Search

UnlabelledAccurate patient risk perception of adverse health events promotes greater autonomy over, and motivation towards, health-related lifestyles.IntroductionWe compared self-perceived fracture risk and 3-year incident fracture rates in postmenopausal women with a range of morbidities in the Global Longitudinal study of Osteoporosis in Women (GLOW).MethodsGLOW is an international cohort study involving 723 physician practices across ten countries (Europe, North America, Australasia); 60,393 women aged ≥55 years completed baseline questionnaires detailing medical history and self-perceived fracture risk. Annual follow-up determined self-reported incident fractures.ResultsIn total 2,945/43,832 (6.8%) sustained an incident fracture over 3 years. All morbidities were associated with increased fracture rates, particularly Parkinson's disease (hazard ratio [HR]; 95% confidence interval [CI], 3.89; 2.78-5.44), multiple sclerosis (2.70; 1.90-3.83), cerebrovascular events (2.02; 1.67-2.46), and rheumatoid arthritis (2.15; 1.53-3.04) (all p < 0.001). Most individuals perceived their fracture risk as similar to (46%) or lower than (36%) women of the same age. While increased self-perceived fracture risk was strongly associated with incident fracture rates, only 29% experiencing a fracture perceived their risk as increased. Under-appreciation of fracture risk occurred for all morbidities, including neurological disease, where women with low self-perceived fracture risk had a fracture HR 2.39 (CI 1.74-3.29) compared with women without morbidities.ConclusionsPostmenopausal women with morbidities tend to under-appreciate their risk, including in the context of neurological diseases, where fracture rates were highest in this cohort. This has important implications for health education, particularly among women with Parkinson's disease, multiple sclerosis, or cerebrovascular disease.

UnlabelledWe evaluated healthcare utilization associated with treating fracture types in >51,000 women aged ≥55 years. Over the course of 1 year, there were five times more non-hip, non-spine fractures than hip or spine fractures, resulting in twice as many days of hospitalization and rehabilitation/nursing home care for non-hip, non-spine fractures.IntroductionThe purpose of this study is to evaluate medical healthcare utilization associated with treating several types of fractures in women ≥55 years from various geographic regions.MethodsInformation from the Global Longitudinal Study of Osteoporosis in Women (GLOW) was collected via self-administered patient questionnaires at baseline and year 1 (n = 51,491). Self-reported clinically recognized low-trauma fractures at year 1 were classified as incident spine, hip, wrist/hand, arm/shoulder, pelvis, rib, leg, and other fractures. Healthcare utilization data were self-reported and included whether the fracture was treated at a doctor's office/clinic or at a hospital. Patients were asked if they had undergone surgery or been treated at a rehabilitation center or nursing home.ResultsDuring 1-year follow-up, there were 195 spine, 134 hip, and 1,654 non-hip, non-spine fractures. Clinical vertebral fractures resulted in 617 days of hospitalization and 512 days of rehabilitation/nursing home care; hip fractures accounted for 1,306 days of hospitalization and 1,650 days of rehabilitation/nursing home care. Non-hip, non-spine fractures resulted in 3,805 days in hospital and 5,186 days of rehabilitation/nursing home care.ConclusionsWhile hip and vertebral fractures are well recognized for their associated increase in health resource utilization, non-hip, non-spine fractures, by virtue of their 5-fold greater number, require significantly more healthcare resources.

UnlabelledAmong 50,461 postmenopausal women, 1,822 fractures occurred (57% minor non-hip, non-vertebral [NHNV], 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D, followed by major NHNV and hip fractures. Decreases in physical function and health status were greatest for spine or hip fractures.IntroductionThere is growing evidence that NHNV fractures result in substantial morbidity and healthcare costs. The aim of this prospective study was to assess the effect of these NHNV fractures on quality of life.MethodsWe analyzed the 1-year incidences of hip, spine, major NHNV (pelvis/leg, shoulder/arm) and minor NHNV (wrist/hand, ankle/foot, rib/clavicle) fractures among women from the Global Longitudinal study of Osteoporosis in Women (GLOW). Health-related quality of life (HRQL) was analyzed using the EuroQol EQ-5D tool and the SF-36 health survey.ResultsAmong 50,461 women analyzed, there were 1,822 fractures (57% minor NHNV, 26% major NHNV, 10% spine, 7% hip) over 1 year. Spine fractures had the greatest detrimental effect on EQ-5D summary scores, followed by major NHNV and hip fractures. The number of women with mobility problems increased most for those with major NHNV and spine fractures (both +8%); spine fractures were associated with the largest increases in problems with self care (+11%), activities (+14%), and pain/discomfort (+12%). Decreases in physical function and health status were greatest for those with spine or hip fractures. Multivariable modeling found that EQ-5D reduction was greatest for spine fractures, followed by hip and major/minor NHNV. Statistically significant reductions in SF-36 physical function were found for spine fractures, and were borderline significant for major NHNV fractures.ConclusionThis prospective study shows that NHNV fractures have a detrimental effect on HRQL. Efforts to optimize the care of osteoporosis patients should include the prevention of NHNV fractures.

UnlabelledWe examined variations in proportions of hip fractures and major fractures among postmenopausal women using the Global Longitudinal Study of Osteoporosis in Women (GLOW). The proportion of major fractures that were hip fractures varied with age and region, whereas variations in the proportion of fractures that were major fractures appeared modest.IntroductionIn many countries, the World Health Organization fracture risk assessment tool calculates the probability of major fractures by assuming a uniform age-associated proportion of major fractures that are hip fractures in different countries. We further explored this assumption, using data from the GLOW.MethodsGLOW is an observational population-based study of 60,393 non-institutionalized women aged ≥55 years who had visited practices within the previous 2 years. Main outcome measures were self-reported prevalent fractures after the age of 45 years and incident fractures during the 2 years of follow-up.ResultsThe adjusted proportion of prevalent and incident major fractures after the age of 45 years that were hip fractures was higher in North America (16%, 17%) than in northern (13%, 12%) and southern Europe (10%, 10%), respectively. The proportion of incident major fractures that were hip fractures increased more than five-fold with age, from 6.6% among 55-59-year-olds to 34% among those aged ≥85 years. Regional and age-associated variations in the proportion of all incident fractures that were major fractures were less marked, not exceeding 16% and 28%, respectively.ConclusionsThe data suggest that there may be regional differences in the proportion of major fractures that are hip fractures in postmenopausal women. In contrast, the regional and age-related variations in the proportion of fractures that are major fractures appear to be modest. However, because of the limited number of fractures in our sample, further studies are necessary to confirm these findings.

UnlabelledWe compared self-perception of fracture risk with actual risk among 60,393 postmenopausal women aged ≥55 years, using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Most postmenopausal women with risk factors failed to appreciate their actual risk for fracture. Improved education about osteoporosis risk factors is needed.IntroductionThis study seeks to compare self-perception of fracture risk with actual risk among postmenopausal women using data from GLOW.MethodsGLOW is an international, observational, cohort study involving 723 physician practices in 17 sites in ten countries in Europe, North America, and Australia. Participants included 60,393 women ≥55 years attended by their physician during the previous 24 months. The sample was enriched so that two thirds were ≥65 years. Baseline surveys were mailed October 2006 to February 2008. Main outcome measures were self-perception of fracture risk in women with elevated risk vs women of the same age and frequency of risk factors for fragility fracture.ResultsIn the overall study population, 19% (10,951/58,434) of women rated their risk of fracture as a little/much higher than that of women of the same age; 46% (27,138/58,434) said it was similar; 35% (20,345/58,434) believed it to be a little/much lower. Among women whose actual risk was increased based on the presence of any one of seven risk factors for fracture, the proportion who recognized their increased risk ranged from 19% for smokers to 39% for current users of glucocorticoid medication. Only 33% (4,185/12,612) of those with ≥2 risk factors perceived themselves as being at higher risk. Among women reporting a diagnosis of osteopenia or osteoporosis, only 25% and 43%, respectively, thought their risk was increased.ConclusionIn this international, observational study, most postmenopausal women with risk factors failed to appreciate their actual risk for fracture.

SummaryThe Global Longitudinal study of Osteoporosis in Women (GLOW) is a prospective cohort study involving 723 physicians and 60,393 women subjects >or=55 years. The data will provide insights into the management of fracture risk in older women over 5 years, patient experience with prevention and treatment, and distribution of risk among older women on an international basis.IntroductionData from cohort studies describing the distribution of osteoporosis-related fractures and risk factors are not directly comparable and do not compare regional differences in patterns of patient management and fracture outcomes.MethodsThe GLOW is a prospective, multinational, observational cohort study. Practices typical of each region were identified through primary care networks organized for administrative, research, or educational purposes. Noninstitutionalized patients visiting each practice within the previous 2 years were eligible. Self-administered questionnaires were mailed, with 2:1 oversampling of women >or=65 years. Follow-up questionnaires will be sent at 12-month intervals for 5 years.ResultsA total of 723 physicians at 17 sites in ten countries agreed to participate. Baseline surveys were mailed (October 2006 to February 2008) to 140,416 subjects. After the exclusion of 3,265 women who were ineligible or had died, 60,393 agreed to participate.ConclusionsGLOW will provide contemporary information on patterns of management of fracture risk in older women over a 5-year period. The collection of data in a similar manner in ten countries will permit comparisons of patient experience with prevention and treatment and provide insights into the distribution of risk among older women on an international basis.

Summary: This study assessed the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and suggested that FLS was cost-effective in patients with a recent fracture aged 50 years and older. The implementation of FLS could lead to lifetime health-economic benefits. Introduction: The objective of this study was to investigate the lifetime cost-effectiveness of a fracture liaison service (FLS) compared to no-FLS in the Netherlands from a societal perspective and using real-world data. Methods: Annual fracture incidence, treatment scenarios as well as treatment initiation in the years 2017–2019 were collected from a large secondary care hospital in the Netherlands. An individual-level, state transition model was designed to simulate lifetime costs and quality-adjusted life years (QALYs). Treatment pathways were differentiated by gender, presence of osteoporosis and/or prevalent vertebral fracture, and treatment status. Results were presented as incremental cost-effectiveness ratios (ICER). Both one-way and probabilistic sensitivity analyses were conducted. Results: For patients with a recent fracture aged 50 years and older, the presence of an FLS was associated with a lifetime €45 higher cost and 0.11 additional QALY gained leading to an ICER of €409 per QALY gained, indicating FLS was cost-effective compared to no-FLS at the Dutch threshold of €20,000/QALY. The FLS remained cost-effectiveness across different age categories. Our findings were robust in all one-way sensitivity analyses, the higher the treatment initiation rate in FLS, the greater the cost-effective of FLS. Probabilistic sensitivity analyses revealed that FLS was cost-effective in 90% of the simulations at the threshold of €20,000/QALY, with women 92% versus men 84% by gender. Conclusion: This study provides the first health-economic analysis of FLS in the Netherlands, suggesting the implementation of FLS could lead to lifetime health-economic benefits. [ABSTRACT FROM AUTHOR]

Summary: This study describes the development of a decision aid (DA), aimed at supporting patients in their decision whether to start anti-osteoporosis medication. People with recent fractures or osteoporosis and health professionals were supportive of the DA initiative. An experimental study been started to assess (cost-)effectiveness of the DA. Purpose: At fracture liaison services (FLS), patients with a recent fracture ánd osteoporosis or a prevalent vertebral fracture are advised to start anti-osteoporosis medication (AOM). This study describes the development of a decision aid (DA) to support patients and healthcare providers (HCPs) in their decision about whether to start AOM. Methods: The DA was developed according to International Patient Decision Aid Standards (IPDAS). A systematic procedure was chosen including scope, design, prototype development, and alpha testing. A previously developed DA for women with osteoporosis was used as a basis. Furthermore, input from literature searches, the Dutch guideline on management of osteoporosis, and from people with a fracture or osteoporosis was used. The updated DA was evaluated during alpha testing. Results: The DA facilitates the decision of patients whether to initiate AOM treatment and provides information on fractures and osteoporosis, general risk factors that increase the likelihood of a subsequent fracture, the role of lifestyle, personalized risk considerations of a subsequent fracture with and without AOM treatment, and AOM options and their characteristics in an option grid. Alpha testing with 15 patients revealed that patient preferences and needs were adequately presented, and several suggestions for improvement (e.g. adding more specific information, simplifying terminology, improving icon use) were accounted for. Participants from the alpha testing recommended use of the DA during outpatient visits. Conclusion: Professionals and persons with osteoporosis were supportive of the proposed DA and its usability. The DA could help in a shared decision-making process between patients and HCPs. [ABSTRACT FROM AUTHOR]

Byline: S. Kaptoge (1,32), G. Armbrecht (2), D. Felsenberg (2), M. Lunt (3), K. Weber (4), S. Boonen (5), I. Jajic (6), J. J. Stepan (7), D. Banzer (8), W. Reisinger (9), J. Janott (10), G. Kragl (11), C. Scheidt-Nave (12), B. Felsch (13), C. Matthis (14), H. H. Raspe (14), G. Lyritis (15), G Poor (16), R. Nuti (17), T. Miazgowski (18), K. Hoszowski (19), J. Bruges Armas (20), A. Lopes Vaz (21), L. I. Benevolenskaya (22), P. Masaryk (23), J. B. Cannata (24), O. Johnell (25), D. M. Reid (26), A. Bhalla (27), A. D. Woolf (28), C. J. Todd (29), C. Cooper (30), R. Eastell (31), J. A. Kanis (31), T. W. O'Neill (3), A. J. Silman (3), J. Reeve (1) Keywords: Algorithm; Osteoporosis diagnosis; Osteoporosis treatment; Radiograph; Spine X-ray; Vertebral fracture Abstract: Introduction Vertebral fracture is a strong risk factor for future spine and hip fractures yet recent data suggest that only 5--20% of subjects with a spine fracture are identified in primary care. We aimed to develop easily applicable algorithms predicting a high risk of future spine fracture in men and women over 50 years of age. Methods Data was analysed from 5,561 men and women aged 50+ years participating in the European Prospective Osteoporosis Study (EPOS). Lateral thoracic and lumbar spine radiographs were taken at baseline and at an average of 3.8 years later. These were evaluated by an experienced radiologist. The risk of a new (incident) vertebral fracture was modelled as a function of age, number of prevalent vertebral fractures, height loss, sex and other fracture history reported by the subject, including limb fractures occurring between X-rays. Receiver Operating Characteristic (ROC) curves were used to compare the predictive ability of models. Results In a negative binomial regression model without baseline X-ray data, the risk of incident vertebral fracture significantly increased with age [RR 1.74, 95% CI (1.44, 2.10) per decade], height loss [1.08 (1.04, 1.12) per cm decrease], female sex [1.48 (1.05, 2.09)], and recalled fracture history [1.65 (1.15, 2.38) to 3.03 (1.66, 5.54)] according to fracture site. Baseline radiological assessment of prevalent vertebral fracture significantly improved the areas subtended by ROC curves from 0.71 (0.67, 0.74) to 0.74 (0.70, 0.77) P=0.013 for predicting 1+ incident fracture and from 0.74 (0.67, 0.81) to 0.83 (0.76, 0.90) P=0.001 for 2+ incident fractures. Age, sex and height loss remained independently predictive. The relative risk of a new vertebral fracture increased with the number of prevalent vertebral fractures present from 3.08 (2.10, 4.52) for 1 fracture to 9.36 (5.72, 15.32) for 3+. At a specificity of 90%, the model including X-ray data improved the sensitivity for predicting 2+ and 1+ incident fractures by 6 and 4 fold respectively compared with random guessing. At 75% specificity the improvements were 3.2 and 2.4 fold respectively. With the modelling restricted to the subjects who had BMD measurements (n=2,409), the AUC for predicting 1+ vs. 0 incident vertebral fractures improved from 0.72 (0.66, 0.79) to 0.76 (0.71, 0.82) upon adding femoral neck BMD (P=0.010). Conclusion We conclude that for those with existing vertebral fractures, an accurately read spine X-ray will form a central component in future algorithms for targeting treatment, especially to the most vulnerable. The sensitivity of this approach to identifying vertebral fracture cases requiring anti-osteoporosis treatment, even when X-rays are ordered highly selectively, exceeds by a large margin the current standard of practice as recorded anywhere in the world. Author Affiliation: (1) Department of Medicine & Institute of Public Health, University of Cambridge, Cambridge, UK (2) Department of Radiology Charite, University Medicine Berlin Campus Benjamin Franklin, Berlin, Germany (3) ARC Epidemiology Unit, University of Manchester, Manchester, UK (4) University Hospital, Graz, Austria (5) University Hospital, Leuven, Belgium (6) Clinical Hospital, Zagreb, Croatia (7) Charles University, Prague, Czech-Republic (8) Behring Hospital, Berlin, Germany (9) Humboldt University, Berlin, Germany (10) Ruhr University, Bochum, Germany (11) Medical Academy, Erfurt, Germany (12) University of Heidelberg, Heidelberg, Germany (13) Clinic for Internal Medicine, Jena, Germany (14) Institute of Social Medicine, Lubeck, Germany (15) University of Athens, Athens, Greece (16) National Institute of Rheumatology and Physiotherapy, Budapest, Hungary (17) University of Siena, Siena, Italy (18) University School of Medicine, Szczecin, Poland (19) PKP Hospital, Warsaw, Poland (20) Hospital de Angra do Herismo, SEEBMO, Azores, Portugal (21) Hospital de San Joao, Oporto, Portugal (22) Institute of Rheumatology, Moscow, Russia (23) Institute of Rheumatic Diseases, Piestany, Slovakia (24) Asturia General Hospital, Oviedo, Spain (25) Lund University, Malmo, Sweden (26) University of Aberdeen, Aberdeen, UK (27) Royal National Hospital for Rheumatic Diseases, Bath, UK (28) Royal Cornwall Hospital, Truro, UK (29) School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK (30) University of Southampton, Southampton, UK (31) University of Sheffield, Sheffield, UK (32) Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK Article History: Registration Date: 23/12/2005 Received Date: 18/07/2005 Accepted Date: 22/12/2005 Online Date: 05/07/2006 Article note: This work was presented in part at the 30th European Symposium on Calcified Tissues, 8--12 May 2003, Rome, Italy. A.J. Silman and J. Reeve are the EU Grant holders and Project Leaders.

