Health-related Quality Of Life In Postmenopausal Women Research Articles

Effects of Pilates exercises on health-related quality of life in postmenopausal women: a systematic review and meta-analysis.

To verify the effects of Pilates exercises on health-related quality of life (HRQoL) in postmenopausal women. A systematic search was conducted in the following databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, LILACS, SportDiscus, Scielo, and PEDro. Randomized clinical trials (RCTs) that intervened with Pilates and had HRQoL as an outcome were eligible. The methodological quality of each RCT was assessed using the PEDro scale and the certainty of the evidence using the GRADE system. Meta-analyses were conducted by standardized mean difference (SMD). Initially, 760 records were located. After screening, 11 RCTs were included in the systematic review. Five studies presented low risk of bias (PEDro score ≥ 6). Evidence of very low to moderate certainty demonstrated significant effects in favor of Pilates exercises vs control groups for five of the nine HRQoL domains analyzed: bodily pain (SMD = 0.96), physical functioning (SMD = 0.85), social functioning (SMD = 0.45), role physical (SMD = 0.79), and role emotional (SMD = 0.61). Subgroup analyzes demonstrated that Pilates had a positive impact on more domains whens administered for ≥ 48 sessions (eight domains) vs < 48 sessions (three domains); and when administered on equipment (seven domains) vs mat (three domains). Pilates exercises, in general, allowed significant effects to improve HRQoL in postmenopausal women, especially when performed on equipment and when administered for at least 48 sessions. However, no analysis showed high certainty of evidence, and more RCTs of high methodological quality are needed to confirm these findings.

The Effects of Pilates vs. Zumba Dancing on Functional Performance, Mood and Health-Related Quality of Life in Postmenopausal Women

This study aimed to compare the effects of Zumba and Pilates training on functional performance, mood, and health-related quality of life in postmenopausal women. Fifty-four postmenopausal women, aged 55–65, were randomly allocated to a control group (CG), a Pilates group (PG), or a Zumba group (ZG). Functional performance factors, in terms of walking speed, lower body muscle strength, dynamic balance, and functional mobility, as well as mood and health-related quality of life (HRQoL), were assessed before and after the intervention period. As results, both training modalities significantly improved the walking speed (PG (p &lt; 0.001)/ZG (p &lt; 0.001)), strength (PG (p &lt; 0.001)/ZG (p &lt; 0.05)), dynamic balance (PG (p &lt; 0.001)/ZG (p &lt; 0.001)), and functional mobility (PG (p &lt; 0.001)/ZG (p &lt; 0.001)), as well as mood (PG (p &lt; 0.01)/ZG (p &lt; 0.001)). Additionally, both intervention programs significantly improved their HRQol [physical function (PG (p &lt; 0.001)/ZG (p &lt; 0.001)) domain and SF36 total scores (PG (p &lt; 0.01)/ZG (p &lt; 0.001))] with better performance following Zumba training. However, the domains of social function (p &lt; 0.001), mental health (p &lt; 0.001), and role limitation due to emotional problems (p &lt; 0.05) significantly enhanced only for the ZG. In conclusion, Pilates or Zumba training appears to be an ideal exercise for promoting functional performance, mood, and HRQoL in postmenopausal women. However, Zumba training seems to be more effective, resulting in optimal scores.

The Effect of Pelvic Floor Muscle Training on Health-Related Quality of Life in Postmenopausal Women With Genitourinary Syndrome: A Systematic Review and Meta-Analysis.

