Objective: We aimed to identify specific combinations of health services used in the 4-months post-major osteoporotic fracture (MOF) that are associated with change in health-related quality of life (HRQoL).
Methods: The International Cost and Utility Related to Osteoporotic Fractures Study (ICUROS) included 903 Australian participants aged ≥50 years with a low-energy fracture: this analysis focused on MOFs (n=678). HRQoL was collected at baseline and 4-months post-fracture using the EQ-5D-3L questionnaire. Health service data were collected through interviews and medical records review, encompassing hospital admissions (including in-hospital rehabilitation), out-of-hospital services (e.g. outpatient clinics, GP, allied health), informal care (e.g. home help) and medication use. Multivariable linear regression was undertaken to assess associations between combinations of health service use and change in HRQoL.
Results: Of the participants with MOF (mean age: 71.3 years; 77% female), there were 173 hip, 282 wrist, 75 vertebral and 55 humeral fractures. Univariate analyses showed hospital admissions, allied health visits, health professional home visits, home modifications and medication use were associated with positive HRQoL change at 4-months. Independent of age and pre-fracture HRQoL, the final model included admission to hospital (β=0.091, 95% CI 0.059-0.123) and allied health visits (β=0.004, 95% CI 0.001-0.007). In sex-stratified analyses, univariate associations between health services and HRQoL change differed, although final models were the same. When analyses were repeated for MOF excluding hip fractures, the final model included admission to hospital (β=0.103, 95% CI 0.035-0.171) and home visits by a health professional (β=0.128, 95% CI 0.066-0.190) for men; and allied health visits (β=0.007, 95% CI 0.002-0.011) for women.
Conclusion: Different combinations of health services have different associations with HRQoL improvement 4-months post-MOF suggesting care pathways for clinicians that can improve short-term HRQoL Further work should be directed toward identifying the combination of health services associated with return to pre-fracture HRQoL.