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Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study

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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<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<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<0.001), had less cognitive impairment (P<0.001), and had better functional status (P<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<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.

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Acknowledgements

We are indebted to the participating women and their families. This work was partly supported by a medical research grant from Merck Sharp and Dohme BV, Belgium. This study was supported by grant G.0171.03 from the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) to S. Boonen. Dr. S. Boonen and Dr. D. Vanderschueren are senior clinical investigators of the Fund for Scientific Research, Flanders, Belgium (FWO Vlaanderen). Dr. S. Boonen is holder of the Leuven University Chair in Metabolic Bone Diseases, founded and supported by Merck, Sharp & Dohme.

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Authors and Affiliations

  1. Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Herestraat 49, B-3000, Leuven, Belgium

    Steven Boonen

  2. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Philippe Autier

  3. Center of Epidemiology and Biostatistics of the Luxembourg Health Institute, Luxemburg, Grand Duchy of Luxemburg

    Philippe Autier

  4. Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium

    Martine Barette

  5. Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium

    Dirk Vanderschueren

  6. Department of Endocrinology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

    Paul Lips

  7. Department of Orthopaedics and Traumatology, Academisch Ziekenhuis VUB, Vrije Universiteit Brussel, Brussels, Belgium

    Patrick Haentjens

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  1. Steven Boonen
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  2. Philippe Autier
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  3. Martine Barette
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  4. Dirk Vanderschueren
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  5. Paul Lips
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  6. Patrick Haentjens
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Corresponding author

Correspondence to Steven Boonen.

Additional information

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, Université Catholique de Louvain, Brussels, Belgium; A.R. Grivegnée, 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.

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Boonen, S., Autier, P., Barette, M. et al. Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 15, 87–94 (2004). https://doi.org/10.1007/s00198-003-1515-z

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  • DOI: https://doi.org/10.1007/s00198-003-1515-z

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