Oral Presentation 30th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2020

Health Service Care Pathways Associated with Quality of Life Recovery Post-Fracture: The International Costs & Utilities Related to Osteoporotic Fractures Study (ICUROS) (#37)

Jason Talevski 1 2 , Kerrie Sanders 1 2 3 , Lucy Busija 4 , Alison Beauchamp 1 2 5 , Gustavo Duque 1 2 , Fredrik Borgström 6 , Axel Svedbom 7 , John Kanis 8 9 , Amanda Stuart 10 , Sharon Brennan-Olsen 1 2 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. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  5. School of Rural Health, Monash University, Melbourne, VIC, Australia
  6. Quantify Research, Stockholm, Sweden
  7. ICON Plc, Stockholm, 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: To identify combinations of health service use associated with recovery of health-related quality of life (HRQoL) 12-months post-major osteoporotic fracture (MOF) – specific to each MOF site (hip, distal forearm, vertebrae, humerus).

Methods: The analyses included 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebral, 434 humeral) from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) conducted across Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain and the UK. HRQoL at pre-fracture and 12-months post-fracture was measured using the EuroQoL questionnaire (EQ-5D-3L). Health service use data were collected via participant interviews and medical record reviews and included: in-hospital care; outpatient care; community health services, medication use and imaging. The data analysis involved two stages: 1) latent class analyses to identify common combinations of health service use (“classes”); and 2) logistic regression to assess associations between classes and HRQoL recovery. Analyses were undertaken separately for each MOF site.

Results: The proportion of participants who recovered to their pre-fracture HRQoL at 12-month follow-up varied across sites: hip (37.3%), distal forearm (65.8%), vertebrae (48.9%) and humerus (49.5%). The latent class analyses determined eight, five, four and three distinct classes for hip, distal forearm, vertebral and humeral participants, respectively. We identified at least one class in each site associated with increased likelihood of HRQoL recovery and one class associated with decreased likelihood (Figure 1). Generally, the combination of hospital presentations without admission; primary care center visits; osteoporosis-related medication use; vitamin D/calcium supplementation and non-opioid analgesic use was associated with higher likelihood of HRQoL recovery.

Conclusion: We identified several, fracture site-specific health service use pathways associated with recovery of HRQoL. The widespread introduction of evidence-based, site-specific care pathways could potentially improve the management and health outcomes of patients treated for a MOF worldwide.

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