Association of Low General Health Status, Measured Prospectively by Euroqol EQ5D, with Osteoporosis, Independent of a History of Prior Fracture

Objectives: There have been no studies of generic health-related quality of life (HR-QOL) measured prospectively, in patients referred for bone mass measurement. The aim of this study was to examine the relationship between HR-QOL, measured before DXA scanning was undertaken, and bone mineral density (BMD). Comparison of HR-QOL with the age- and sex-matched general population was also made.

Design: HR-QOL questionnaires were completed by patients who were being entered into a randomized, prospective, parallel group trial to assess the impact of direct access DXA scanning (DADS) versus referral to a hospital consultant, upon clinical decision making by general practitioners (GPs) (Dhillon et al., Osteoporos Int 14:326-333, 2003). HR-QOL questionnaires were completed prior to both randomization and DXA scanning.

Participants: 325 patients from 18 representative general practices of a total of 77 in the city of Edinburgh. Patients had been referred by their GPs who had access to national guidelines on the identification of patients at high risk of osteoporosis.

Outcome Measures: Generic HR-QOL was measured using Euroqol (EQ5D). This provides a profile of self-reported problems in five dimensions (EQ5D(profile)), health utility (EQ5D(utility)), and a visual analogue global self-rated health assessment (EQ5D(vas)).

Results: Odds ratios (ORs) for any self-reported problems on EQ5D(profile) were higher in patients with osteoporosis than those without, and compared with the general population. Age-adjusted mean (SD) EQ5D(utility )was significantly lower in patients with osteoporosis than in those without (0.65 [0.28] vs 0.76 [0.27]; p< 0.01), but the difference lessened with advancing age. Age-adjusted mean (SD) EQ5D(vas) was significantly reduced in patients with compared with no osteoporosis (68 [20] vs 76 [16]; p<0.01). There were no such differences in patients with a history of prior fracture compared with those without a history of prior fracture.

Conclusions: Female patients with osteoporosis have reduced generic HR-QOL compared with the age-matched female general population, irrespective of a history of prior fracture. The causal relationship between osteoporosis and HR-QOL, if any, is unclear. Further studies are needed to define this relationship and to determine whether treatment of osteoporosis has a beneficial effect on HR-QOL independent of fracture risk.