Genitourinary syndrome is commonly reported in postmenopausal women. Kegel's exercise is a noninvasive therapy that improves pelvic floor muscle parameters. However, the effect of Kegel's exercise on health-related quality of life (HRQoL) in postmenopausal women with genitourinary syndrome has not been synthesized or shown. This study was designed to systematically review and analyze the previous literature to determine whether Kegel's exercise enhances HRQoL in postmenopausal women with genitourinary syndrome of menopause. A systematic review and meta-analysis of randomized controlled trials was conducted, and six databases were searched, including Embase, MEDLINE, Cochrane, CINAHL, Web of Science, and Scopus, from their dates of inception to November 2021. Eligible studies evaluated the effects of Kegel's exercise on HRQoL in postmenopausal women with urinary, sexual, or genital symptoms. Review Manager software was used to perform the meta-analysis using a random-effects model. Chi-square and I2 tests were used to evaluate heterogeneity among the studies. Meta-analysis was performed based on the symptoms (i.e., urinary, sexual, and genital) identified in the quality-of-life questionnaires. This systematic review covered five studies with 268 participants. The research appraisal found most of these studies had a low risk of bias. The intervention periods ranged from 4 to 12 weeks. Compared with non-Kegel's exercise or regular activity, Kegel's exercise was found to significantly improve HRQoL-related urinary symptoms (three studies, standardized mean difference = -0.95, 95% CI [-1.35, -0.54], I2 = 0%). However, the effect of this exercise on HRQoL-related sexual symptoms did not differ from non-Kegel's exercise or regular activity (two studies, standardized mean difference = 1.11, 95% CI [-0.25, 2.47], I2 = 94%). None of the covered studies examined the effect of Kegel's exercise on HRQoL-related genital symptoms. Kegel's exercise is an effective intervention for improving HRQoL-related urinary symptoms in postmenopausal women. However, there remains insufficient evidence to assess the effectiveness of Kegel's exercise on HRQoL-related genital symptoms in this population. The results support using Kegel's exercise as a useful intervention to manage urinary symptoms in postmenopausal women.

Factors influencing the health-related quality of life of postmenopausal women with diabetes and osteoporosis: a secondary analysis of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018)

The prevalence of osteoporosis in postmenopausal women is increasing, and diabetes patients have decreased bone density. Their health-related quality of life (HRQoL) is diminished by the resultant physical dysfunction and depression. The purpose of this study was to identify factors influencing HRQoL in postmenopausal women with diabetes and osteoporosis. This was a secondary data analysis of the Seventh Korea Health and Nutrition Examination Survey (2016-2018), which utilized a complex, multistage probability sample design. The participants in the study were 237 women with diabetes and osteoporosis. To evaluate the factors that influenced HRQoL, a complex-samples general linear model was constructed, and the Bonferroni correction was performed. In this sample of women aged 45 to 80 years (mean±standard deviation, 71.12±7.21 years), the average HRQoL score was 0.83±0.18 out of 1.0. Factors influencing HRQoL were age (70s: t=-3.74, p<.001; 80s: t=-3.42, p=.001), walking for exercise more than 5 days a week (t=-2.83, p=.005), cerebrovascular disease (t=-8.33, p<.001), osteoarthritis (t=-2.04, p=.014), hypertension (t=2.03, p=.044), higher perceived stress (t=-2.17, p=.032), poor glycemic control (t=3.40, p=.001), waist circumference (t=-2.76, p=.007), sitting time per day (t=-2.10, p=.038), and a longer postmenopausal period (t=3.09, p=.002). In order to improve the HRQoL of postmenopausal women with osteoporosis and diabetes, it is necessary to implement intervention strategies that enable the effective management of chronic diseases, while preventing the complications of diabetes and minimizing stress through physical activity.

Hand grip strength and health-related quality of life in postmenopausal women: a national population-based study.

