Mapi, Stockholm, Sweden.
LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
Osteoporos Int. 2018 Mar;29(3):557-566. doi: 10.1007/s00198-017-4317-4. Epub 2017 Dec 11.
This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months.
The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture.
Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture.
Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types.
Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
本研究使用国际骨质疏松性骨折成本与效用研究（ICUROS）的数据，估算骨折对生活质量（QoL）的影响。髋部、椎体和远端前臂骨折会导致 QoL 显著下降。髋部和椎体骨折至少 18 个月后会显著降低 QoL。
在骨折后 4、12 和 18 个月进行了 5 次 QoL 点估计的 4 次时间点数据采集。使用 EQ-5D-3L 衍生的健康状态效用值（HSUVs）测量生活质量。采用完全案例分析作为基础分析，进行可用案例和多重插补的敏感性分析。采用多变量分析来探讨骨折对 QoL 影响的预测因素。
在采用便利抽样纳入的 5456 例患者中，3021 例患者符合基础分析的条件（1415 例髋部、1047 例远端前臂和 559 例椎体骨折）。髋部、椎体和远端前臂骨折后 HSUV 与骨折前的平均（SD）差值分别估计为 0.89（0.40）、0.67（0.45）和 0.48（0.34）（所有骨折类型均 p<0.001）。骨折后 18 个月，髋部骨折（0.66 比 0.77，p<0.001）和椎体骨折（0.70 比 0.83，p<0.001）患者的 HSUV 均低于骨折前。住院和更高的骨折前回忆 QoL 与所有骨折类型的 QoL 影响增加相关。
髋部、椎体和远端前臂骨折会导致 QoL 显著下降，且对于髋部或椎体骨折患者，QoL 至少在 18 个月内显著受损。
