title: Health-related quality of life after vertebral or hip fracture: a seven-year follow-up study.
abstract: BACKGROUND
  The negative impact of vertebral and hip low-energy fractures on health-related quality-of-life (HRQOL) has been demonstrated previously, but few prospective long-term follow-up studies have been conducted. This study aims to (i) investigate the changes and long-term impact of vertebral or hip fracture and between fracture groups on HRQOL in postmenopausal women prospectively between two and seven years after the inclusion fracture, (ii) compare HRQOL results between fracture and reference groups and (iii) study the relationship between HRQOL and physical performance, spinal deformity index and bone mineral density at seven-year follow-up.
  
  
  METHODS
  Ninety-one women examined two years after a low-energy vertebral or hip fracture were invited to a new examination seven years after the diagnosis. HRQOL was examined using the SF-36 questionnaire and was compared with an age and sex-matched reference group. Physical function was assessed using tests and questionnaires. Bone mineral density was measured. Radiographs of the spine were evaluated using the visual semiquantitative technique. A longitudinal and cross-sectional design was used in this study. Statistical analyses included descriptive statistics, Student's t-tests, ANCOVA, and partial correlation.
  
  
  RESULTS
  Sixty-seven women participated. In the 42 women (mean age 75.8, SD 4.7) with vertebral fracture as inclusion fracture, bodily pain had deteriorated between two and seven years and might be explained by new fracture. Remaining pronounced reduction of HRQOL was seen in all domains except general health and mental health at seven-year follow-up in women with vertebral fractures compared to the reference group (p < 0.05). All 25 women (mean age 75.0, SD 4.7) with hip fracture as inclusion fracture had no significant changes in HRQOL between two and seven years and did not differ from the reference group regarding HRQOL after seven years. The vertebral group had significantly lower values for bodily pain, vitality, role-emotional function and mental health compared to the hip group. HRQOL showed a positive relationship between physical activity, static balance and handgrip strength.
  
  
  CONCLUSIONS
  The long-term reduction of HRQOL in women with vertebral fracture emerged clearly in this study. The relationships between HRQOL and physical performance in women with vertebral and hip fracture raise questions for more research.
authors.affiliation: Department of Medical and Health Sciences, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 85 Linköping, Sweden. inger.hallberg@liu.se
authors.forename: Inger
authors.initials: I
authors.lastname: Hallberg
authors.forename: Margareta
authors.initials: M
authors.lastname: Bachrach-Lindström
authors.forename: Staffan
authors.initials: S
authors.lastname: Hammerby
authors.forename: Göran
authors.initials: G
authors.lastname: Toss
authors.forename: Anna-Christina
authors.initials: AC
authors.lastname: Ek
mesh_terms: D000368:Aged; D015519:Bone Density; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006620:Hip Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D008603:Mental Health; D009043:Motor Activity; D010146:Pain / Q000517:prevention & control / Q000523:psychology; D010147:Pain Measurement; D017698:Postmenopause; D004856:Postural Balance; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D013997:Time Factors; D016896:Treatment Outcome