Muscle strength progressively decreases after menopause. Hand grip strength (HGS) reflects overall muscle strength and may be associated with health-related quality of life (HRQoL). We aimed to assess the association between HGS and HRQoL in postmenopausal women. We used nationally representative data on 6,059 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2014-2018). HGS was determined as the maximum value in kilograms (kg) achieved using either hand. HRQoL was estimated using the European Quality of Life Questionnaire-Five Dimensions (EQ-5D) questionnaire. The prevalence ratios of having moderate/severe problems on the EQ-5D were evaluated with adjustment for covariates using complex survey analysis. The prevalence of having a problem in at least one of the HRQoL dimensions among postmenopausal women was 43.6%. Compared with participants with the lowest quintile of HGS, women in the highest quintile had a significantly lower prevalence of moderate/severe problems in most dimensions (fully adjusted prevalence ratios [95% confidence intervals]; 0.73 [0.60-0.89], 0.45 [0.28-0.72], 0.52 [0.38-0.71], 0.74 [0.63-0.87], and 0.91 [0.70-1.18] for mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, respectively). The associations between HGS and EQ-5D index were stronger among the participants who were older (65-79 y), had a higher body mass index (≥ 25.0 kg/m2), had low physical activity, had a longer duration since menopause (≥ 10 y), and had a chronic disease. Higher HGS was associated with a lower prevalence of moderate/severe problems in each dimension of the EQ-5D in postmenopausal women. These associations were more apparent in individuals who were older, had higher body mass index, or had a chronic disease.

Effectiveness of denosumab on back pain-related disability and quality-of-life in patients with vertebral fragility fractures

Background: Denosumab is a fully human IgG2 monoclonal antibody that, neutralizing the receptor activator of nuclear factor kappa-Β ligand (RANKL), inhibits the osteoclast-mediated bone resorption. It is yet to be defined if denosumab can reduce osteoporosis-related disability and improve health-related quality-of-life (HRQoL) in patients with fragility fractures.Objective: To assess the effectiveness of denosumab in reducing back pain related disability and improving HRQoL in osteoporotic post-menopausal women with vertebral fractures.Research design and methods: A real practice prospective study was carried out, enrolling women over 50 years with a post-menopausal osteoporosis that experienced at least one vertebral fracture receiving subcutaneous denosumab (60 mg, every 6 months), calcium carbonate (500–1000 mg/day) and cholecalciferol (800 IU/day) for 1 year. Back pain related disability was assessed as the primary outcome using the Spine Pain Index (SPI); secondary outcomes were: SF-12 (Physical Health Composite Score, PCS, and Mental Health Composite Score, MCS), and EuroQol-5D (EuroQol-5D-3L index and EuroQol-Visual Analog Scale, EQ-VAS). All outcome measures were assessed at baseline (T0), after 6 months (T1), and after 12 months (T2) of treatment. Trabecular Bone Score (TBS), lumbar spine (LS) and femoral neck (FN) BMD at T0 and T2 were also evaluated.Results: This study included 140 post-menopausal women, mean age = 70.60 (SD = 8.81) years. There were statistically significant differences after 12 months (T2–T0) in all outcomes assessed: SPI (p < 0.001), SF-12 PCS (p < 0.001), SF-12 MCS (p < 0.001), EQ-5D-3L index (p = 0.039), and EQ-VAS (p = 0.003). Moreover, there was a significant improvement of both LS BMD (p < 0.001) and FN BMD (p < 0.001). No local or systemic adverse events, including new vertebral fractures, osteonecrosis of the jaw and atypical femur fractures, were reported.Conclusions: The data demonstrated that denosumab was effective in reducing back pain related disability and in improving HRQoL in post-menopausal women with vertebral fractures.

Depression and Its Association with Health-Related Quality of Life in Postmenopausal Women in Korea.

Menopause is associated with depressive symptoms that can significantly affect a woman’s quality of life. The objective of this study was to evaluate the association between depression and health-related quality of life (HRQoL) in postmenopausal women. In this cross-sectional descriptive study, participants (n = 3860) were selected from the 2013–2015 Korea National Health and Nutrition Examination Survey (KNHANES). The sociodemographic characteristics, medical history of depression, and EQ-5D scores of the participants were obtained from the KNHANES dataset. Age, educational level, and income were associated with HRQoL in these participants. Moreover, depression exerted a considerable influence on HRQoL in postmenopausal women. The adjusted odds ratios in participants with depression for the EQ-5D dimensions were as follows: 5.52 (95% CI = 4.04–7.55, p < 0.001) for anxiety/depression, 3.86 (95% CI = 2.78–5.36, p < 0.001) for usual activities, and 2.52 (95% CI = 1.68–3.78, p < 0.001) for self-care. Our findings suggest a strong association between depression and HRQoL. Hence, preventing the onset or exacerbation of depression may significantly improve quality of life in postmenopausal women.

