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Sex differences in recovery of quality of life 12 months post-fracture in community-dwelling older adults: analyses of the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS)

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Abstract

Summary

In this study of 695 Australian older adults (aged ≥50 years), we found that men and women had a similar trajectory of health-related quality of life (HRQoL) recovery following fragility fracture at any skeletal site. These results provide us with critical knowledge that improves our understanding of health outcomes post-fracture.

Introduction

Mortality is higher in men than that in women following a fragility fracture, but it is unclear whether recovery of patient-reported outcomes such as health-related quality of life (HRQoL) differs between sexes. This study aimed to identify sex differences in HRQoL recovery 12 months post-fracture.

Methods

Data were from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Participants recruited to AusICUROS were adults aged ≥50 years who sustained a fragility fracture. HRQoL was measured using the EQ-5D-3L at three time-points post-fracture: within 2 weeks (including pre-fracture recall) and at 4 and 12 months. Multivariate logistic regression analyses were undertaken, adjusting for confounders including age, education, income, and healthcare utilization post-fracture.

Results

Overall, 695 AusICUROS participants (536 women, 77.1%) were eligible for analysis with fractures at the hip (n = 150), distal forearm (n = 261), vertebrae (n = 61), humerus (n = 52), and other skeletal sites (n = 171). At the time of fracture, men were younger, reported a higher income, and were more likely to be employed, compared with women. For all fracture sites combined, there were no differences between men and women in recovery to pre-fracture HRQoL at 12-month follow-up (adjusted OR = 1.09; 95% CI: 0.75–1.61). When stratified by fracture site, no significant sex differences were seen for hip (OR = 1.02; 95% CI: 0.42–2.52), distal forearm (OR = 1.60; 95% CI: 0.68–3.78), vertebral (OR = 2.28; 95% CI: 0.61–8.48), humeral (OR = 1.62; 95% CI: 0.16–9.99), and other fractures (OR = 1.00; 95% CI: 0.44–2.26).

Conclusion

Community-dwelling men and women who survived the 12 months following fragility fracture had a similar trajectory of HRQoL recovery at any skeletal site.

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Acknowledgements

We are grateful to the quality of life and Epidemiology Working Group of the Committee of Scientific Advisors for the International Osteoporosis Foundation under whose supervision ICUROS was undertaken.

Data and materials availability

The data for these analyses was accessed from the AusICUROS central database. Access to this database should be discussed with the data custodian (KMS).

Code availability

Not applicable.

Funding

JT is supported by an Australian National Health and Medical Research Council (NHMRC, of Australia) Postgraduate Scholarship (1151089). AusICUROS was supported by the NHMRC (Project Grant Number: 628422) with subsidiary funding support from Merck Australia Pty Ltd.

Author information

Authors and Affiliations

  1. Department of Medicine–Western Health, WCHRE Building, The University of Melbourne, 176 Furlong Road, St Albans, Victoria, VIC, 3021, Australia

    J. Talevski, K.M. Sanders, G.C. Nicholson, G. Duque, A. Beauchamp & S.L. Brennan-Olsen

  2. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Victoria, Australia

    J. Talevski, K.M. Sanders, S. Iuliano, G. Duque, A. Beauchamp & S.L. Brennan-Olsen

  3. School of Health and Social Development, Deakin University, Geelong, Victoria, Australia

    K.M. Sanders, J.J. Watts & S.L. Brennan-Olsen

  4. Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia

    J.J. Watts & S.L. Brennan-Olsen

  5. Rural Clinical School, The University of Queensland, Toowoomba, Australia

    G.C. Nicholson

  6. Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, Victoria, Australia

    E. Seeman & S. Iuliano

  7. Mary McKillip Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia

    E. Seeman & J.A. Kanis

  8. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia

    R. Prince

  9. Medical School, Sir Charles Gardner Unit, The University Western Australia, Perth, Western Australia, Australia

    R. Prince

  10. Institute of Bone and Joint Research, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia

    L. March

  11. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

    T. Winzenberg

  12. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia

    P.R. Ebeling

  13. Quantify Research, Stockholm, Sweden

    F. Borgström

  14. Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden

    F. Borgström

  15. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK

    J.A. Kanis

  16. The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine Deakin University, Geelong, Victoria, Australia

    A.L. Stuart

  17. School of Rural Health, Monash University, Victoria, Australia

    A. Beauchamp

Authors
  1. J. Talevski
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  2. K.M. Sanders
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  3. J.J. Watts
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  5. E. Seeman
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  6. S. Iuliano
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  8. L. March
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  16. S.L. Brennan-Olsen
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Contributions

KMS (principal investigator), JJW, GCN, SI, RP, LM, TW, PE, and GD are chief investigators of the AusICUROS. JT, KMS, and SLB-O contributed to the investigated research question, including conception and design. JT designed and executed the statistical analyses with assistance from SLB-O. JT led the interpretation of findings with inputs from all authors. JT drafted all sections of the manuscript. All authors provided critical input regarding interpretation of results and approved the final manuscript for publication.

Corresponding author

Correspondence to J. Talevski.

Ethics declarations

Ethics approval

AusICUROS was approved by the relevant human research ethics committees (HREC) in each of the eight participating study centers in Australia (lead site Barwon Health HREC: 09/49). Approval for the use of the AusICUROS data for these analyses was obtained from Melbourne Health HREC (2010.115).

Consent to participate

Informed consent was individually obtained from all participants included in the study and participants could withdraw from the study at any time.

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All authors approved the final manuscript for publication.

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None

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Talevski, J., Sanders, K., Watts, J. et al. Sex differences in recovery of quality of life 12 months post-fracture in community-dwelling older adults: analyses of the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Osteoporos Int 33, 67–75 (2022). https://doi.org/10.1007/s00198-021-06058-3

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