Introduction
Method
Study design and population
Data collection
All fractures | Hip | Wrist | Vertebral | Humerus | Ankle | ‘Other Fractures’ | Non-hip, non-wrist and non-vertebral | Non-hip, non-vertebral | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | Baseline | 12 mths | |
N = 915 |
N = 703 |
N = 224 |
N = 150 |
N = 308 |
N = 263 |
N = 92 |
N = 65 |
N = 65 |
N = 54 |
N = 89 |
N = 69 |
N = 137 |
N = 102 |
N = 291 |
N = 225 |
N = 599 |
N = 488 | |
Age (years) | 69.8 (11.5) | 68.9 (11.0) | 77.8 (9.9) | 76.5 (9.9) | 66.6(10.3) | 66.5 (10.3) | 70.6 (11.3) | 68.8 (10.9) | 69.5 (11.1) | 68.9 (11.5) | 63.6 (9.2) | 63.0 (7.3) | 67.7 (11.5) | 67.8 (10.8) | 66.8 (10.9) | 66.6 (10.3) | 66.7 (10.6) | 66.6 (10.3) |
Male (%) | 24.3 | 23.3 | 24.1 | 22 | 15.6 | 14.5 | 37 | 44.6 | 30.8 | 25.9 | 23.6 | 26.1 | 32.9 | 31.4 | 29.6 | 28.4 | 22.4 | 20.9 |
Previous fracture (%) | 18.9 | 17.9 | 17 | 16.7 | 15.9 | 13.7 | 27.2 | 21.5 | 15.4 | 18.5 | 16.9 | 17.4 | 26.3 | 28.4 | 21.0 | 22.7 | 18.4 | 17.8 |
Job pre-fracture (%) | 32 | 34.5 | 8.9 | 11.3 | 41.2 | 41.1 | 28.6 | 32.8 | 31.3 | 35.6 | 56.2 | 58.0 | 35.8 | 35.3 | 41.0 | 42.4 | 41.1 | 41.9 |
Income (%) | ||||||||||||||||||
Low | 50.4 | 48 | 63.9 | 62 | 45.2 | 42.9 | 42.9 | 41.7 | 58.9 | 56.3 | 36.8 | 36.8 | 50.8 | 49.0 | 48.0 | 46.7 | 46.5 | 44.7 |
Mid-high | 49.6 | 52.0 | 36.1 | 38.0 | 54.8 | 57.1 | 57.1 | 58.3 | 41.1 | 43.4 | 63.2 | 63.2 | 49.2 | 51.0 | 52.0 | 53.3 | 53.5 | 55.3 |
Education (%) | ||||||||||||||||||
Primary | 8.8 | 7.1 | 13.6 | 11.6 | 5.2 | 4.2 | 11 | 10.9 | 6.4 | 3.8 | 5.8 | 1.5 | 10.4 | 11.0 | 8.1 | 6.4 | 6.6 | 5.2 |
Secondary | 54.8 | 54.5 | 64.6 | 66.7 | 50 | 49.1 | 49.5 | 50 | 57.1 | 56.6 | 41.9 | 44.8 | 60.7 | 59.0 | 54.2 | 54.1 | 52.0 | 51.4 |
Post-secondary | 36.4 | 38.5 | 21.8 | 21.8 | 44.8 | 46.8 | 39.6 | 39.1 | 36.5 | 39.6 | 52.3 | 53.7 | 28.9 | 30.0 | 37.7 | 39.6 | 41.4 | 43.5 |
Fracture site | Mean utility index (SD), % change from baseline, sample size | ||||
---|---|---|---|---|---|
Before fracture (phase 0) | At fracture (phase 1) | 4 mths PF (phase 2) | 12 mths PF (phase 3) | 18 mths PF (phase 4) | |
All fractures | 0.86 (0.19)
N = 915 | 0.42 (0.28) −51.2 %
N = 915 | 0.74 (0.22) −14.0 %
N = 795 | 0.80 (0.21) −7.0 %
N = 703 | 0.83 (0.22) −3.5 %
N = 543 |
Hip | 0.84 (0.20)
N = 224 | 0.26 (0.25) −69.0 %
N = 224 | 0.69 (0.22) −17.9 %
N = 175 | 0.74 (0.22) −11.9 %
N = 150 | 0.73 (0.25) −13.1 %
