Deterioration in quality of life following hip fracture: a prospective study

To examine longitudinal change in health-related quality of life (HRQoL) following hip fracture in elderly subjects, 32 patients with hip fractures and 29 sex-matched non-fracture control subjects (mean +/- SD age 82 +/- 8 and 86 +/- 6 years respectively) were enrolled in a prospective, case-control study. Fracture subjects completed a generic questionnaire, Short Form 36 (SF-36), and a disease-targeted measure, the revised Osteoporosis Assessment Questionnaire (OPAQ2), on two separate occasions, within 1 week of fracture and 12-15 weeks after fracture. Controls completed both questionnaires on two occasions 12 weeks apart. SF-36 scores were significantly correlated with OPAQ2 in comparable domains of Physical Function (r = 0.76), General Health (r = 0.70) and Mental Health/Tension (r=0.86). Control subjects had stable scores with the OPAQ2 and SF-36. At 3 months after fracture there was a significant reduction in HRQoL in the SF-36 domains Physical Function (-51%), Vitality (-24%) and Social Function (-26%) and in the OPAQ2 domains Physical Function (-20%), Social Activity (-49%) and General Health (-24%). Hip fracture patients thus had a lower baseline HRQoL and experienced a significant deterioration in HRQoL after hip fracture on both the SF-36 and OPAQ2. HRQoL should be part of a comprehensive assessment of the costs of osteoporosis including fracture-associated morbidity.

Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire

OBJECTIVE

To determine the reliability, consistency, and clinical utility of the Osteoporosis Assessment Questionnaire (OPAQ), an AIMS2 based self-assessment questionnaire.

METHODS

Reliability of individual questions, scales, and domains were evaluated in 40 subjects by test-retest and intraclass correlation coefficients and internal consistency by Cronbach's alpha. Construct validity was evaluated by disease state. The relationships between domains and scales were modeled by confirmatory factor analysis.

RESULTS

Mean kappa (79 questions) and intraclass correlation (18 health scales) coefficients were 0.58+/-0.16 (mean+/-SD) and 0.82+/-0.07, respectively. Internal consistency was greater than 0.8 in all but 3 scales. Construct validity was confirmed. Patients with hip fracture recorded lower OPAQ scores than patients with vertebral fracture. Correlation and confirmatory factor analyses grouped the 18 health scales into 7 domains.

CONCLUSION

These findings suggest that OPAQ is a reliable, consistent, and valid instrument capable of distinguishing hierarchy of functional loss in disease states in osteoporosis.

A comparison of longitudinal measurements in the spine and proximal femur using lunar and hologic instruments

Absolute values of bone mineral density (BMD), using dual-energy X-ray absorptiometry (DXA), differ between instruments from different manufacturers. Despite these differences, the rates of change calculated from serial measurements on different densitometers have been assumed to be comparable. We compared the change in BMD in 34 subjects in the lumbar spine and at the standard sites in the proximal femur, from measurements performed using a Lunar DPX-L and a Hologic QDR-1000. Measurements were obtained on the same day, and repeated on the same day, on both machines after a mean interval of 4.8 years (range 4.1-6.3 years). There were strong positive correlations between the percentage change in BMD calculated using the two machines in the lumbar spine, trochanteric region, and total proximal femur: r = 0.82, 0.84, and 0.73, respectively (p < 0.0001 at all sites). In the femoral neck and in Ward's triangle, the correlations were not as high: r = 0.55 (p = 0.003) and 0.43 (p = 0.028), respectively. At all sites, despite the significant correlations, the agreement between the two densitometers was not high and there may be significant errors in individual subjects if one uses measurements from one densitometer to predict the change in BMD using the scanner of the other manufacturer. There is less of a problem comparing group data in the lumbar spine and trochanteric region, although errors are still likely to occur in comparing group data of bone loss, calculated using different densitometers, in the other proximal femur sites. In conclusion, the study suggests that caution is necessary in combining bone loss data derived using densitometers from different manufacturers, particularly in the proximal femur. This has important implications for multicenter studies.