Introduction: Risedronate, a bisphosphonate for treatment and prevention of osteoporosis, has been shown in several clinical trials to reduce the risk of fractures in postmenopausal women with osteoporosis. The cost-effectiveness of risedronate treatment has previously been evaluated within different country settings using different model and analysis approaches. The objective of this study was to assess the cost-effectiveness of risedronate in postmenopausal women in four European countries--Sweden, Finland, Spain, and Belgium--by making use of the same modelling framework and analysis setup. Methods: A previously developed Markov cohort model for the evaluation of osteoporosis treatments was used to estimate the cost-effectiveness of risedronate treatment. For each country, the model was populated with local mortality, fracture incidence, and cost data. Hip fractures, clinical vertebral fractures, and wrist fractures were included in the model. Results: The incremental cost per quality-adjusted life years (QALY) gained from a 5-year intervention with risedronate compared to 'no intervention' in 70-year-old women at the threshold of osteoporosis [T-score = -2.5 based on National Health and Nutrition Examination Survey (NHANES) III data] and previous vertebral fracture was estimated to be 860 [euro], 19,532 [euro], 11,782 [euro], and 32,515 [euro] in Sweden, Finland, Belgium, and Spain, respectively. Among 70-year-old women at the threshold of osteoporosis without previous fracture the estimated cost per QALY gained ranged from 21,148 [euro] (Sweden) to 80,100 [euro] (Spain). The differences in cost-effectiveness between countries are mainly explained by different costs (fracture and treatment costs), fracture risks, and discount rates. Based on cost per QALY gained threshold values found in the literature, the study results indicated risedronate to be cost effective in the treatment of elderly women with established osteoporosis in all the included countries. Conclusions: At a hypothetical threshold value of 40,000 [euro] per QALY gained, the results in this study indicate that risedronate is a cost-effective treatment in elderly women at the threshold of osteoporosis (i.e., a T-score of -2.5) with prevalent vertebral fractures in Sweden, Finland, Belgium, and Spain. Keywords Belgium * Cost-effectiveness * Finland * Fracture * Osteoporosis * Postmenopausal women * Risedronate * Spain * Sweden

