Fractures Affect Long-Term Health-Related Quality of Life in Older People

Doctor and patient with crutches
patient on crutches, injury, fracture
Single and multiple fragility fractures significantly affect long-term health-related quality of life in older people.

Single and multiple hip fractures and multiple spine and rib fractures significantly affect long-term health-related quality of life (QoL) in older people, according to study results published in the Journal of Bone and Mineral Research.

Although incident fragility fractures are known to negatively affect health-related QoL in the short term, there is little evidence regarding long-term effects of single and multiple fractures. To determine whether these fractures encumber older people over a prolonged period of time, researchers prospectively followed 7753 participants (2187 men and 5566 women; age ≥50 years at baseline) over a 10-year period and assessed the relationship between fracture type, repeated fractures, and health-related QoL.

Each participant was measured at baseline and year 10 for health-related QoL using the validated Health Utility Index. Data from interviews at year 5 and 10 and annual mailed questionnaires from years 1 to 4 and 6 to 9 were used to document any incident fragility fractures experienced throughout the study period.

The researchers discovered significant associations between hip, shoulder, and spine fractures and substantial deficits on Health Utility Index scores in men, ranging from -0.19 to -0.07. More than other fractures, hip and spine fractures were also significantly associated with deficits in mobility, self-care, and ambulation attributes, but not vision, dexterity, or emotion. In women, spine, hip, rib, and pelvis fractures were all associated with significant deficits in health-related QoL scores varying from -0.12 to -0.05. Hip fractures were found to contribute the greatest deficits in women compared with other types of fractures.

Multiple hip fractures significantly affected health-related QoL in women (average difference, -0.14), as did fractures in the spine (average difference, -0.16) and rib (average difference, -0.21). Furthermore, women who experienced ≥1 hip fracture were never able to recover to their pre-fracture level health-related QoL score (odds ratio, 0.41).

Especially in women, more recent incident fractures occurring closer to the follow-up assessment (ie, years 6 to 10) were associated with significantly greater reductions in health-related quality of life than those occurring between years 1 and 5.

Several limitations were noted for this study, including the potential underestimation of incident fractures given the use of self-reported data.

Overall, the researchers said their results demonstrate that “hip and spine fractures have significant negative impact on [health-related QoL], especially on mobility, self-care, ambulation, and pain,” and provide “convincing evidence regarding the burden and recovery of fractures on health-related quality of life.”

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Borhan S, Papaioannou A, Gajic-Veljanoski O, et al. Incident fragility fractures have a long-term negative impact on health-related quality of life of older people: the Canadian Multicentre Osteoporosis Study [published online February 5, 2019]. J Bone Miner Res. doi:10.1002/jbmr.3666