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Multicenter Study
. 2012 Dec;23(12):2863-71.
doi: 10.1007/s00198-012-1935-8. Epub 2012 Mar 8.

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW)

C Roux  1 , A Wyman, F H Hooven, S H Gehlbach, J D Adachi, R D Chapurlat, J E Compston, C Cooper, A Díez-Pérez, S L Greenspan, A Z Lacroix, J C Netelenbos, J Pfeilschifter, M Rossini, K G Saag, P N Sambrook, S Silverman, E S Siris, N B Watts, S Boonen; GLOW investigators
Affiliations
Multicenter Study

Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW)

C Roux et al. Osteoporos Int. 2012 Dec.

Abstract

Among 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures.

Introduction: There is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life.

Methods: We analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey.

Results: Among 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures.

Conclusion: This prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.

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Conflict of interest statement

Conflicts of interest Christian Roux––honoraria/consultant/advisory board: Alliance, Amgen, Lilly, Merck, Novartis, Nycomed, Roche, GlaxoSmithKline, Servier, Wyeth.

Allison Wyman: None.

Fred H Hooven––funding: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott). Stephen Gehlbach––funding: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Jonathan D Adachi–consultant/speaker: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Servier, Warner Chilcott, Wyeth; clinical trials: Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Warner Chilcott, Wyeth, Bristol-Myers Squibb.

Roland Chapurlat–funding: French Ministry of Health, French Ministry of Research, Merck, Servier, Lilly; honoraria: Amgen, Servier, Novartis, Lilly, Roche; consultant/advisory board: Amgen, Merck, Servier, Novartis.

Juliet E Compston–paid consultancy work: Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gamble, Wyeth, Pfizer, The Alliance for Better Bone Health, Roche, and GlaxoSmithKline; paid speaker and received reimbursement, travel and accommodation: Servier, Procter & Gamble, and Lilly; research grants: Servier R&D and Procter & Gamble.

Cyrus Cooper–consulting fees/lecturer: Amgen, The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott), Lilly, Merck, Servier, Novartis, Roche-GSK.

Adolfo Díez-Pérez–consulting fees/lecturer: Eli Lilly, Amgen, Procter & Gamble, Servier, Daiichi-Sankyo; expert witness: Merck; consultant/advisory board: Novartis, Eli Lilly, Amgen, Procter & Gamble.

Susan L Greenspan–consultant/advisory board: Amgen, Lilly, Merck; research grants: The Alliance for Better Bone Health (sanofi-aventis and Procter & Gamble), Lilly.

Andrea LaCroix–funding: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott); advisory board: Amgen.

J Coen Netelenbos–consultant: Roche Diagnostics, Daiichi-Sankyo, Procter & Gamble, Nycomed; speaker/reimbursement, travel and accommodation: Roche Diagnostics, Novartis, Daiichi-Sankyo, Procter & Gamble; research grants: The Alliance for Better Bone Health, Amgen.

Johannes Pfeilschifter–research grants: Amgen, Kyphon, Novartis, Roche; other research support (equipment): GE Lunar; Speakers’ bureau: Amgen, sanofi-aventis, GlaxoSmithKline, Roche, Lilly Deutschland, Orion Pharma, Merck, Merckle, Nycomed, Procter & Gamble; advisory board: Novartis, Roche, Procter & Gamble, Teva.

Maurizio Rossini–Speakers’ bureau: Roche, Merck Sharp & Dohme, GlaxoSmithKline.

Kenneth G Saag–consulting fees/other remuneration: Eli Lilly & Co, Merck, Novartis, Amgen; paid research: Eli Lilly & Co, Merck, Novartis, Amgen.

Philip N Sambrook–honoraria/consultant/advisory board: Merck, sanofi-aventis, Roche, Servier.

Stuart Silverman–research grants: Wyeth, Lilly, Novartis, Alliance; Speakers’ bureau: Lilly, Novartis, Pfizer, Procter & Gamble; honoraria: Procter & Gamble; consultant/advisory board: Lilly, Argen, Wyeth, Merck, Roche, Novartis.

Ethel S Siris–consultant: Amgen, Lilly, Novartis, The Alliance for Better Bone Health; Speakers’ bureau: Amgen, Lilly.

Nelson B Watts–honoraria: Amgen, Novartis, Warner Chilcott; consultant: Amgen, Arena, Baxter, InteKrin, Johnson & Johnson, Lilly, Medpace, Merck, NPS, Orexigen, Pfizer/Wyeth, Takeda, Vivus, Warner Chilcott; research support: Amgen, Merck, NPS; co-founder/stock options/director: OsteoDynamics.

Steven Boonen–research grants: Amgen, Lilly, Novartis, Pfizer, Procter & Gamble, sanofi-aventis, Roche, GlaxoSmithKline; honoraria/Speakers’ bureau/consultant/advisory board: Amgen, Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier. Dr Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases.

Figures

Fig. 1
Fig. 1
Distribution of incident fracture types. Major NHNV pelvis, upper leg, lower leg, shoulder, upper arm, knee, and elbow; minor NHNV wrist, hand, ankle, foot, rib, and clavicle.
Fig. 2
Fig. 2
Distribution of incident fracture types. NHNV non-hip, non-vertebral.
Fig. 3
Fig. 3
One-year incidence of fractures in GLOW by age group.
See this image and copyright information in PMC

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