Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey

Figures & data

Table 1. Patient and physician characteristics.

	Overall	Patient has not completed all PROs	Patient has completed all PROs
Patient age, years
n	1848	867	981
Mean (SD)	69.2 (10.3)	70.1 (10.9)	68.4 (9.8)
Median (IQR)	69 (62.0, 76.5)	70 (63.0, 78.0)	68 (62.0, 75.0)
Patient gender, n (%)
n	1848	867	981
Female	1690 (91.5)	791 (91.2)	899 (91.6)
Male	158 (8.6)	76 (8.8)	82 (8.4)
Patient BMI
n	1848	867	981
Mean (SD)	25.4 (4.6)	25.3 (4.7)	25.5 (4.5)
Median (IQR)	24.9 (22.3, 27.8)	24.9 (22.1, 27.8)	24.9 (22.5, 27.8)
Number of days since diagnosis
n	1251	538	713
Mean (SD)	1044.9 (1100.2)	1092.9 (1152.5)	1008.7 (1058.3)
Median (IQR)	732 (336.0, 1422.0)	734 (287.0, 1475.0)	731 (351.0, 1258.0)
Physician reported severity, n (%)
n	1848	867	981
Mild	549 (29.7)	257 (29.6)	292 (29.8)
Moderate	944 (51.1)	415 (47.9)	529 (53.9)
Severe	304 (16.5)	171 (19.7)	133 (13.6)
Very severe	51 (2.8)	24 (2.8)	27 (2.8)
Physician type grouping, n (%)
n	1848	867	981
PCP	771 (41.7)	343 (39.6)	428 (43.6)
Specialist	1077 (58.3)	524 (60.4)	553 (56.4)
Charlson Comorbidity Index
n	1848	867	981
Mean (SD)	0.9 (1.3)	1.0 (1.4)	0.8 (1.2)
Site of most recent fracture, n (%)
n	369	184	185
Hip	69 (18.7)	40 (21.7)	29 (15.7)
Spine	137 (37.1)	66 (35.9)	71 (38.4)
Wrist	90 (24.4)	45 (24.5)	45 (24.3)
Rib	17 (4.6)	7 (3.8)	10 (5.4)
Humerus	12 (3.3)	9 (4.9)	3 (1.6)
Other	44 (11.9)	17 (9.2)	27 (14.6)
Number of days since most recent fracture
n	367	182	185
Mean (SD)	1165 (1300)	1366 (1600)	968 (874)
EQ-5D Health Index score
n	1025	44	981
Mean (SD)	0.8 (0.2)	0.8 (0.2)	0.8 (0.2)
EQ-VAS
n	1021	40	981
Mean (SD)	75.2 (16.0)	75.9 (13.5)	75.2 (16.1)
OPAQ-SV—normalized physical score
n	1075	94	981
Mean (SD)	75.7 (15.8)	68.5 (16.9)	76.4 (15.5)
OPAQ-SV—normalized emotional score
n	1039	58	981
Mean (SD)	69.4 (15.1)	66.1 (18.1)	69.6 (14.9)
OPAQ-SV—normalized symptom score
n	1074	93	981
Mean (SD)	68.1 (20.5)	63.5 (21.4)	68.6 (20.3)

Abbreviations. BMI, body mass index; EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; IQR, interquartile range; PCP, primary care physician; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version; PRO, patient-reported outcomes; SD, standard deviation.

Figure 1. Mean PRO scores by number of fractures (n = 935). **ANOVA p < .0001. Abbreviations. EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version; PRO, patient-reported outcomes; SD, standard deviation. Number of patients in each group were as follows: overall, n = 935; 0 fractures, n = 750; 1 fracture, n = 145; ≥2 fractures, n = 40. Includes participants who completed all PROs and had values for all variables used in the analysis.

Figure 2. Mean PRO scores by site of most recent fracture (n = 185). *ANOVA p < .01; **ANOVA p < .0001. Abbreviations. EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version; PRO, patient-reported outcomes; SD, standard deviation. Number of patients in each group were as follows: overall, n = 185; wrist, n = 45; rib, n = 10; humerus, n = 3; other, n = 27; hip, n = 29; spine, n = 71.

Table 2. Mean PRO scores by time since most recent fracture.

