In the Journals Plus

Low odds for full recovery from hip fracture found among older adults

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February 8, 2019

Among older adults, hip fractures are associated with a significant, persistent negative impact on health-related quality of life over 10 years, affecting levels of mobility, self-care, ambulation and pain, according to findings published in the Journal of Bone and Mineral Research.

In a population-based, prospective study of older men and women, researchers also found that hip, spine and rib fractures were associated with lasting negative effects on self-care, mobility and ambulation capability in both sexes, whereas women who sustained a hip fracture were unlikely to recover to prefracture-level scores, as measured by the Health Utility Index.

Alexandra Papaioannou

Hip and spine fractures have lasting effects on the ability to manage your everyday life, including bathing, dressing and mobility,” Alexandra Papaioannou, BScN, MD, MSc, FRCP(C), FACP, professor of medicine at the McMaster University GERAS Centre for Aging Research in Hamilton, Ontario, Canada, told Endocrine Today. “These fractures can permanently change an individual’s enjoyment of life.”

Assessing health-related quality of life

Papaioannou and colleagues analyzed data from 7,753 adults aged at least 50 years, using data from the Canadian Multicentre Osteoporosis Study (5,566 women; median age of women, 67 years; median age of men, 66 years). Health-related quality of life, as measured by the Health Utility Index, was assessed at baseline and 10 years. The Health Utility Index Mark 2 includes six attributes: sensation, mobility, emotion, cognition, self-care and pain. The Health Utility Index Mark 3 includes eight attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. Respondents must select one level  (from three to six levels) of ability or disability for each attribute. The utility score for each domain was transformed between zero (death) and 1 (full health), with minimal clinically important differences for a multi-attribute and single-attribute scores defined as 0.03 and 0.05, respectively, the researchers wrote.

Impact on mobility, pain

Researchers assessed incident fragility fractures recorded during follow-up at the spine, hip, rib, shoulder, pelvis and forearm, and used regression analyses to measure the mean difference in the Health Utility Index scores for participants with and without fractures. They also examined the effects of single or multiple fragility fractures, time (fractures that occurred between years 1 to 5 and between years 5 to 10) and recovery to prefracture levels.

Researchers found that, among women, incident hip fracture was associated with substantial deficits as measured by the Health Utility Index Mark 2 and Mark 3 when compared with other types of fractures. The magnitude of deficits was similar for spine and rib fractures, except for the ambulation attribute, whereas forearm fractures were not associated with Health Utility Index scores.

In men, incident hip or spine fractures were associated with deficits in the mobility and ambulation attributes of the Health Utility Index Mark 2 and Mark 3. Only five men experienced pelvis fractures, according to researchers, and these were associated with a substantial deficit in pain.

Recovery after fracture

In logistic regression analyses, recovery to prefracture-level score was lower for women after sustaining a hip fracture for both the Health Utility Index Mark 2 (OR = 0.36; 95% CI, 0.16-0.76) and the Health Utility Index Mark 3 (OR = 0.41; 95% CI, 0.19-0.86) when compared with women who did not sustain a hip fracture. Recovery to prefracture-level score was similarly lower for women who sustained a spine fracture for both the Health Utility Index Mark 2 (OR = 0.53; 95% CI, 0.3-0.93) and the Health Utility Index Mark 3 (OR = 0.6; 95% CI, 0.34-1.04) when compared with women who did not sustain a spine fracture. There were no between-group differences observed for women who did and did not sustain rib fractures, according to researchers.

Among men, recovery after hip, spine and rib fractures was low, with ORs less than 0.5; however, results were not statistically significant.

Researchers also found that more recent fractures (occurring between years 6 to 10) were associated with greater deficits in health-related quality of life at year 10 vs. fractures sustained between years 1 and 5.

“Prevention of fractures are critical — we can reduce the risk of hip, spine and non-vertebral fractures by 40% to 70% with the current medication treatments available for high-risk patients,” Papaioannou said. “We can reduce the impact of hip fractures on our overburdened health care systems with our current research.”– by Regina Schaffer

For more information:

Alexandra Papaioannou, BScN, MD, MSc, FRCP(C), FACP, can be reached at McMaster University GERAS Centre for Aging Research, Hamilton Health Sciences, St. Peter’s Hospital, 88 Maplewood Ave., Hamilton, ON L8M 1W9; email: papaioannou@hhsc.ca.

Disclosures: Papaioannou reports she has received grant funding and honorarium from Amgen and Eli Lilly. Please see the study for all other authors’ relevant financial disclosures.