Osteoporosis Linked to Lower Quality of Life Regardless of Fracture History

Shot of a doctor showing a senior patient a bone scan on a digital tablet while sitting in her office, fracture, osteoporosis
Even without a history of fragility fracture, the presence of osteoporosis is associated with substantially lower health-related quality of life.

Even without a history of fragility fracture, the presence of osteoporosis is associated with substantially lower health-related quality of life (HRQoL), according to study results published in Osteoporosis International.

Previous studies have reported that fragility fractures can negatively affect HRQoL of patients with osteoporosis. However, the effect of osteoporosis without a history of a fragility fracture on HRQoL is less understood. In this study, the researchers examined the association of HRQoL with osteoporosis separately in men and women and compared patients with and without prior fragility fracture. In addition, they tracked changes in HRQoL over 10 years in patients who did and did not sustain a fragility fracture. Patients were selected for inclusion from the Canadian Multicentre Osteoporosis Study, during which repeated assessments of HRQoL and bone mineral density were collected.

The study enrolled 5266 women and 2112 men age ≥50. All participants completed the Medical Outcomes Trust 26-item health survey (SF-36) and underwent bone mineral density testing with dual-energy x-ray absorptiometry. Of the women in the study, 699 (13.3%) self-reported a diagnosis of osteoporosis, of whom 251 (35.9%) had a prior fragility fracture. In the population of men, 39 (1.8%) reported that they had osteoporosis, of whom 11 (28.4%) reported a history of fragility fracture.

In women with self-reported osteoporosis, SF-36 scores were substantially and clinically lower at baseline compared with women without osteoporosis, particularly in the physically oriented domains. In women with a history of fragility fracture, SF-36 scores were even lower for most domains. The findings were similar but weaker in men, limited by the small sample size.

Complete follow-up data at 10 years were available for 2797 women and 1023 men. The longitudinal data indicated that having or developing osteoporosis may be associated with a greater decline in HRQoL over 10 years compared with not having osteoporosis.

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With the exception of the mental health domain and mental component summary, men and women showed lower SF-36 scores regardless of osteoporosis status from baseline to year 10. In the subset of participants who developed osteoporosis during the follow-up, the presence of fragility fracture was associated with significant declines in SF-36 scores in men, while in women the declines were not very different with and without fragility fracture.

The researchers acknowledged some limitations of this study, including the relatively small sample size of men, some loss to follow-up, and missing data regarding osteoporosis-specific aspects of HRQoL.

Quality of life “should therefore be thoroughly investigated even prior to the occurrence of fracture, to develop appropriate interventions that would empower patients to effectively manage all stages of the disease,” concluded the researchers.

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Hopman WM, Berger C, Joseph L, et al. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study [published online May 8, 2019]. Osteoporos Int. doi:10.1007/s00198-019-05000-y