligible studies were identified involving 3131 men and women. There was evidence of publication bias and heterogeneity. The meta-analysis showed worse physical (SMD = 0.53, 95 % confidence interval (CI) 0.38 to 0.68; P < 0.001) and mental (SMD = 0.19, 95 % CI 0.05 to 0.33; P = 0.009) HRQoL in osteoporotic older people with vertebral fracture compared to those without fracture. Similar differences were observed for physical HRQoL in further analyses accounting for possible confounding effects of age. Sub-analysis to assess associations between number/severity of fractures and time since fracture was not possible due to small numbers of studies that accounted for age. Osteoporotic older people with vertebral fracture have worse physical HRQoL than osteoporotic older people without vertebral fracture, even after accounting for age differences.
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References
Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, 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 15:721–739. doi:10.1359/jbmr.2000.15.4.721
Silverman SL et al (2007) Prevalence of depressive symptoms in postmenopausal women with low bone mineral density and/or prevalent vertebral fracture: results from the Multiple Outcomes of Raloxifene Evaluation (MORE) study. J Rheumatol 34(1):140–144
Falling short: delivering integrated falls and osteoporosis services in England. All party parliamentary osteoporosis group, Dec 2004 https://www.nos.org.uk/document.doc?id=752. Access 27 Feb 2016
Ferrans CE (2005) Definitions and conceptual models of quality of life. In: Lipscomb J, Gotay CC, Snyder C (eds) Outcomes assessment in cancer. Cambridge University, Cambridge, pp 14–30
Ware JE Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233
EuroQol G (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208
Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Kellingray S, Leplege A, Liberman UA, McCloskey E, Minne H, Reeve J, Reginster JY, Scholz M, Todd C, de Vernejoul MC, Wiklund I (1999) Quality of life in patients with vertebral fractures: validation of the quality of life questionnaire of the European foundation for osteoporosis (QUALEFFO). Working party for quality of life of the European foundation for osteoporosis. Osteoporos Int 10(2):150–160
Wilson S, Sharp CA, Davie MW (2012) Health-related quality of life in patients with osteoporosis in the absence of vertebral fracture: a systematic review. Osteoporos Int 23(12):2749–2768
The Cochrane Collaboration Additional module 1: meta-analysis of continuous data. http://www.ibrarian.net/navon/paper/Additional_Module_1__Meta_analysis_of_continuous_.pdf?paperid=19001124. Access 27 Feb 2016
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560
Salaffi F, Cimmino MA, Malavolta N, Carotti M, Di Matteo L, Scendoni P, Grassi W (2007) The burden of prevalent fractures on health-related quality of life in postmenopausal women with osteoporosis: the IMOF study. J Rheumatol 34(7):1551–1560
Lombardi I Jr, Oliveira LM, Monteiro CR, Confessor YQ, Barros TL, Natour J (2004) Evaluation of physical capacity and quality of life in osteoporotic women. Osteoporos Int 15(1):80–85
Yilmaz F, Sahin F, Ergoz E, Deniz E, Ercalik C, Yucel SD, Kuran B (2008) Quality of life assessments with SF 36 in different musculoskeletal diseases. Clin Rheumatol 27(3):327–332
Sanfelix-Genoves J, Hurtado I, Sanfelix-Gimeno G, Reig-Molla B, Peiro S (2011) Impact of osteoporosis and vertebral fractures on quality-of-life. a population-based study in Valencia, Spain (The FRAVO Study). Health Qual Life Outcomes 9:20
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(12):2175–2179
Oleksik A, Lips P, Dawson A, Minshall ME, Shen W, Cooper C, Kanis J (2000) Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res 15(7):1384–1392
de Oliveira Ferreira N, da Silva RB, Arthuso M, Pinto-Neto AM, Caserta N, Costa-Paiva L (2012) Prevalence of vertebral fractures and quality of life in a sample of postmenopausal Brazilian women with osteoporosis. Arch Osteoporos 7:101–106
Romagnoli E, Carnevale V, Nofroni I, D’Erasmo E, Paglia F, De Geronimo S, Pepe J, Raejntroph N, Maranghi M, Minisola S (2004) Quality of life in ambulatory postmenopausal women: the impact of reduced bone mineral density and subclinical vertebral fractures. Osteoporos Int 15(12):975–980
Tadic I, Vujasinovic Stupar N, Tasic L, Stevanovic D, Dimic A, Stamenkovic B, Stojanovic S, Milenkovic S (2012) Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes 10:74
Alekna V, Tamulaitiene M, Butenaite V (2006) The impact of subclinical vertebral fractures on health-related quality of life in women with osteoporosis. Medicina (Kaunas) 42(9):744–750
Bianchi ML, Orsini MR, Saraifoger S, Ortolani S, Radaelli G, Betti S (2005) Quality of life in post-menopausal osteoporosis. Health Qual Life Outcomes 3:78. doi:10.1186/1477-7525-3-78
Baczyk G, Tomasz O, Kleka P (2011) Quality of life in postmenopausal women with reduced bone mineral density: psychometric evaluation of the Polish version of QUALEFFO-41. Arch Med Sci 7(3):476–485
Hakan Nur, Füsun Toraman N. Postmenopozal Osteoporozda Vertebral Kırıkların Yaşam Kalitesine Etkisi. Turkish J Osteoporos 2012. 2011; 17
Yoh K, Tanaka K, Ishikawa A, Ishibashi T, Uchino Y, Sato Y, Tobinaga M, Hasegawa N, Kamae S, Yoshizawa M (2005) Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment. J Bone Miner Metab 23(2):167–173
Ramirez Perez E, Clark P, Wacher NH, Cardiel MH, del Pilar Diez Garcia M (2008) Cultural adaptation and validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) in a Mexican population. Clin Rheumatol 27(2):151–161
Demirdal ÜS, Yigit I, Solak Ö, Toktas H, Dundar Ü, Kavuncu V (2010) The relationship between vertebral fractures and quality of life in patients with osteoporosis. Göztepe Tıp Dergisi 25(1):20–24
Lezak M, Howieson D, Bigler E, Tranel D (2012) Neuropsychological assessment, 5th edn. Oxford University Press, New York
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Al-Sari, U.A., Tobias, J. & Clark, E. Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 27, 2891–2900 (2016). https://doi.org/10.1007/s00198-016-3648-x
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DOI: https://doi.org/10.1007/s00198-016-3648-x