title: Impact of recent fracture on health-related quality of life in postmenopausal women.
abstract: The effect of fractures other than hip and spine on HRQoL in younger and older women has not been extensively studied. In a cohort of 86,128 postmenopausal women, we found the impact of recent osteoporosis-related fractures on HRQoL to be similar between women < 65 compared with those > or = 65 years of age. The impact of spine, hip, or rib fractures was greater than that of wrist fractures in both age groups.
  
  
  BACKGROUND
  Health-related quality of life (HRQoL) after vertebral and hip fractures has been well studied. Less is known about HRQoL after fractures at other sites. We studied the effect of recent clinical fractures on HRQoL, using Short Form-12 (SF-12).
  
  
  METHODS
  This study included 86,128 postmenopausal participants in the National Osteoporosis Risk Assessment (NORA) who responded to two follow-up surveys during a 2-year interval. At each survey, they completed the SF-12 HRQoL questionnaire and reported new fractures of the hip, spine, wrist, and rib. The effect of recent fracture on HRQoL was assessed by comparing Physical Component Score (PCS) and Mental Component Score (MCS) means for women with and without new fractures at the second survey. Analyses were by fracture type and by age group (50-64 and 65-99) and were adjusted for PCS and MCS at the first survey.
  
  
  RESULTS
  New fractures (320 hip, 445 vertebral, 657 rib, 835 wrist) occurring during the interval between the first and second follow-up surveys were reported by 2257 women. The PCS was poorer in both older and younger women who had fractured the hip, spine, or rib (p < or = 0.001). Wrist fractures had an impact on PCS in women < or = 65 years of age (p < 0.001), but not older women (p > 0.10). These differences in PCS by fracture status were similar to those reported for other chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD), and osteoarthritis. MCS was less consistently changed by fracture status, but younger and older women with vertebral fracture (p < 0.004), older women with hip fracture (p < 0.004), and younger women with rib fracture (p < 0.004) had poorer MCS compared with those who did not fracture within their age cohort.
  
  
  CONCLUSIONS
  Recent osteoporosis-related fractures have significant impact on HRQoL as measured by SF-12. The impact of recent fracture on HRQoL was similar for older and younger postmenopausal women. Fracture prevention and postfracture interventions that target the subsequent symptoms are needed for postmenopausal women of any age.
authors.affiliation: Outcomes Research & Management, Merck & Co., Inc WP39-170, West Point, PA 19486, USA. skbrenneman@yahoo.com
authors.forename: Susan K
authors.initials: SK
authors.lastname: Brenneman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Shiva
authors.initials: S
authors.lastname: Sajjan
authors.forename: Leona E
authors.initials: LE
authors.lastname: Markson
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Siris
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D016743:Mental Competency; D008875:Middle Aged; D009043:Motor Activity; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology; D017698:Postmenopause; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology