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Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS)

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Abstract

Summary

Little is known about factors that lead to excess mortality post-fracture. This study demonstrated that 5-year mortality is lower in older adults who recovered to their pre-fracture health-related quality of life (HRQoL) at 12-months compared to those who did not recover. Our results highlight the importance of post-fracture interventions known to improve HRQoL.

Introduction

Fragility fractures lead to increased mortality and decreased health-related quality of life (HRQoL) in older adults, although whether an association exists between these outcomes remains uncertain. The aim of this study was to determine whether recovery of HRQoL 12-month post-fracture is associated with lower 5-year mortality.

Methods

This data linkage study included 524 adults (mean age: 70.2 years; 79.2% women) with fragility fracture (150 hip, 261 distal forearm, 61 vertebral, 52 humerus) from the Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS). HRQoL was measured using the EQ-5D-3L and all-cause mortality post-fracture was ascertained from the Australian National Death Index (NDI). Cox proportional hazards models were used to assess the association between HRQoL recovery (vs. non-recovery) and all-cause mortality within 5 years.

Results

Overall, 279 participants (53.2%) recovered to their pre-fracture HRQoL at 12-month follow-up. There were 70 deaths (13.4%) during the 5-year post-fracture. Mortality rate was the highest in hip fracture participants (24.7%), followed by vertebral (16.4%), humeral (13.5%), and distal forearm fracture participants (6.1%). After adjustment for age, pre-fracture HRQoL, and fracture site, mortality risk was lower in participants who recovered to their pre-fracture HRQoL at 12-months compared to those who did not recover (HR = 0.56, 95% CI: 0.33–0.96, p = 0.034).

Conclusion

This study provides evidence that HRQoL recovery post-fracture is associated with improved 5-year survival in older adults. The extent to whether current interventions known to improve HRQoL post-fracture could prevent some of these deaths is unknown.

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Data 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).

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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. We are also grateful the Australian Institute for Health and Welfare (AIHW) team for undertaking the data linkage.

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, The University of Melbourne, C/- Western Health, Sunshine Hospital, WCHRE Building, 176 Furlong Road, St Albans, VIC, 3021, Australia

    Jason Talevski, Kerrie M. Sanders, Sara Vogrin, Gustavo Duque, Alison Beauchamp & Sharon L. Brennan-Olsen

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

    Jason Talevski, Kerrie M. Sanders, Sara Vogrin, Gustavo Duque, Alison Beauchamp, Sandra Iuliano & Sharon L. Brennan-Olsen

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

    Kerrie M. Sanders & Sharon L. Brennan-Olsen

  4. School of Rural Health, Monash University, Melbourne, VIC, Australia

    Alison Beauchamp

  5. Departments of Endocrinology and Medicine, The University of Melbourne/Austin Health, Heidelberg, VIC, Australia

    Ego Seeman & Sandra Iuliano

  6. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia

    Ego Seeman & John A. Kanis

  7. ICON Plc, Stockholm, Sweden

    Axel Svedbom

  8. Quantify Research, Stockholm, Sweden

    Fredrik Borgström

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

    Fredrik Borgström

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

    John A. Kanis

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

    Amanda L. Stuart

  12. Institute for Health Transformation, Deakin University, Geelong, VIC, Australia

    Sharon L. Brennan-Olsen

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  1. Jason Talevski
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Contributions

JK, FB, and AS are integral to the ICUROS international study protocol and are Principal Investigators and members of the ICUROS Steering Committee. KMS (principal investigator), ES, SI, and GD are chief investigators of AusICUROS. JT, KMS, and SLB-O contributed to the conception and design of the study. KMS, SI, AS, and ALS provided additional participant data for the data linkage. JT designed and executed the statistical analyses with assistance from SV. JT drafted all sections of the manuscript and led the interpretation of findings. All authors provided critical input regarding interpretation of results and approved the final manuscript for publication.

Corresponding author

Correspondence to Jason 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 AusICUROS data in these post hoc analyses was obtained from Melbourne Health HREC (2020.182) and from the Australian Institute of Health and Welfare (AIHW) HREC (2020.4.1189).

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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.M., Vogrin, S. et al. Recovery of quality of life is associated with lower mortality 5-year post-fracture: the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study (AusICUROS). Arch Osteoporos 16, 112 (2021). https://doi.org/10.1007/s11657-021-00981-y

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