Quality of life issues in patients with osteoporotic fractures

Abstract

According to the World Health Organization Quality of Life group (1), quality of life may be defined as individuals’ perceptions of their position in life in the context of culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. Quality of life therefore represents a prominent aspect of the existence of each patient, being more and more important with advancing age. At the end of our existence, global quality of life constitutes one of the factors by which we also judge the value of medical care; it is one of the most important referents to which drugs should compare (2). Osteoporosis is a disease of aging whose social and economic burden will become increasingly heavier in the near future. The 20 th century has in fact witnessed the addition of 30 years to our life expectancy; furthermore, the global population of people aged over 75 is projected to increase by almost 140% from 1990 to 2020 (3). As far as quality of life in patients with osteoporosis is concerned, a number of studies have been carried out in order to evaluate its changes following the principal complications of the disease, i.e., Colles’ fracture, vertebral and hip fractures. Colles’ fracture causes a worsening of the main qualitative indices which, in the majority of cases, rapidly and significantly reverse toward the normal following treatment. A recent investigation carried out in 50 patients with this type of complication demonstrated that when taking quality-adjusted life-years as a referent parameter, the loss associated with Colles’ fracture is only about 2% (4). The first question we should answer when taking into consideration osteoporotic patients is whether differences exist between those with and without fractures. The basal evaluation of 751 patients enrolled in the MORE (Multiple Outcome of Raloxifene Evaluation) study may provide an answer. Patients were assessed by means of a questionnaire, i.e., QUALEFFO (5, 6), specifically targeted by the European Foundation of Osteoporosis for osteoporotic patients. Those with vertebral fractures had higher QUALEFFO scores (that is, worse health-related quality of life) than patients without vertebral fractures. The differences between patients without fracture and patients with at least one fracture were significant for all domains and total scores except mental function. However, patients with fracture only in the lumbar region had a significantly worse health-related quality of life than patients without fractures in all domains including mental function, thereby emphasizing the importance of fracture location. Furthermore, this study showed an increasing trend in health-related quality of life scores associated with number of prevalent vertebral fractures for all but the mental function domains, indicating a progressive worsening of quality of life with increasing number of fractures. The analysis also demonstrated that with just one vertebral fracture, health-related quality of life significantly decreased with regard to pain, general health, and total scores. More importantly, the association between the number of vertebral fractures and health-related quality of life was observed consistently within each age subgroup (7). This investigation (7) also demonstrated that QUALEFFO discriminated better between patients with and without vertebral fractures than two other generic instruments previously used to address these issues, that is the Nottingham Health Profile (8) and the EQ-5D, formerly called EuroQol (9). In addition, the