title: The importance of physical function to people with osteoporosis.
abstract: There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function.
  
  
  
  There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients' physical function and everyday activity.
  
  
  
  Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings.
  
  
  
  Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity.
  
  
  
  More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.
authors.affiliation: ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
authors.forename: C
authors.initials: C
authors.lastname: Kerr
authors.affiliation: ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shingler
authors.affiliation: University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.|Geriatric Education and Research in Aging Sciences Centre, Hamilton, ON, Canada.|Research Institute for Aging, Waterloo, ON, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Giangregorio
authors.affiliation: ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA. hdefreitas@mapigroup.com.|Mapi, Translation and Innovation Hub Building, 80 Wood Lane, White City, London, W12 0BZ, UK. hdefreitas@mapigroup.com.
authors.forename: H M
authors.initials: HM
authors.lastname: de Freitas
authors.affiliation: ICON Patient Reported Outcomes, W. Diamond Avenue, Suite 1000, Gaithersburg, MD, 20878, USA.
authors.forename: C
authors.initials: C
authors.lastname: Patel
authors.affiliation: National Osteoporosis Foundation, 251 18th Street South, Suite 630, Arlington, VA, 22202, USA.
authors.forename: S
authors.initials: S
authors.lastname: Randall
authors.affiliation: Duke University Medical Center, Durham, NC, 27710, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Gold
mesh_terms: D001007:Anxiety / Q000209:etiology; D001828:Body Image; D003863:Depression / Q000209:etiology; D015444:Exercise / Q000502:physiology*; D006801:Humans; D053580:Muscle Strength / Q000502:physiology; D010024:Osteoporosis / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation; D058866:Osteoporotic Fractures / Q000503:physiopathology / Q000534:rehabilitation; D010349:Patient Compliance; D063868:Patient Outcome Assessment; D011788:Quality of Life; D012649:Self Concept
keywords: Health-related quality of life; Osteoporosis; Patient-centred outcomes; Physical function; Psychological outcomes; Social outcomes