THE IMPACT OF ASYMPTOMATIC VERTEBRAL FRACTURES ON QUALITY OF LIFE IN COMMUNITY-DWELLING OLDER WOMEN: SAO PAULO AGEING & HEALTH STUDY (SPAH)

Abstract

Aims: To investigate the impact of asymptomatic vertebral fractures on community-dwelling older women’s quality of life (QOL) from the Sao Paulo Ageing & Health Study (SPAH). Methods: This cross-sectional study is nested within the larger epidemiological project of prevalence vertebral fractures in older living in Sao Paulo, Brazil. 180 women with 65 years of age or over were evaluated. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) was administered to all subjects. The QUALEFFO is a specific questionnaire designed to be used by patients with vertebral fractures attributed to osteoporosis. This questionnaire has 41 questions, covering five domains: pain, physical function, social function, general health perception and mental function. Each domain score was computed by summing the scores of all questions and submitting the sum to a linear transformation to a scale of 100. A low score indicates worse health and a high score indicates better health. Anthropometric data was obtained by physical examination and BMI was calculated. The participants underwent a lateral thoracic and lumbar spine X-ray to identify asymptomatic vertebral fractures using semiquantitative method (Genant-1993). Results: Women with asymptomatic vertebral fractures had lower QUALEFFO-Total [61.4 (15.3) vs. 67.1 (14.2), p=0.03] and worse QUALEFFO-physical-function domain [69.5 (20.1) vs. 77.3 (17.1), p=0.02] compared to those without fractures. QUALEFFO-Total was also worse in women classified as obese, compared to those classified as overweight and normal [61.7(15.4) vs. 66.4(13.8) vs. 70.8 (13.5), p=0.008]. Lower QUALEFFO-Total was found in women with low physical activity compared to those with moderate or high activity [51.8(19.1) vs. 64.8(14.3) vs. 70.3 (13.2), p=0.010]. The analysis each domain showed that lower QUALEFFO-physical-function domain was also observed in women with higher BMI and lower physical activity. The final statistical analysis using generalized linear models with gamma distribution and logarithmic link function showed that impair QUALEFFO-Total was associated with vertebral fractures regardless of age (p<0.05). Lower QUALEFFO-physical-function domain remain associated with high BMI (p=0.004), lower physical activity (<0.001) and vertebral fractures (p=0.041). Conclusion: Vertebral fractures are associated to decreased QOL and physical function in community-dwelling older women. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures in order to reduce their impact on QOL among older women.