Byline: S. Boonen (1), R. Rizzoli (2), P. J. Meunier (3), M. Stone (4), G. Nuki (5), U. Syversen (6), M. Lehtonen-Veromaa (7), P. Lips (8), O. Johnell (9), J.-Y. Reginster (10) Keywords: Calcium; Fracture prevention; Osteoporosis drugs; Vitamin D Abstract: A European Union (EU) directive on vitamins and minerals used as ingredients of food supplements with a nutritional or physiological effect (2002/46/EC) was introduced in 2003. Its implications for the use of oral supplements of calcium and vitamin D in the prevention and treatment of osteoporosis were discussed at a meeting organized with the help of the World Health Organization (WHO) Collaborating Center for Public Health Aspects of Rheumatic Diseases (Liege, Belgium) and the support of the WHO Collaborating Center for Osteoporosis Prevention (Geneva, Switzerland). The following issues were addressed: Is osteoporosis a physiological or a medical condition? What is the evidence for the efficacy of calcium and vitamin D in the management of postmenopausal osteoporosis? What are the risks of self-management by patients in osteoporosis? From their discussions, the panel concluded that: (1) osteoporosis is a disease that requires continuing medical attention to ensure optimal therapeutic benefits (2) when given in appropriate doses, calcium and vitamin D have been shown to be pharmacologically active (particularly in patients with dietary deficiencies), safe, and effective for the prevention and treatment of osteoporotic fractures (3) calcium and vitamin D are an essential, but not sufficient, component of an integrated management strategy for the prevention and treatment of osteoporosis in patients with dietary insufficiencies, although maximal benefit in terms of fracture prevention requires the addition of antiresorptive therapy (4) calcium and vitamin D are a cost-effective medication in the prevention and treatment of osteoporosis (5) it is apparent that awareness of the efficacy of calcium and vitamin D in osteoporosis is still low and further work needs to be done to increase awareness among physicians, patients, and women at risk and (6) in order that calcium and vitamin D continues to be manufactured to Good Manufacturing Practice standards and physicians and other health care professionals continue to provide guidance for the optimal use of these agents, they should continue to be classified as medicinal products. Author Affiliation: (1) Leuven University Centre for Metabolic Bone Diseases &amp Division of Geriatric Medicine, University Hospital Leuven, Herestraat 49, B-3000, Leuven, Belgium (2) University Hospital, Geneva, Switzerland (3) Hopital Edouard Herriot, Lyon, France (4) Llandough Hospital, Penarth, UK (5) University of Edinburgh, Edinburgh, UK (6) St Olavs Hospital HF, Trondheim, Norway (7) University of Turku, Turku, Finland (8) VU Medical Centre, Amsterdam, The Netherlands (9) Malmo Hospital, University of Malmo, Malmo, Sweden (10) Unite d'Exploration de l'Os et du Cartilage, Liege, Belgium Article History: Registration Date: 05/03/2004 Received Date: 03/10/2003 Accepted Date: 24/02/2004 Online Date: 07/04/2004

Byline: Steven Boonen (1), Philippe Autier (2,3), Martine Barette (4), Dirk Vanderschueren (5), Paul Lips (6), Patrick Haentjens (7) Keywords: Elderly women; Functional outcome; Hip fracture; Quality of life Abstract: The aim of this prospective study was to document the functional outcome and quality of life (QoL) over 1 year following hip fracture in elderly women. A total of 159 unselected elderly women with a first hip fracture were matched for age and residence with an equal number of control women. Functional status was measured by completing a Rapid Disability Rating Scale version 2 (RDRS-2) questionnaire [score ranging from 0 (best) to 54 (worse)], before hospital discharge and 12 months later. To examine longitudinal change in health-related QoL, fracture subjects and controls completed the Short Form 36 (SF-36) questionnaire. For the 134 women still alive at 1 year, the mean RDRS-2 score before hospital discharge was 16.2 (95% CI: 15.0--18.0) and 3.5 (2.6--4.3) in patients and controls, respectively (P&lt 0.001). During the year following hospital discharge, the mean RDRS-2 score improved to 13.0 (11.1--14.1) in hip-fracture women and worsened to 4.3 (3.3--5.0) in the control group (differences with initial scores: P&lt 0.001 in both groups). After adjustment for potential confounders (including age and comorbidity), the estimated functional decline attributable to a hip fracture was 24% in the first year. Poor functional status upon discharge was the strongest predictor of a poor functional status at 1 year. Overall, similar trends were observed when using SF-36 scores as compared with RDRS-2 scores. However, only 51% of the study population was able to complete the SF-36 questionnaire at discharge and after 1 year, and these subjects were considerably younger (P&lt 0.001), had less cognitive impairment (P&lt 0.001), and had better functional status (P&lt 0.001) than those who were unable to complete the SF-36. For those women able to complete the SF-36 questionnaires, the mean SF-36 score before hospital discharge was 56.4 (95% CI: 51.9--60.9) and 71.1 (67.5--74.8) in patients and controls, respectively (P&lt 0.001). During the year following hospital discharge, the mean SF-36 score improved significantly to 61.1 (56.5--65.7) in hip-fracture patients (P=0.03), but remained unchanged in the control group (P=0.23). Overall, the results of this study indicate that women who sustain a hip fracture continue to suffer from substantial functional impairment and loss in QoL at 1 year, despite a significant recovery during this 12-month period. Function upon hospital discharge is the strongest predictor of functional status 1 year later. Assessing QoL in hip fracture women through self-administered questionnaires is subject to considerable bias due to non-response. Author Affiliation: (1) Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Herestraat 49, B-3000, Leuven, Belgium (2) Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy (3) Center of Epidemiology and Biostatistics of the Luxembourg Health Institute, Luxemburg, Grand Duchy of Luxemburg (4) Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium (5) Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium (6) Department of Endocrinology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (7) Department of Orthopaedics and Traumatology, Academisch Ziekenhuis VUB, Vrije Universiteit Brussel, Brussels, Belgium Article History: Received Date: 10/04/2003 Accepted Date: 03/09/2003 Online Date: 07/11/2003 Article note: The authors represent the Belgian Hip Fracture Study Group, the full membership of which comprises the following investigators: P. Autier, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy, and Center for Research in Epidemiology and Health Information Systems Luxemburg, Grand Duchy of Luxemburg J.M. Baillon, Department of Orthopedics, Ixelles-Etterbeek Hospital, Brussels, Belgium M. Barette, Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium J. Bentin, Service of Rheumatology, Louis Cathy Hospital, Baudourt, Belgium S. Boonen, Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium R. Bouillon, Leuven University Center for Metabolic Bone Diseases and Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium P. Broos, Leuven University Center for Metabolic Bone Diseases and Division of Traumatology and Emergency Surgery, Katholieke Universiteit Leuven, Leuven, Belgium M.C. Closon, Interdisciplinary Center in Health Economics, Universite Catholique de Louvain, Brussels, Belgium A.R. Grivegnee, Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium P. Haentjens, Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium P. Opdecam, Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium D. Vanderschueren, Leuven University Center for Metabolic Bone Diseases and Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.

