The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis - Results from the multiple outcomes of raloxifene evaluation study

Objective. To examine the effect of both Prevalent and incident vertebral f ractures on health-related quality of life (HRQOL) in postmenopausal women with osteoporosis and to characterize the effect of prevalent vertebral fra ctures on HRQOL with respect to number, location, severity, and adjacency. Methods. Participants were a subset of women (n = 1,395, mean age 68.5 year s) from the Multiple Outcomes of Raloxifene Evaluation trial who had low bo ne mineral density and/or prevalent vertebral fractures. Vertebral fracture s were measured by radiography at baseline, 2 years, and 3 years. HRQOL was assessed using the Osteoporosis Assessment Questionnaire (OPAQ), a validat ed disease-targeted instrument, at baseline and annually for 3 years. Results. Both prevalent and incident radiographic vertebral fractures were associated with decreased HRQOL. At baseline, women with a prevalent verteb ral fracture had significantly lower OPAQ scores on physical function, emot ional status, clinical symptoms, and overall HRQOL compared with women with out a prevalent fracture (all P < 0.01). HRQOL scores were lower with each subsequent fracture. The effect of prevalent vertebral fracture was depende nt on the location within the spine and was strongest in the lumbar region (L1-L4). Incident vertebral fractures significantly decreased OPAQ scores o n physical function, emotional status, clinical symptoms, and overall HRQOL (all P < 0.001). Conclusion. Our findings demonstrate the importance of treating postmenopau sal women who have prevalent vertebral fractures to prevent further decreas es in HRQOL associated with subsequent incident vertebral fracture.