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Can’t Get a Break: Osteoporotic Fractures and Quality of Life
Women with fragility fractures and inadequate osteoporosis treatment were at increased risk for another fracture within a year, with negative effects on quality of life.
Osteoporotic fractures are on the rise globally. In the international Observational Study of Severe Osteoporosis, an industry-sponsored 12-month prospective study, researchers compared fracture incidence and health-related quality of life (HR-QOL) in postmenopausal women who had previous fragility fractures and in those who did not. Inadequate clinical outcome of osteoporosis therapy was defined either as a fragility fracture despite osteoporosis treatment for at least 1 year or as nonadherence to medication.
During follow-up, 9% of participants experienced fractures. Compared with women who had no histories of fracture, those who had fractures within 1 year before study entry were almost twice as likely to sustain incident fractures (hazard ratio, 1.91; P<0.001). Such fractures also occurred in a significantly higher percentage of women with comorbidities, especially rheumatoid arthritis and chronic obstructive pulmonary disease. At 12 months of follow-up, women who had incident fractures reported lower HR-QOL scores than did women who did not (P<0.001), regardless of prior fracture status.
Comment: The authors do not state clearly how many women had an "inadequate clinical response" because they discontinued medication; instead, they focus on the presence or absence of osteoporotic fractures during follow-up. The participants had severe osteoporosis, so these results might not apply to women with better T-scores; furthermore, 40% of women with incident fractures had comorbidities that are frequently treated with corticosteroids, which can rapidly reduce BMD. Despite these limitations, the results are consistent with those of other studies: A fragility fracture during a 12-month time frame predicts risk for another fracture within a year, with concomitant adverse effects on QOL. Clinicians should emphasize to their patients the importance of taking bisphosphonates consistently to prevent osteoporotic fractures.
Published in Journal Watch Women's Health May 15, 2008
Citation(s):
Cooper C et al. Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: The Observational Study of Severe Osteoporosis (OSSO). Osteoporos Int 2008 Apr; 19:493.
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