Cross cultural adaptation and analysis of psychometric properties of Sinhala version of Menopause Rating Scale

BackgroundMenopause Rating Scale (MRS) evaluates eleven menopausal symptoms and health related quality of life (HRQOL) of postmenopausal women under three subscales. In this study we attempted cross cultural adaptation and evaluation of psychometric properties of a Sinhala translation of MRS.MethodsSinhala version of MRS was adapted following standard methodology; forward and backward translations, review by an expert group, focus group discussion (FGD) and pre-testing. It was self-administered among randomly selected healthy, Sinhalese, community-dwelling 166 postmenopausal women (aged; median = 56.5, IQR, 53.0–59.0 years) along with the Short Form 36 (SF-36) survey questionnaire. MRS was re-administered among a subsample (n = 80) after two weeks of first administration. Psychometric properties; reliability and validity were evaluated.ResultsIn Sinhala version of MRS, both internal consistency (Cronbach’s alpha coefficient = 0.79) and test retest reliability (intra class correlation / ICC = 0.86, 95%CI = 0.82–0.91, p < 0.001 and Pearson correlation / r = 0.93) were high. Factor analysis (FA) with Principal Component Analysis (PCA) extracted three factors explaining 59.82% cumulative variance with few exceptions from the original version. In the item-subscale correlation analysis items showed stronger correlations within their own subscale score (r range between 0.56–0.84) than with other subscales scores and subscales' scores showed strong correlations with the overall MRS score (r range between 0.70–0.86) indicating strong convergent validity. Mean (SD) symptom severities of each item were significantly different between symptomatic and asymptomatic women (p < 0.05) emphasizing good discriminant validity. The overall MRS and SF-36 scores correlated significantly (Pearson correlation: − 0.52, p < 0.01 and Kendall’s tau-b: − 0.39, p < 0.01) ensuring strong criterion validity.ConclusionsThe Sinhala version of MRS we adapted is an informative tool with high reliability and validity and this tool can be used to evaluate the menopausal symptoms and HRQOL in postmenopausal women conversant in Sinhala.

Vertebral fractures and self-perceived health in elderly women and men in a population-based cross-sectional study: the Tromsø Study 2007–08

BackgroundHealth-related quality of life (HRQL) may be associated with increased mortality in the elderly. The effect of prevalent vertebral fractures on HRQL in elderly women and men is not well described. The purpose of this study was to examine the association between prevalent vertebral fractures and back pain, neck pain, and HRQL in elderly women and men, and to study possible gender differences in the reported pain and HRQL.MethodsInformation on prevalent vertebral fractures was ascertained by a vertebral fracture assessment (VFA) method (dual-energy X-ray absorptiometry (DXA), GE Lunar Prodigy) in 2887 women and men, mean age 65.4 (SD 9.4) who participated in the population-based Tromsø Study which was conducted in 2007–08. Bone mineral density (BMD; g/cm2) was measured by DXA at the femoral sites. Self-reported HRQL was assessed using the standardized measures EQ-5D-3 L and EQ VAS from the EuroQol Group. Lifestyle information was collected by questionnaires. The association between vertebral fractures and pain was analyzed using logistic regression, between vertebral fractures and EQ-5D-3 L and EQ VAS scores by multiple regression analyses.ResultsIn women, presence of vertebral fractures was associated with an increased risk of back pain with an OR of 1.76 (95% CI: 1.24 – 2.50) after adjustments for age, height, weight, and BMD. Women with vertebral fractures had lower EQ-5D-3 L scores (p < 0.001) than women without vertebral fractures, also after adjustments. These associations were not present in men. Type of fracture was not associated with EQ-5D-3 L scores, but increasing numbers (p < 0.001) and severity of fractures (p < 0.002) were associated with decreasing EQ-5D-3 L score in women.ConclusionPrevalent vertebral fractures are associated with increased risk of back pain and reduced HRQL in postmenopausal women, but not in men.

