Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Is recovery of quality of life post-fracture associated with 5-year mortality? The Australian arm of the International Costs and Utilities Related to Osteoporotic fractures Study (AusICUROS) (#19)

Jason Talevski 1 2 , Kerrie Sanders 1 2 3 , Sara Vogrin 2 4 , Gustavo Duque 1 2 , Alison Beauchamp 5 , Ego Seeman 2 , Sandra Iuliano 1 2 , Axel Svedbom 6 , Fredrik Borgstrom 7 , John Kanis 8 9 , Amanda Stuart 10 , Sharon Brennan-Olsen 1 3
  1. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC, Australia
  2. Department of Medicine–Western Health, The University of Melbourne, Melbourne, VIC, Australia
  3. School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
  4. Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, VIC, Australia
  5. School of Rural Health, Monash University, Melbourne, VIC, Australia
  6. ICON Plc, Stockholm, Sweden
  7. Quantify Research, Stolkholm, Sweden
  8. Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
  9. University of Sheffield, Sheffield, United Kingdom
  10. The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Melbourne, VIC, Australia

Aim: While evidence that suggests fractures are associated with increased mortality and decreased health-related quality of life (HRQoL), it is unknown if these outcomes are correlated. This study aimed to determine whether recovery of HRQoL 12-months post-fracture is associated with lower 5-year all-cause mortality.

Methods: This prospective study included 524 older adults (mean age: 70.2 years; % female: 79.2) with a fracture (150 hip, 261 wrist, 61 vertebral, 52 humerus) recruited from eight study centers across Australia. HRQoL was assessed using the EQ-5D-3L at baseline (including recall of HRQoL prior to fracture) and at 12-months post-fracture. HRQoL recovery was calculated as the difference between EQ-5D-3L utility scores at pre-fracture and 12-months. All-cause mortality was ascertained through linkage with the Australian National Death Index. Overall survival was compared between the two HRQoL groups (recovered vs. not recovered) using a two-sided log-rank test. Cox proportional hazards models were used to assess the association between mortality and HRQoL recovery.

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

Conclusion: This study provides evidence that HRQoL recovery post-fracture is associated with improved long-term survival in older adults, and also highlights important contributions of a variety of factors that predict long-term mortality post-fracture. Current post-fracture interventions known to improve HRQoL may have the potential to prevent deaths in older adults following fragility fracture.

6115d720e14ec-Figure+1_Abstract.png