	Overall (n = 185)	≤1 year ago (n = 40)	1–2 years ago (n = 41)	>2 years ago (n = 104)	p-Value
EQ-5D Health Index
Mean ± SD	0.72 ± 0.19	0.70 ± 0.19	0.75 ± 0.15	0.72 ± 0.20	.4841
Median (IQR)	0.77 (0.59, 0.83)	0.71 (0.64, 0.81)	0.77 (0.69, 0.83)	0.77 (0.59, 0.83)
EQ-VAS
Mean ± SD	68.85 ± 18.23	68.55 ± 18.31	69.05 ± 18.23	68.89 ± 18.38	.992
Median (IQR)	70 (55.0, 80.0)	70 (59.5, 80.0)	70 (60.0, 80.0)	70 (52.0, 82.5)
Normalized physical score - OPAQ-SV
Mean ± SD	66.3 ± 16.03	62.13 ± 16.96	67.95 ± 13.93	67.25 ± 16.31	.1731
Median (IQR)	66 (55.0, 78.0)	59 (48.5, 74.0)	70 (58.0, 78.0)	68 (56.0, 78.5)
Normalized emotional score - OPAQ-SV
Mean ± SD	59.72 ± 14.78	58.25 ± 15.42	60.95 ± 12.63	59.81 ± 15.38	.7125
Median (IQR)	60 (47.0, 69.0)	57 (46.5, 67.0)	64 (51.0, 71.0)	60 (47.0, 71.0)
Normalized symptom score - OPAQ-SV
Mean ± SD	57.03 ± 19.59	57.00 ± 17.31	59.88 ± 15.91	55.91 ± 21.66	.5501
Median (IQR)	55 (40.0, 70.0)	55 (45.0, 65.0)	55 (50.0, 70.0)	55 (40.0, 75.0)

Abbreviations. EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; IQR, interquartile range; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version; PRO, patient-reported outcomes; SD, standard deviation.

Table 3. Regression analysis for association between fracture site, time since fracture, and number of fractures with PROs in patients with fractures (n  =  185)^a.

Variable	Coefficient (95% CI)
			OPAQ-SV
	EQ-5D	EQ-VAS	Physical	Emotional	Symptom
Days since fracture	0.0000	−0.0021	0.0017	0.0016	0.0007
	(−0.00003, 0.00004)	(−0.0018, 0.0060)	(−0.0019, 0.0052)	(−0.0016, 0.0048)	(−0.0036, 0.0050)
	p = .895	p = .285	p = .363	p = .319	p = .752
Fracture site^b
Hip (n  =  29)	−0.110	−8.6285	−13.834	−12.561	−15.274
	(−0.1947, −0.0253)	(−16.4079, −0.8491)	(−21.1488, −6.5184)	(−17.9830, −7.1384)	(−23.3411, −7.2076)
	p = .011	p = .030	p < .001	p<.001	p<.001
Spine (n  =  71)	−0.129	−11.454	−13.205	−11.765	−17.131
	(−0.1937, −0.0644)	(−18.0936, −4.8151)	(−18.2881, −8.1209)	(−16.7712, −6.7583)	(−24.0758, −10.1868)
	p<.001	p = .001	p<.001	p<.001	p<.001
Rib (n  =  10)	0.004	−7.935	−1.422	−0.881	−6.495
	(−0.0851, 0.0930)	(−17.8313, −1.9604)	(−10.8690, 8.0241)	(−9.9859, 8.2233)	(−17.4503, 4.4605)
	p = .930	p = .115	p = .766	p = .848	p = .243
Humerus (n  =  3)	−0.040	−4.702	−11.060	−5.761	−8.914
	(−0.1209, 0.0411)	(−9.9148, 0.5102)	(−31.0558, 8.9356)	(−14.4575, 2.9356)	(−16.2919, −1.5364)
	p = .331	p = .077	p = .275	p = .192	p = .018
Other (n  =  27)	−0.044	−10.756	−7.660	−12.619	−12.666
	(−0.1310, 0.0433)	(−20.8036, −0.7080)	(−14.8730, −0.4470)	(−20.4102, −4.8284)	(−22.6770, −2.6559)
	p = .321	p = .036	p = .038	p = .002	p = .014
Number of fractures	−0.021	−5.751	−0.663	−1.930	−2.278
	(−0.0588, 0.0167)	(−10.4627, −1.0391)	(−4.1802, 2.8540)	(−4.7582, 0.8978)	(−6.2619, 1.7068)
	p = .272	p = .017	p = .709	p = .179	p = .260

Abbreviations. CI, confidence interval; EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version.

^a Model included number of fractures, fracture site, and days since fracture only. p-values were adjusted to account for physician clustering.

^b Reference fracture site was the wrist.

Table 4. Regression analyses for association between the number of fractures and demographic and clinical variables with PROs^a (n = 935)^b.

	Coefficient (95% CI)
			OPAQ-SV
Variable	EQ-5D	EQ-VAS	Physical	Emotional	Symptom
Number of fractures	−0.0543	−4.682	−5.2196	−5.5403	−6.7456
	(−0.0722, −0.0363)	(−7.3076, −2.0573)	(−6.8898, −3.5493)	(−7.3200, −3.7607)	(−8.9615, −4.5298)
	p<.001	p=.001	p<.001	p<.001	p<.001
Age	−0.0046	−0.2843	−0.5164	−0.5217	−0.5137
	(−0.0058, −0.0034)	(−0.4175, −0.1512)	(−0.6680, −0.3647)	(−0.6627, −0.3807)	(−0.6807, −0.3466)
	p<.001	p<.001	p<.001	p<.001	p<.001
Male gender^c	0.0045	2.6280	−0.1021	2.9503	−1.060
	(−0.0364, 0.0455)	(−0.8718, 6.1278)	(−3.7036, 3.4994)	(−0.5394, 6.4399)	(−5.6449, 3.5252)
	p=.827	p=.140	p=.955	p=.097	p=.649
BMI	−0.0036	−0.3243	−0.4211	−0.2736	−0.5592
	(−0.0063, −0.0009)	(−0.5697, −0.0789)	(−0.6587, −0.1836)	(−0.5031, −0.0441)	(−0.9131, −0.2054)
	p=.009	p=.010	p=.001	p=.020	p=.002
CCI	−0.0332	−3.4995	−2.703	−1.9865	−3.2203
	(−0.0430, −0.0235)	(−4.5141, −2.4849)	(−3.8029, −1.6035)	(−2.8830, −1.0899)	(−4.4874, −1.9532)
	p<.001	p<.001	p<.001	p<.001	p<.001

Abbreviations. BMI, body mass index; CCI, Charlson Comorbidity Index; CI, confidence interval; EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version.

^a Model included number of fractures, age, gender, BMI, and CCI only. p-values were adjusted to account for physician clustering.

^b Includes participants who completed all PROs and had values for all variables used in the regression analysis.

^c Reference was female gender.

Table 5. Regression analyses for associations between the site of fracture and demographic and clinical variables with PROs in patients with fractures (n = 185)^a.

Variable	Coefficient (95% CI)
	EQ-5D	EQ-VAS	OPAQ-SV
			Physical	Emotional	Symptom
Fracture site^b
Hip (n  =  29)	−0.0854	−8.1315	−11.0303	−10.4118	−12.6570
	(−0.1644, −0.0064)	(−14.0580, −2.2050)	(−17.5155, −4.5451)	(−15.8833, −4.9403)	(−20.0996, −5.2143)
	p = .034	p = .008	p = .001	p<.001	p = .001
Spine (n  =  71)	−0.1277	−13.1196	−11.7272	−11.7648	−16.5482
	(−0.1904, −0.0650)	(−20.4239, −5.8154)	(−16.6302, −6.8241)	(−16.6327, −6.8969)	(−23.0725, −10.0238)
	p<.001	p = .001	p<.001	p<.001	p<.000
Rib (n  =  10)	−0.0164	−12.6208	−0.9039	−1.1075	−8.3533
	(−0.1023, 0.0695)	(−22.2924, −2.9492)	(−8.9915, 7.1836)	(−9.2450, 7.0300)	(−18.0183, 1.3117)
	p = .706	p = .011	p = .825	p = .788	p = .090
Humerus (n  =  3)	−0.0408	−5.3668	−9.7721	−6.3037	−8.0426
	(−0.1310, 0.0494)	(−9.9976, −0.7361)	(−28.5261, 8.9819)	(−16.2690, 3.6616)	(−14.9761, −1.1090)
	p = .372	p = .024	p = .304	p = .213	p = .023
Other (n  =  27)	−0.0551	−11.8812	−7.8692	−13.3592	−13.6090
	(−0.1361, 0.0259)	(−20.9066, −2.8559)	(−14.8121, −0.9262)	(−20.1668, −6.5515)	(−22.9135, −4.3044)
	p = .180	p = .010	p = .027	p<.001	p = .005
Age	−0.0021	−0.0286	−0.3140	−0.2111	−0.2472
	(−0.0045, 0.0003)	(−0.2706, 0.2135)	(−0.5354, −0.0927)	(−0.4338, 0.0116)	(−0.5292, 0.0348)
	p = .084	p = .815	p = .006	p = .063	p = .085
Male gender^c	0.0728	6.6171	2.4228	5.3676	4.7063
	(0.0011, 0.1446)	(0.8050, 12.4291)	(−2.7352, 7.5807)	(−0.3703, 11.1056)	(−1.7510, 11.1637)
	p = .047	p = .026	p = .354	p = .066	p = .151
BMI	−0.0004	−0.0790	−0.2158	0.2609	−0.2078
	(−0.0064, 0.0057)	(−0.7225, 0.5646)	(−0.7221, 0.2906)	(−0.2863, 0.8082)	(−0.7653, 0.3496)
	p = .900	p = .808	p = .400	p = .347	p = .462
CCI	−0.0437	−4.3839	−3.2585	−2.1882	−4.7962
	(−0.0648, −0.0225)	(−6.3593, −2.4085)	(−4.9125, −1.6046)	(−3.8457, −0.5306)	(−6.8591, −2.7334)
	p<.001	p<.001	p<.001	p = .010	p<.001

Abbreviations. BMI, body mass index; CCI, Charlson Comorbidity Index; CI, confidence interval; EQ-5D, European Quality of Life 5 Domains; EQ-VAS, European Quality of Life Visual Analog Scale; OPAQ-SV, Osteoporosis Assessment Questionnaire short-version.

^a Model included fracture site, age, gender, BMI, and CCI only. p-values were adjusted to account for physician clustering.

^b Reference fracture site was the wrist.

^c Reference was female gender.

Data availability statement

The data supporting the findings of this study are commercially available from the 2016 Adelphi US Osteoporosis Disease Specific Programme™. The analysis was conducted using Stata 15.1. Analysis of variance was conducted using command “oneway.” Regression analyses were conducted using command “regress,” with option “VCE cluster” to account for physician clustering. The Protocol Synopsis is available on request by contacting [email protected].