Association between anthropometric indices and quality of life in menopausal women

Objective: To investigate whether body mass index (BMI), abdominal obesity or fat distribution influence the quality of life of postmenopausal women.Methods: Subjects in this cross-sectional study were 233 postmenopausal women (aged 45–70 years) with an intact uterus and ovaries and who were sexually active and not using hormone therapy. Anthropometric measurements were recorded and subjects were interviewed using a specific health-related quality of life (HR-QoL) instrument, the MENQoL scale.Results: According to BMI values, 31.5% of the women were obese, 42.2% were overweight, 25.8% were normal weight and none were underweight. However, according to the MENQOL scale results, obese women scored significantly higher on symptoms for physical domains. The women with the android pattern of fat distribution had significantly higher scores in the vasomotor and physical domains (p < 0.05).Conclusions: Obesity did not affect global HR-QoL in postmenopausal women, but appeared to have an influence on the psychical domains. Other anthropometric measurements were not associated with differences in HR-QoL. Keeping the anthropometric indices in the normal/premenopausal might improve the quality of life in menopause women.

The course of Health Related Quality of Life in postmenopausal women with breast cancer from breast surgery and up to five years post-treatment

BackgroundPrevious studies include too few patients over 70 years to be able to assess treatment effects on Health Related Quality Of Life (HRQOL) in the older age group. We aimed to follow HRQOL in postmenopausal women (55–80 years) with breast cancer receiving adjuvant treatment, until five years post-treatment, and compare with a general population. Patients and methodsThe patient sample included 150 women (adjuvant CT n = 75 and RT n = 75) and two reference samples from the Swedish SF-36 norm database. ResultsData from baseline showed significantly higher levels of physical functioning and general health among the patients compared to the reference sample, and significantly lower levels of bodily pain, emotional role functioning and mental health. Longitudinal analyses showed significant changes in all scales, and three different patterns (a decrease-stable, a decrease-increase, and a stable- increase pattern) were identified. ConclusionPostmenopausal women seem to successfully manage the effects of adjuvant treatment on HRQOL.

The impact of vertebral fractures on quality of life in postmenopausal women with osteoporosis. Validity of the Italian version of mini-Osteoporosis Quality of Life Questionnaire

Vertebral fracture is one of the most commonly occurring osteoporotic fractures. Vertebral fractures associated with osteoporosis are a major cause of pain in elderly people and may hardly affect patient's health-related quality of life (HRQOL), making this an important parameter for assessment in these patients. Studies comparing the performance of HRQOL instruments in osteoporosis are lacking. The purposes of this study were to assess the effect of vertebral fractures on health HRQOL in post-menopausal women with osteoporosis and to investigate the validity of the Italian version of the mini-Osteoporosis Quality of Life Questionnaire (mini-OQOL) in a clinical setting. Patients were divided into two study groups, according to fracture status: vertebral fractures (41 patients) and no vertebral fractures (27 patients). Baseline assessments of anthropometric data, medical history, and prevalent fracture status were obtained from all participants. All of the participants were evaluated using both disease-targeted mini-OQOL and QUALEFFO, generic instrument (EUROQoL), disability scale (Roland Morris Disability questionnaire- RMDQ) and chronic pain grade questionnaire. Vertebral fractures due to osteoporosis significantly decreases scores on physical function, socio-emotional status, clinical symptoms, and overall HRQOL. Both disease-targeted questionnaires showing an association between the number of prevalent vertebral fractures and decreased HRQOL. Significant correlations existed between scores of similar domains of mini-OQOL and the QUALEFFO, especially for symptoms, physical function, activities of daily living and social function. The receiver operating characteristic (ROC) curve analysis of mini-OQOL and the QUALEFFO indicated that both questionnaires were significantly predictive of vertebral fractures. Number of concomitant diseases presented a weak significant correlation with EUROQoL (p=0.041). Our study suggests that the patients with vertebral fractures due to osteoporosis have a relevant impairment in quality of life. Both disease-targeted questionnaires discriminated between patients with and without vertebral fractures though the mini-OQOL, originally developed to measure the effect of vertebral fractures on quality of life, showed slightly better discriminant power. The benefit of the mini-OQOL is that it is efficient, self administered, and requires 3-4 minutes to complete.

