Skip to main content

Advertisement

Log in

Health-related quality of life and radiographic vertebral fracture

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Enisa Shevroja, Jean-Yves Reginster, … Nicholas C. Harvey

References

  1. Leidig G, Minne HW, Sauer P et al (1990) A study of complaints and their relation to vertebral destruction in patients with osteoporosis. Bone Miner 8:217–229

    CAS  PubMed  Google Scholar 

  2. Ettinger B, Black DM, Nevitt MC et al (1992) Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner Res 7:449–456

    CAS  PubMed  Google Scholar 

  3. Matthis C, Weber U, O’Neill TW, Raspe H and the European Vertebral Osteoporosis Study Group (1998) Health impact associated with vertebral deformities: results from the European Vertebral Osteoporosis Study (EVOS). Osteoporos Int 8:364–372

    Article  CAS  PubMed  Google Scholar 

  4. Nevitt MC, Ettinger B, Black DM et al (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800

    CAS  PubMed  Google Scholar 

  5. Lips P, Cooper C, Agnusdei D et al (1997) Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int 7:36–38

    CAS  PubMed  Google Scholar 

  6. Lips P, Cooper C, Agnusdei D et al (1999) Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporos Int 10:150–160

    Article  CAS  PubMed  Google Scholar 

  7. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ III (1992) Incidence of clinically diagnosed vertebral fractures: a population based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227

    CAS  PubMed  Google Scholar 

  8. van Staa TP, Dennison EM, Leufkens HGM, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522

    Article  PubMed  Google Scholar 

  9. O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1017

    PubMed  Google Scholar 

  10. European Prospective Osteoporosis Study (EPOS) Group (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724

    PubMed  Google Scholar 

  11. McCloskey EV, Spector TD, Eyres KS, Fern ED, O’Rourke N, Vasikaran S, Kanis JA (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3:138–147

    PubMed  Google Scholar 

  12. Lunt M, Ismail AA, Felsenberg D, Cooper C, Kanis JA, Reeve J et al (2002) Defining incident vertebral deformities in population studies: a comparison of morphometric criteria. Osteoporos Int 13:809–815

    Article  Google Scholar 

  13. Murrell P, Todd CJ, Martin A, Walton J, Lips P, Reeve J, on behalf of the working party for quality of life of the International Osteoporosis Foundation (2001) Postal administration compared with nurse-supported administration of the QUALEFFO-41 in a population sample: comparison of results and assessment of psychometric properties. Osteoporos Int 12:672–679

    Article  CAS  PubMed  Google Scholar 

  14. EuroQol Group (1996) EQ-5D user guide. EuroQol Group, Rotterdam, The Netherlands

  15. Ware JE, Kosinski M, Keller SD (1998) SF-12: how to score the SF-12 physical and mental health summary scales, 3rd edn. Quality Metric, Lincoln, RI

  16. 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 15:1384–1392

    CAS  PubMed  Google Scholar 

  17. Dolan P (1997) Modelling valuations for EuroQol health states. Med Care 35:1095–1108

    Article  CAS  PubMed  Google Scholar 

  18. Scane AC, Sutcliffe AM, Francis RM (1994) The sequelae of vertebral crush fractures in men. Osteoporos Int 4:89–92

    CAS  PubMed  Google Scholar 

  19. Silverman SL, Minshall ME, Shen W, Harper KD, Xie S, on behalf of the Health-Related Quality of Life Subgroup of the Multiple Outcomes of Raloxifene Evaluation Study (2001) The relationship of health related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis. Arthritis Rheum 44:2611–2619

    Article  CAS  PubMed  Google Scholar 

  20. Osteoporosis Quality of Life Study Group (1997) Measuring quality of life in women with osteoporosis. Osteoporos Int 7:478–487

    PubMed  Google Scholar 

  21. Lydick E, Zimmerman SI, Yawn B et al (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQol). J Bone Miner Res 12:456–463

    CAS  PubMed  Google Scholar 

  22. Randell AG, Bhalerao N, Nguyen TV, Sambrook PN, Eisman JA, Silverman SL (1998) Quality of life in osteoporosis: reliability, consistency and validity of the Osteoporosis Assessment Questionnaire. J Rheumatol 25:1171–1179

    CAS  PubMed  Google Scholar 

  23. Kessenich CR, Guyatt GH, Rosen CJ (1998) Health-related quality of life and participation in osteoporosis clinical trials. Calcif Tissue Int 62:189–192

    Article  CAS  PubMed  Google Scholar 

  24. Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case control study of quality of life and functional impairment in women with long standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The study was financially supported by European Union Concerted Action Grants under Biomed-1 (BMH 1CT 931448 and 920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 & 940229. The central coordination was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536), and the European Foundation for Osteoporosis and Bone Disease. Also a grant from Eli Lilly and Company. The EU’s PECO program linked to Biomed-1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin, and Moscow centers. Data collection in Cambridge was supported by a HSR grant from the Anglia and Oxford region. The central X-ray evaluation was generously sponsored by the Bundesministerium fur Forschung and Technologie, Germany. Individual centers acknowledge the receipt of locally acquired support for their data collection. We would like to thank the following individuals: Rita Smith, Aberdeen, UK; Uday Bhonsle, Anna Martin, Judith Walton, and Bridget Wardley-Smith, Cambridge and Harrow, UK; Mrs Joanna Parsons, Truro, UK; and J. Bernardino Diaz Lopez and Ana Rodriguez Rebollar, Oviedo, Spain. We would also like to thank the individuals who took part in the study and the many individuals who helped access our population samples.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. W. O’Neill.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cockerill, W., Lunt, M., Silman, A.J. et al. Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15, 113–119 (2004). https://doi.org/10.1007/s00198-003-1547-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-003-1547-4

Keywords

Navigation