N = 114 |
Wrist | 0.90 (0.17)
N = 308 | 0.58 (0.22) −35.6 %
N = 308 | 0.82 (0.19) −8.9 %
N = 285 | 0.88 (0.18) −2.2 %
N = 263 | 0.90 (0.17) 0 %
N = 233 |
Vertebral | 0.80 (0.21)
N = 92 | 0.43 (0.28) −46.3 %
N = 92 | 0.68 (0.27) −15.0 %
N = 81 | 0.73 (0.25) −8.8 %
N = 65 | 0.71 (0.28) −11.3 %
N = 51 |
Humerus | 0.82 (0.17)
N = 65 | 0.34 (0.26) −58.5 %
N = 65 | 0.72 (0.18) −12.2 %
N = 58 | 0.78 (0.16) −4.9 %
N = 54 | 0.83 (0.13) 1.2 %
N = 34 |
Ankle | 0.86 (0.19)
N = 89 | 0.34 (0.24) −60.5 %
N = 89 | 0.70 (0.18) −18.6 %
N = 80 | 0.79 (0.18) −8.1 %
N = 69 | 0.87 (0.13) 1.2 %
N = 46 |
‘Other Fractures’ | 0.85 (0.19)
N = 137 | 0.37 (0.28) −56.5 %
N = 137 | 0.71 (0.25) −16.5 %
N = 116 | 0.75 (0.24) −11.8 %
N = 102 | 0.82 (0.23) −3.5 %
N = 65 |
Non-hip, non-wrist and non-vertebral | 0.85 (0.18)
N = 291 | 0.36 (0.27) −57.6 %
N = 291 | 0.71 (0.21) −16.5 %
N = 253 | 0.77 (0.21) −9.4 %
N = 225 | 0.84 (0.18) −1.2 %
N = 145 |
Non-hip, non-vertebral | 0.86 (0.21)
N = 599 | 0.38 (0.35) −55.8 %
N = 599 | 0.75 (0.25) −12.8 %
N = 537 | 0.81 (0.23) −5.8 %
N = 488 | 0.87 (0.20) 1.2 %
N = 378 |
Analysis of quality of life
Fracture site
Statistical analysis
Results
Population characteristics
Quality of life
Fracture site | No. of participants | Mean QALY lost | QALY lost (%) |
---|---|---|---|
All fractures |
N = 703 | 0.156 (0.180) | 18 |
Hip |
N = 150 | 0.216 (0.196) | 26 |
Wrist |
N = 263 | 0.099 (0.144) | 11 |
Vertebral |
N = 65 | 0.162 (0.215) | 20 |
Humerus |
N = 54 | 0.142 (0.186) | 17 |
Ankle |
N = 69 | 0.208 (0.165) | 24 |
‘Other Fractures’ |
N = 102 | 0.182 (0.178) | 21 |
Non-hip, non-wrist and non-vertebral |
N = 224 | 0.181 (0.177) | 21 |
Non-hip, non-vertebral |
N = 486 | 0.137 (0.165) | 16 |
Changes in quality-adjusted life years
All fractures | Hip | Wrist | Vertebral | Humerus | Ankle | ‘Other Fractures’ | Non-hip, non-wrist and non-vertebral | Non-hip non-vertebral | |
---|---|---|---|---|---|---|---|---|---|
1-year QALY loss |
N = 643, R
2 = 0.306 |
N = 132, R
2 = 0.342 |
N = 247, R
2 = 0.249 |
N = 59, R
2 = 0.403 |
N = 48, R
2 = 0.564 |
N = 64, R
2 = 0.556 |
N = 93, R
2 = 0.166 |
N = 204, R
2 = 0.269 |
N = 451, R
2 = 0.209 |
Baseline HRQOL utility index |
0.478
[0.410; 0.546] |
0.532
[0.371; 0.693] |
0.410
[0.314; 0.508] |
0.525
[0.265; 0.785] |
0.785
[0.496; 1.074] |
0.716
[0.478; 0.954] |
0.316
[0.111; 0.520] |
0.525
[0.392; 0.658] |
0.424
