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Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study

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Abstract

Summary

Studying 12,839 fracture cases and 91,426 controls, we found that fractures of the spine and hip are associated with clinically important HRQoL deficits up to 5 years post-fracture. Fracture cases with a low educational attainment are more likely to report very low HRQoL due to a low pre-fracture HRQoL.

Introduction

The aim of this study was to explore the short-term and long-term impact of fractures on health-related quality of life (HRQoL) and to study the effect of educational attainment as a proxy for socio-economic status (SES) on post-fracture HRQoL.

Methods

In a population-based survey including 12,839 fracture cases and 91,426 controls, HRQoL was measured using the physical component score (PCS) and the mental component score (MCS) of the 12-Item Short Form Health Survey (SF-12). Information about fractures, age, sex, ethnicity, comorbidity and SES was obtained from national registers. Multiple regression analysis was conducted to measure the mean HRQoL difference, termed deficit, between non-fracture controls and fracture cases (all fractures combined and fractures at six different skeletal sites).

Results

PCS and MCS were significantly lower among fracture cases than among controls. Statistically and clinically important PCS deficits (≥ 5 points) were observed among people with fractures of the spine and hip up to 5 years post-fracture and among people with upper arm fractures up to 1 year post-fracture. Greater deficits were observed for MCS but not for PCS in post-fracture HRQoL in the low than in the high SES group.

Conclusion

Fractures of the spine and hip are associated with clinically important deficits in physical HRQoL up to 5 years post-fracture. Low educational attainment widened the gap in mental but not in physical post-fracture HRQoL. However, due to low pre-fracture PCS and MCS, people with a low educational attainment and fractures were more likely to report very low HRQoL post-fracture.

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Data availability

There are restrictions prohibiting the provision of data in this manuscript. The data were obtained from a third party upon application to the national steering group (NATSUP). All interested researchers can apply for data from the Danish National Health Survey at the National Institute of Public Health.

Code availability

Not applicable.

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Funding

The Danish National Health Survey was funded by The Capital Region, Region Zealand, The South Denmark Region, The Central Denmark Region, The North Denmark Region, The Ministry of Interior and Health and the National Institute of Public Health, University of Southern Denmark. The conduction of the paper was supported by the Department of Clinical Medicine, Aarhus University and by DEFACTUM, Central Denmark Region.

Author information

Authors and Affiliations

  1. DEFACTUM, Department of Public Health and Health Services Research, Central Denmark Region, Aarhus, Denmark

    G. Valentin, K. Friis, C. P. Nielsen & F. B. Larsen

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    G. Valentin & B. L. Langdahl

  3. Department of Endocrinology (MEA), Aarhus University Hospital, Aarhus, Denmark

    B. L. Langdahl

Authors
  1. G. Valentin
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  2. K. Friis
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  3. C. P. Nielsen
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  4. F. B. Larsen
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  5. B. L. Langdahl
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Contributions

All of the authors were responsible for the design and analysis plan. The analysis was conducted by GV with input from the co-authors. The initial draft of the manuscript was prepared by GV, and then circulated among all authors for critical revision. All authors have provided final approval of the version to be published.

Corresponding author

Correspondence to G. Valentin.

Ethics declarations

Conflicts of interest

Gitte Valentin, Karina Friis, Camilla Palmhøj Nielsen, Finn Breinholt Larsen declare that they have no conflicts of interest. Bente L Langdahl has received research funding from Amgen and Novo Nordisk for her institution. She serves on advisory boards and speaker bureaus for Amgen, UCB, Eli Lilly, Gilead and Gedeon-Richter.

Ethics approval

The study was approved by the Danish Data Protection Agency (journal number 2016-051-000001).

Consent to participate

Written information about the purpose of the survey was given to each invited participant, and respondents were informed that by completing and submitting the questionnaire they gave their consent to participate in the survey.

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Valentin, G., Friis, K., Nielsen, C.P. et al. Fragility fractures and health-related quality of life: does socio-economic status widen the gap? A population-based study. Osteoporos Int 32, 63–73 (2021). https://doi.org/10.1007/s00198-020-05540-8

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