title: Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study.
abstract: We studied 7,897 women with postmenopausal osteoporosis to assess factors that influence health-related quality of life (HRQoL). An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL. Understanding the factors that affect HRQoL may improve management of these patients.
  
  
  BACKGROUND
  HRQoL is impaired in women treated for postmenopausal osteoporosis (PMO). The objective of this study was to examine the relationship between clinical characteristics, comorbidities, medical history, patient demographics, and HRQoL in women with PMO.
  
  
  METHODS
  Baseline data were obtained and combined from two large and similar multinational observational studies: Prospective Observational Scientific Study Investigating Bone Loss Experience in Europe (POSSIBLE EU®) and in the US (POSSIBLE US™) including postmenopausal women in primary care settings initiating or switching bone loss treatment, or who had been on bone loss treatment for some time. HRQoL measured by health utility scores (EQ-5D™) were available for 7,897 women (94 % of study participants). The relationship between HRQoL and baseline clinical characteristics, medical history and patient demographics was assessed using parsimonious, multivariable, mixed-model analyses.
  
  
  RESULTS
  Median health utility score was 0.80 (interquartile range 0.69-1.00). In multivariable analyses, young age, low body mass index, previous vertebral fracture, increased number of comorbidities, high fear of falling, and depression were associated with reduced HRQoL. Regression-based model estimates showed that previous vertebral fracture was associated with lower health utility scores by 0.08 (10.3 %) and demonstrated the impact of multiple comorbidities and of fear of falling on HRQoL.
  
  
  CONCLUSIONS
  In this large observational study of women with PMO, there was substantial interindividual variability in HRQoL. An increased number of comorbidities, fear of falling, and previous vertebral fracture were associated with significant reductions in HRQoL.
authors.affiliation: Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France, Francis.Guillemin@univ-lorraine.fr.
authors.forename: F
authors.initials: F
authors.lastname: Guillemin
authors.forename: L
authors.initials: L
authors.lastname: Martinez
authors.forename: M
authors.initials: M
authors.lastname: Calvert
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: T
authors.initials: T
authors.lastname: Ganiats
authors.forename: M
authors.initials: M
authors.lastname: Gitlin
authors.forename: R
authors.initials: R
authors.lastname: Horne
authors.forename: A
authors.initials: A
authors.lastname: Marciniak
authors.forename: J
authors.initials: J
authors.lastname: Pfeilschifter
authors.forename: S
authors.initials: S
authors.lastname: Shepherd
authors.forename: A
authors.initials: A
authors.lastname: Tosteson
authors.forename: S
authors.initials: S
authors.lastname: Wade
authors.forename: D
authors.initials: D
authors.lastname: Macarios
authors.forename: N
authors.initials: N
authors.lastname: Freemantle
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015897:Comorbidity; D005060:Europe / Q000453:epidemiology; D005239:Fear; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D016103:Spinal Fractures / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D014481:United States / Q000453:epidemiology