Comparing the effects of intrauterine progestin system and oral progestin on health‐related quality of life and Kupperman index in hormone replacement therapy

The aim of this study was to compare the effects of intrauterine-system-releasing 20 µg daily of levonorgestrel (LNG IUS) plus 1 mg 17 beta-estradiol daily, orally with combined oral pill containing 1 mg 17 beta-estradiol/2 mg drospirenone daily as hormone replacement therapy, on health-related quality of life (HRQoL) and climacteric symptoms in postmenopausal women. A 6-month prospective clinical trial was conducted at the Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. Ninety postmenopausal women were accepted to be part of the study. The Euro Quality of Life-5 Dimensions (EQ-5D) and Euro Quality of Life Visual Analogue Scale (EQ VAS) indexes for HRQoL and Kupperman indexes were compared between two groups of patients. Kupperman indexes of both treatment groups decreased gradually over 6 months, but indexes decreased significantly more in the group with intrauterine-system-releasing 20 µg daily of levonorgestrel. Elevations were observed in EQ-5D indexes and VAS values of both groups. EQ VAS values significantly increased in the group on intrauterine progestogen system. Similar changes were observed in the EQ-5D indexes of both groups. A hormone replacement therapy regimen that includes an intrauterine progestin system decreased climacteric symptoms and increased HRQoL in postmenopausal women during a follow-up period of 6 months. The extent of the relief of symptoms was greater in this group than in women receiving oral combined hormone replacement therapy. It seems therefore that the intrauterine progestin system could represent a method of choice for endometrial suppression in women using estrogen replacement therapy with distinct advantages over systemically administered progestogens, which have been the subject of considerable debate as reported in the recent literature.

Abstract P5-11-12: Quality of Life in the PACT-Programme (Patient's Anastrozole Compliance to Therapy Programme): Influence of a Standardized Information Service on Patient Satisfaction and Health Related Quality of Life in Postmenopausal Women with Early Breast Cancer (EBC)

Abstract Introduction: In recent years, patient reported outcomes have become increasingly a focus in clinical investigations. Health related quality of life (HRQoL) is now regularly evaluated in clinical trials, yet data on HRQoL in postmenopausal women receiving adjuvant aromatase inhibitor treatment for early breast cancer (EBC) is limited. Here, we present the 12 months results on HRQoL and patient satisfaction from PACT, a program which aims to increase awareness, motivation and adherence to adjuvant anastrozole therapy in routine clinical practice by adding regular standardized information (brochures and motivational letters) to standard clinical care. Methods: PACT is a prospective, randomised, two-arm parallel-group study with 60 months follow-up (NCT00555867, sponsored by AstraZeneca Germany). Postmenopausal women on anastrozole for hormone-receptor positive (HR+) EBC were randomized to routine clinical care alone or additional regular standardized information (educational arm) for the first year of adjuvant endocrine therapy. Primary endpoint was the compliance rate in the educational vs. routine arm after 12 months. Secondary endpoints include HRQoL and patient satisfaction, evaluated via EORTC IN-PATSAT32, QLQ-C30, and QLQ-BR23. The present analysis focuses on differences in HRQoL and patient satisfaction between the standard and educational arm and between compliant and non-compliant patients at 12 months after treatment initiation. Results: 4,923 patients were enrolled into PACT by Nov. 2008. Of these, 2,707 were evaluable for analysis of the primary endpoint compliance and the secondary endpoints patient satisfaction and HRQoL. Analysis of HRQoL and patient satisfaction scores showed no differences between the standard and the educational arm at 12 months. When comparing compliant vs. non-compliant patients, however, compliant patients reached significantly higher (=better) patient satisfaction scores in all domains. In addition, compliant patients achieved significantly higher (=better) scores in the HRQoL domains of physical functioning (p=0.04), emotional functioning (p=0.018), cognitive functioning (p=0.004), social functioning (p=0.005), and sexual enjoyment (p=0.047), as well as lower (=better) scores in the domains of fatigue (p=0.01), systemic therapy (p=0.003), and arm symptoms (p=0.03). After correction for multiple testing, statistically significant differences favouring compliant patients were retained in the areas of information provision and availability (p=0.0008 and p=0.0005, respectively). Conclusion: In postmenopausal patients with HR+ EBC assigned to adjuvant endocrine treatment with an aromatase inhibitor (anastrozole), HRQoL and patient satisfaction were not affected by the intervention. However, analysis of compliant vs. non-compliant patients revealed improved scores for patient satisfaction in multivariate analysis favouring compliant patients at 12 months after treatment initiation. PACT represents an important project in health outcomes research regarding adjuvant endocrine therapy in postmenopausal patients with HR+ EBC. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-11-12.

Excess Weight and Physical Health-Related Quality of Life in Postmenopausal Women of Diverse Racial/Ethnic Backgrounds

Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998). Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group. Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study

BackgroundThe negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.MethodsNinety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student's t-tests, ANCOVA, and partial correlation.ResultsSixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p < 0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.ConclusionThe long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.

Abstract 2090: Health Related Quality of Life Outcomes of Therapeutic Life Style Modification Program for Women with Metabolic Syndrome

Background: The metabolic syndrome (MetS), with associated increased CHD risk, is highly prevalent among postmenopausal women in Korea. Although therapeutic lifestyle modification (TLM) has been recommended as a cornerstone therapy, studies investigating the effects of TLM on health related quality of life (HRQOL) are limited. Purpose : This study was to evaluate HRQOL outcomes of a six-month TLM in Korean women with Mets. Methods: A randomized controlled design was used. Fifty four women (mean age of 63.2 y) with Mets were recruited from community health centers and randomly assigned to the intervention (N=31) or control (N=23) groups. The subjects in the intervention group participated in a supervised weekly TLM session for six months. The TLM program was consisted of health monitoring, education, aerobic exercise (40-min/session, 200 Kcal/day), and a low calorie diet with low carbohydrate (≈1300Kcal/d). Those in the control group received a booklet about MetS and were instructed to maintain their usual diet and activities. HRQOL was measured using the MOS SF-36 at before, during (month 3), completion (month 6), and after completion of the TLM program (month 12). Mixed-model repeated measures ANCOVA was used to evaluate HRQOL outcomes. Results : There were significant group by time interactions for general health ( P = .043) and vitality ( P = .012). Both general health (mean 23-point change) and vitality scores (mean 16-point change) greatly improved in the treatment group over 6 months of TLM, compared with control group. However, the improvement of the general health and vitality in the experimental group was not sustained at month 12. There were significant treatment main effects (all P &lt; .05) for the remaining SF-36 subscale scores. Conclusion : A systematic TLM program may be effective strategy for improving HRQOL in postmenopausal women with MetS.