Byline: S. Boonen (1), J.-M. Kaufman (2), J.-Y. Reginster (3), J.-P. Devogelaer (4) Abstract: Dual-energy X-ray absorptiometry (DXA) devices from the three main manufacturers provide different bone mineral density (BMD) values, due in part to technical differences in the algorithms for bone mineral content (BMC) and area measurements and in part to the use of different manufacturer-derived reference databases. As a result, significant differences exist between Hologic, Lunar and Norland systems in the reported young normal standard deviation scores or T-scores. In a number of European countries, including Belgium, a T-score below -2.5 is one of the key criteria for reimbursement of osteoporosis treatments. This paper addresses the first attempt to implement a nationwide, uniform expression of BMD in patients, in order to harmonize drug reimbursement. To this end, measures were taken to implement a uniform expression of BMD in Belgian patients, by converting each manufacturer's absolute BMD to standardized BMD (sBMD) values and by establishing a single national reference range. Author Affiliation: (1) Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven (2) Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital (3) Centre Universitaire d'Investigation du Metabolisme Osseux et du Cartilage Articulaire, State University of Liege (4) Arthritis Unit, Universite catholique de Louvain, Belgium (5) Service de Rhumatologie, UCL 5390, Saint-Luc University Hospital, Avenue Hippocrate 10, 1200, Brussels, Belgium Article History: Received Date: 29/05/2002 Accepted Date: 06/09/2002 Article note: Electronic Publication

Byline: J. Aerssens (1), J. Dequeker (1), J. Peeters (1), S. Breemans (1), P. Broos (3), S. Boonen (1) Keywords: Key words:COLIA1 polymorphism --ER polymorphism -- Hip fracture --VDR polymorphism Abstract: In view of the reported associations between osteoporosis and polymorphisms of the vitamin D receptor (VDR), collagen I[alpha]1 (COLIA1) and estrogen receptor (ER) genes, an association study was performed between VDR, COLIA1, and ER genotypes and bone mineral density, biochemical markers of bone turnover and hip fracture occurrence in Belgian older postmenopausal women. The gene polymorphisms were evaluated by restriction fragment length polymorphism analyses, using the restriction enzymes BsmI (VDR), AccB7I (COLIA1), and PvuII and XbaI (ER), respectively. As expected, bone mineral density and biochemical analyses demonstrated significant differences between hip fracture patients and elderly controls. However, no significant differences in genotype distributions or allele frequencies were observed between the cases (n= 135, age 78 +- 9 years) and controls (n= 239, age 76 +- 4 years) for any of the gene polymorphisms. Stratification of both study populations according to VDR, COLIA1 or ER genotype did not reveal any statistically significant difference in bone density or bone turnover between subgroups with different genotypes. In conclusion, despite its limited statistical power the outcome of this study does not support the hypothesis of a major contribution of the VDR, COLIA1 or ER polymorphisms to explain variations in bone mineral density or bone turnover, or to identify elderly women at risk of osteoporotic hip fracture. Author Affiliation: (1) Arthritis and Metabolic Bone Disease Research Unit, BE (2) Leuven University Center for Metabolic Bone Diseases, BE (3) Department of Surgery, Division of Traumatology and Emergency Surgery, K.U. Leuven, Leuven, Belgium, BE Article note: Received: 26 May 1999 / Accepted: 10 January 2000