[0.342; 0.506] |
Male | −0.015 [−0.044; 0.012] | 0.024 [−0.045; 0.094] | −0.028 [−0.074; 0.018] | −0.065 [−0.167; 0.036] | −0.059 [−0.155; 0.038] | −0.031 [−0.102; 0.041] | 0.045 [−0.030; 0.120] | −0.017 [−0.063; 0.030] | 0.001 [−0.032; 0.034] |
Age (years) | −0.0002 [−0.002; 0.001] | 0.0001 [−0.003; 0.004] | −0.0005 [−0.003; 0.002] | 0.002 [−0.004; 0.007] | −0.002 [−0.007; 0.003] | −0.005 [−0.010; 0.0003] | 0.003 [−0.001; 0.007] | <0.001 [−0.003; 0.003] | −0.0004 [−0.002; 0.001] |
Fracture in last 5 years | −0.005 [−0.037; 0.026] | 0.007 [−0.071; 0.086] | 0.002 [−0.046; 0.050] | −0.014 [−0.139; 0.110] | −0.068 [−0.184; 0.049] | −0.074 [−0.152; 0.005] | 0.023 [−0.057; 0.103] | −0.019 [−0.071; 0.033] | −0.003 [−0.033; 0.039] |
Hospitalised |
0.030
[0.004; 0.055] | 0.0223 [−0.037; 0.084] | 0.018 [−0.018; 0.055] | 0.081 [−0.026; 0.189] | 0.050 [−0.067; 0.166] | 0.028 [−0.034; 0.090] | 0.038 [−0.037; 0.113] | 0.034 [−0.012; 0.079] |
0.032
[0.002; 0.061] |
Job pre-fracture | 0.010 [−0.024; 0.044] |
0.130
[0.014; 0.245] | 0.002 [-0.043; 0.048] | -0.029 [-0.167; 0.108] | 0.029 [-0.119; 0.177] | 0.015 [-0.069; 0.100] | -0.016 [-0.107; 0.062] | 0.002 [-0.056; 0.059] | 0.011 [-0.026; 0.048] |
Mid-high incomea
| −0.017 [−0.044; 0.010] | −0.018 [−0.081; 0.045] | −0.009 [−0.049; 0.030] |
0.130
[0.011; 0.248] | −0.126
[−0.239; − 0.014] | −0.091
[−0.170; −0.012] | −0.030
[−0.108; −0.048] | −0.052
[−0.101; −0.003] | −0.032
[−0.064; 0.001] |
Education primaryb
| 0.030 [−017; 0.077] |
0.071
[0.020; 0.161] | −0.016 [−0.098; 0.066] | 0.033 [−0.125; 0.192] | 0.058 [−0.166; 0.282] | 0.088 [−0.223; 0.398] | −0.054 [−0.174; 0.067] | −0.018 [−0.110; 0.075] | −0.006 [−0.070; 0.058] |
Post-secondary university | −0.030
[−0.057; −0.004] | −0.112
[−0.185; −0.039] | −0.005 [−0.040; 0.031] | −0.143
[−0.267; 0.019] | −0.002 [−0.096; 0.092] | −0.024 [−0.087; 0.040] | −0.018 [−0.101; 0.065] | 0.011 [−0.057; 0.035] | −0.010
[−0.040; −0.019] |
Hip (base wrist) |
0.128
[0.094; 0.164] | ||||||||
Humerus |
0.072
[0.025; 0.120] | ||||||||
Vertebral |
0.105
[0.061; 0.149] | ||||||||
Ankle |
0.107
[0.064; 0.149] | ||||||||
Other |
0.095
[0.058; 0.132] | ||||||||
Constant | −0.306
[−0.426; −0.185] | −0.256 [−0.551; 0.038] | −0.234
[−0.410; −0.058] | −0.388 [−0.846; 0.071] | −0.319
[−0.810; −0.172] | −0.065
[−0.442; −0.311] | −0.296 [−0.620; −0.027] | −0.243
[−0.460; −0.026] | −0.210
[−0.353; −0.067] |