Health-related quality of life and radiographic vertebral fracture

Byline: W. Cockerill (1), M. Lunt (1), A. J. Silman (1), C. Cooper (2), P. Lips (3), A. K. Bhalla (4), J. B. Cannata (5), R. Eastell (6), D. Felsenberg (7), C. Gennari (8), O. Johnell (9), J. A. Kanis (10), C. Kiss (11), P. Masaryk (12), M. Naves (5), G. Poor (11), H. Raspe (13), D. M. Reid (14), J. Reeve (15), J. Stepan (16), C. Todd (17), A. D. Woolf (18), T. W. O'Neill (1) Keywords: Health impact; Osteoporosis; Quality of life; 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. Author Affiliation: (1) ARC Epidemiology Research Unit, University of Manchester, Stopford Building, Manchester, M13 9PT, UK (2) MRC Environmental Epidemiology Unit, Southampton General Hospital, Southampton, UK (3) Department of Endocrinology, Academic Hospital, Vrije Universiteit, Amsterdam, The Netherlands (4) Royal National Hospital for Rheumatic Diseases, Bath, UK (5) Asturia General Hospital, Oviedo, Spain (6) Bone Metabolism Group, Northern General Hospital, Sheffield, UK (7) Department of Radiology and Nuclear Medicine, Free University, Berlin, Germany (8) Institute of Clinical Medicine, University of Siena, Siena, Italy (9) Department of Orthopedics, Lund University, Malmo, Sweden (10) Centre for Metabolic Bone Disease, Sheffield, UK (11) National Institute of Rheumatology and Physiotherapy, Budapest, Hungary (12) Institute of Rheumatic Diseases, Piestany, Slovakia (13) Institute of Social Medicine, Lubeck, Germany (14) Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK (15) Institute of Public Health, Cambridge, UK (16) Institute of Rheumatology, Charles University, Prague, Czech Republic (17) Department of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, UK (18) Department of Rheumatology, Royal Cornwall Hospital, Truro, UK Article History: Registration Date: 16/10/2003 Received Date: 26/08/2002 Accepted Date: 15/10/2003 Online Date: 13/11/2003