Byline: P. Autier (1), P. Haentjens (2), J. Bentin (3), J. M. Baillon (4), A. R. Grivegnee (5), M. C. Closon (6), S. Boonen (7) Keywords: Key words:Controlled study -- Economic cost -- Hip fracture Abstract: The economic burden of hip fractures is thought to be important, but the excess medical costs they induce remain largely unknown. We assessed the direct medical costs induced by hip fractures during and after hospitalization. Hospital costs of 170 consecutive Belgian women with hip fracture were gathered. During the year following discharge, all medical costs were collected for the 159 hip fracture women who survived the acute hospitalization stay. A similar collection of data was performed on a comparison group of 159 age-and residence-matched women without a history of hip fracture. The mean cost of the acute hospital stay was C8667, and the mean 1-year hip-fracture-related extra costs after hospitalization was C6636. During the year following the acute hospital stay, 19% of the hip fracture women and 4% of the comparison women were newly admitted to nursing homes (p&lt 0.001). Although health care costs increased with age, hip-fracture-related extra costs after hospitalization seemed similar in those below or above 81 years old. These extra costs amounted to C7710 in women not living in nursing homes at the time of fracture, and to C3479 in women who lived in nursing homes. Health or mental status before hip fracture seemed not to affect extra costs. Taking into account the higher mortality of women with hip fracture, the extra costs during the acute hospital stay and during the 1-year follow-up amounted to a mean C15151. In conclusion, both acute hospital stays and subsequent medical care contribute significantly to medical costs induced by hip fractures. Author Affiliation: (1) Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy, IT (2) Department of Orthopedics and Traumatology, Academisch Ziekenhuis VUB, Belgium, BE (3) Service of Rheumatology, Louis Cathy Hospital, Baudourt, Belgium, BE (4) Department of Orthopedics, Ixelles-Etterbeek Hospital, Brussels, Belgium, BE (5) Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium, BE (6) Interdisciplinary Center in Health Economics, UniversiteA' Catholique de Louvain, Brussels, Belgium , BE (7) Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium, BE Article note: Received: 12 April 1999 / Accepted: 9 November 1999

Summary: This study explored the course of health state utility value over 3 years in patients with a recent fracture attending a Fracture Liaison Service and suggested that the overall change in health-related quality of life was not significant, although significant improvements were observed at 6 and 12 months compared to baseline. Introduction: To estimate the 3-year health-related quality of life (HRQoL) of patients with a recent fracture presenting at a Fracture Liaison Service (FLS) and to explore factors associated with health state utility value (HSUV). Methods: Patients' HSUVs were derived from the EQ-5D-5L and SF-6D and calculated at six time points. Multiple imputation was applied for missing data. Linear mixed-effects regression analysis with random intercept and slope was applied to explore the course of HSUV over 3 years. The impact of subsequent fracture and the length of time between FLS visit and patients' index fracture on HSUV were also investigated. A backward stepwise elimination was applied to identify factors associated with HSUV. Results: A total of 499 patients were included. The change of EQ-5D HSUV was not significant over 3-year follow-up (P = 0.52), although slightly but significantly higher HSUV was captured at 6 months (mean difference (MD): 0.015, P = 0.02) and 12 months (MD: 0.018, P = 0.01). There was no significant difference in the course of EQ-5D HSUV between fracture locations (P = 0.86). A significant increase in HSUV was only captured for patients had shorter time period (< 107 days) between FLS visit and their index fracture. Suffering a subsequent fracture was associated with significant QoL loss (MD: − 0.078, P < 0.001). Subsequent fracture, previous treatment with anti-osteoporosis medication, a prevalent vertebral fracture (grade 2 or 3), use of a walking aid, previous falls, and higher BMI were negatively associated with mean EQ-5D HSUV over 3 years. Comparable results were found using SF-6D HSUV. The lack of HRQoL data immediately after fracture and selection bias were two main limitations. Conclusion: The 3-year change in HSUV was not statistically significant, although significant improvements were observed at 6 and 12 months in comparison with baseline. Six factors were negatively associated with EQ-5D HSUV. [ABSTRACT FROM AUTHOR]