Change in health-related quality of life and wellbeing following a fragility fracture: AUSICUROS  — ASN Events
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Change in health-related quality of life and wellbeing following a fragility fracture: AUSICUROS  (#115)

Kerrie M Sanders 1 , G C Nicholson 2 , E Seeman 3 , G Duque 4 , R L Prince 5 , L March 6 , T Winzenberg 7 , P R Ebeling 8 , F Borgström 9 , K Lim 1 , C Connaughton 1 , J J Watts 10
  1. Institute for Health and Ageing, Australian Catholic University, Melbourne, VICTORIA, Australia
  2. Rural Clinical School , The University of Queensland, Toowoomba, Queensland, Australia
  3. Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
  4. Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School , The University of Melbourne & Western Health, Melbourne, Victoria, Australia
  5. School of Medicine & Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
  6. University of Sydney Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia
  7. University of Tasmania, Hobart, Tasmania, Australia
  8. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
  9. Quantify Research , Stockholm, Sweden
  10. Centre for Population Health Research, School of Health and Social Development, Faculty of Health , Deakin University , Melbourne, Victoria, Australia

Objective: To compare the change in wellbeing using a capability instrument and health-related quality of life (HRQOL) in 809 Australian adults with a fragility fracture (Fx) during 18 months.

Material and Methods: Wellbeing and HRQOL data were obtained prospectively using ICECAP-O and EQ5D-3L respectively from adults aged 50+ years within 2 weeks of a fracture, at 4, 12 and 18 months from patients in 8 locations across Australia. Wellbeing was determined by ICECAP measuring a person’s capacity (1 of 4 levels) to achieve 5 attributes: attachment, role, enjoyment, security and control. Using Australian population weightings, we examined changes and predictors of the ICECAP(1) and EQ5D(2) for all fractures and by fracture type (hip, wrist and vertebral).

Results: There was a rapid fall in wellbeing and HRQOL at 4 months. Both improve by 12 months, but did not return to pre-fracture levels by 18 months except for HRQOL for wrist Fx. In contrast to HRQOL.  A further decline in wellbeing was observed between 12 and 18 months in patients with hip and vertebral Fx. ICECAP and EQ5D were positively correlated for all fracture types but the relationship was weaker for hip Fx (Spearman’s correlation; rho=0.484, p<0.001). The greatest predictor for both wellbeing and HRQOL loss was the baseline measure and fracture type.

Conclusions: Fx has an immediate and pronounced impact on both a broad measure of wellbeing and HRQOL which extends over 18 months. The further decline of wellbeing 12 months after hip or vertebral Fx is inconsistent with HRQOL and reflects the longer-term impact of Fx on non-physical attributes of attachment, role, enjoyment, security and control of one’s life. Increased focus on these aspects of patient’s wellbeing may reverse this trend.

  1. Couzner L, et al. Int J Public Health. 2013;58(3):367-76.
  2. Viney R, et al. Value Health. 2011;14(6):928-36.