Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Hamilton Health Sciences-Geriatric Education and Research in Aging Sciences (GERAS) Centre, Hamilton, ON, Canada.
J Bone Miner Res. 2019 May;34(5):838-848. doi: 10.1002/jbmr.3666. Epub 2019 Feb 5.
Although the short-term impact of incident fragility fractures on health-related quality of life (HRQL) of older people has been confirmed, we lack long-term evidence. We explored the impact of incident fragility fractures on HRQL, among people aged 50 years and older, using 10-year prospective data from the Canadian Multicentre Osteoporosis Study (CaMos). This study was based on data from 7753 (2187 men and 5566 women) participants of CaMos. The HRQL, measured through the Health Utility Index (HUI), was captured at baseline and year 10. The incident fragility fractures were recorded over 10 years of follow-up at spine, hip, rib, shoulder, pelvis, or forearm. Multivariable regression analysis was conducted to measure the mean difference, termed as deficit, in the HUI scores for participants with and without fractures. We examined the effects of single or multiple fragility fractures, time (fractures that occurred between year 1 to 5 and 6 to 10) and recovery to the prefracture level. Incident spine and hip fractures were associated with significant deficits (varied from -0.19 to -0.07) on the HUI scores. Hip and spine fractures were associated with negative impact on mobility, self-care, and ambulation. Fractures that occurred closer to the follow-up assessment were associated with significant impact on HRQL compared to fractures occurring a long time before it, except for hip fracture (deficits lasted 5 years or longer). Similarly, multiple hip (-0.14), spine (-0.16), and rib (-0.21) fractures significantly impacted the HRQL of women. Women with a hip fracture never recovered to their prefracture level score (OR = 0.41; 95% confidence interval [CI], 0.19 to 0.98). Our analysis suggests that single and multiple hip fractures as well as multiple spine and rib fractures strongly impact the HRQL of older people over a prolonged period of time. © 2019 American Society for Bone and Mineral Research.
尽管已经证实偶发性脆性骨折对老年人健康相关生活质量（HRQL）的短期影响，但我们缺乏长期证据。我们使用加拿大骨质疏松多中心研究（CaMos）的 10 年前瞻性数据，探讨了偶发性脆性骨折对 50 岁及以上人群 HRQL 的影响。该研究基于 CaMos 7753 名参与者（2187 名男性和 5566 名女性）的数据。HRQL 通过健康效用指数（HUI）进行测量，在基线和第 10 年进行评估。10 年的随访期间，在脊柱、髋部、肋骨、肩部、骨盆或前臂处记录偶发性脆性骨折。采用多变量回归分析来衡量有和无骨折的参与者在 HUI 评分上的平均差异，称为缺陷。我们研究了单发或多发脆性骨折、时间（发生在第 1 年至第 5 年和第 6 年至第 10 年）和恢复到骨折前水平对 HUI 评分的影响。偶发性脊柱和髋部骨折与 HUI 评分显著下降（从-0.19 到-0.07）相关。髋部和脊柱骨折与活动能力、自我护理和步行能力下降相关。与随访评估时间较近的骨折相比，与骨折发生时间较长的相比，对 HRQL 的影响更为显著，除髋部骨折外（缺陷持续 5 年或更长时间）。同样，多发髋部（-0.14）、脊柱（-0.16）和肋骨（-0.21）骨折显著影响女性的 HRQL。髋部骨折的女性从未恢复到骨折前的评分水平（OR=0.41；95%置信区间[CI]，0.19 至 0.98）。我们的分析表明，单发和多发髋部骨折以及多发脊柱和肋骨骨折在较长时间内严重影响老年人的 HRQL。©2019 美国骨矿研究协会。
