title: The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study.
abstract: OBJECTIVE
  To examine the effect of both prevalent and incident vertebral fractures on health-related quality of life (HRQOL) in postmenopausal women with osteoporosis and to characterize the effect of prevalent vertebral fractures on HRQOL with respect to number, location, severity, and adjacency.
  
  
  METHODS
  Participants were a subset of women (n = 1,395, mean age 68.5 years) from the Multiple Outcomes of Raloxifene Evaluation trial who had low bone mineral density and/or prevalent vertebral fractures. Vertebral fractures were measured by radiography at baseline, 2 years, and 3 years. HRQOL was assessed using the Osteoporosis Assessment Questionnaire (OPAQ), a validated disease-targeted instrument, at baseline and annually for 3 years.
  
  
  RESULTS
  Both prevalent and incident radiographic vertebral fractures were associated with decreased HRQOL. At baseline, women with a prevalent vertebral fracture had significantly lower OPAQ scores on physical function, emotional status, clinical symptoms, and overall HRQOL compared with women without a prevalent fracture (all P < 0.01). HRQOL scores were lower with each subsequent fracture. The effect of prevalent vertebral fracture was dependent on the location within the spine and was strongest in the lumbar region (L1-L4). Incident vertebral fractures significantly decreased OPAQ scores on physical function, emotional status, clinical symptoms, and overall HRQOL (all P < 0.001).
  
  
  CONCLUSIONS
  Our findings demonstrate the importance of treating postmenopausal women who have prevalent vertebral fractures to prevent further decreases in HRQOL associated with subsequent incident vertebral fracture.
authors.affiliation: Cedars-Sinai Medical Center, Greater Los Angeles VA Health System, University of California, USA. stuarts@omcresearch.org
authors.forename: S L
authors.initials: SL
authors.lastname: Silverman
authors.forename: M E
authors.initials: ME
authors.lastname: Minshall
authors.forename: W
authors.initials: W
authors.lastname: Shen
authors.forename: K D
authors.initials: KD
authors.lastname: Harper
authors.forename: S
authors.initials: S
authors.lastname: Xie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D011859:Radiography; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology
chemical_list: D020849:Raloxifene Hydrochloride