Weight Regain and Health‐related Quality of Life in Postmenopausal Women

Weight loss improves health-related quality of life (HRQoL). However, regain after loss is common; little is known about the impact of weight regain on HRQoL in postmenopausal women. Woman on the Move through Activity and Nutrition (WOMAN) is a randomized lifestyle intervention trial of diet, physical activity, and weight loss in 508 postmenopausal women aged 52-62 years. This analysis focused on the women who lost > or =5 lb during the initial phase of the study, baseline to 6 months (n = 248). This cohort was divided into three groups based on subsequent weight change between 6 and 18 months: weight loss (WL; > or =5 lb loss), weight stable (WS; <+/-5 lb change), and weight regain (WR; > or =5 lb gain). HRQoL was measured at baseline, 6, and 18 months using the Short Form-36. Of the 248 women studied, 51 (21%) continued to lose weight after initial weight loss, while 127 (51%) maintained a stable weight, and 70 (28%) regained weight. Between baseline and 6 months, women in WR group had decreased mental health and social-functioning scores, while the WL and WS groups improved in these subscales. Between baseline and 18 months, energy improved most significantly in those with continued weight loss (P = 0.0003). Weight loss was correlated with a small to moderate improvement in perceived general health and energy, which was reversed by weight gain. Further study is needed to investigate the impact of a decline in mental health and social functioning on future weight regain.

Quality of life in obese postmenopausal women

The aim of this review was to identify the ways in which obesity affects the health-related quality of life (HRQoL) of postmenopausal women. This was considered important because a growing body of literature has identified obesity as a significant predictor for a poor psychological wellbeing and negative HRQoL, particularly in women, and because during the transition through the menopause women tend to accumulate more body weight. After searching eight electronic databases, only nine papers appeared meaningful. Although a meta-analysis was not possible, we found that a body mass index (BMI) > 30 kg/m2 was associated with a poor HRQoL in postmenopausal women; particularly in the areas associated with physical functioning, energy and vitality, and health perceptions. Thus, clinical management of obese postmenopausal women should focus on weight reduction and exercise in an attempt to improve wellbeing in these areas. However, the paucity of research, the different instruments chosen to measure HRQoL and the methodological limitations of the studies identified, prevented firm conclusions being made about whether the relationship between BMI and HRQoL is linear in postmenopausal women. Further research is needed to explore this relationship; particularly in comparison with underweight postmenopausal women and obese premenopausal women, where a few papers have identified these women as having a worse HRQoL than their obese postmenopausal counterparts. Other measures of central adiposity, including waist circumference and waist-hip ratio are recommended as useful supplemental measures to BMI in future studies.

Association of severe vertebral fractures with reduced quality of life: Reduction in the incidence of severe vertebral fractures by teriparatide

The association between vertebral fracture severity and health-related quality of life (HRQOL) was investigated in a subset of patients in the Fracture Prevention Trial. We sought to determine whether vertebral fracture severity was associated with HRQOL scores, and if so, to determine the effects of teriparatide (recombinant human parathyroid hormone 1-34) on vertebral fracture grades that most strongly impact HRQOL in postmenopausal women with osteoporosis. Vertebral fracture severity was assessed by the visual semiquantitative (SQ) method. A subset of 444 patients with a baseline radiograph completed the Osteoporosis Assessment Questionnaire. Baseline HRQOL scores were modeled as a function of maximum baseline vertebral fracture grade, while controlling for age, bone mineral density, body mass index, and back pain. The effect of baseline vertebral fracture grade on baseline HRQOL was statistically significant, while interactions between vertebral fracture grade and the other variables were not statistically significant. SQ grade 3 (SQ3) vertebral fractures were associated with a significantly lower overall HRQOL score and with significantly lower physical function, symptoms, and emotional status dimension scores. After a median of 19 months of therapy, new or worsening SQ3 vertebral fractures occurred in 21 of 448 patients (4.7%) in the placebo group compared with 3 of 444 patients (0.7%) in the 20 mug/day teriparatide group. The risk of developing a new or worsened SQ3 vertebral fracture was reduced by 86% (P < 0.001) in patients treated with 20 mug/day teriparatide. Compared with prevalent fractures of lesser severity, SQ3 vertebral fractures were associated with reduced HRQOL. Teriparatide treatment significantly reduced the risk of new or worsening SQ3 vertebral fractures. These findings suggest, but do not directly demonstrate, a benefit of teriparatide on HRQOL.