The importance of physical function to people with osteoporosis

Osteoporosis International, Mar 2017

Summary There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. Introduction There is increasing need to understand patient-centred outcomes in osteoporosis (OP) clinical research and management. This multi-method paper provides insight on the effect of OP on patients’ physical function and everyday activity. Methods Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. Results Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. Conclusion More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence.

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The importance of physical function to people with osteoporosis

Osteoporos Int The importance of physical function to people with osteoporosis C. Kerr 0 1 2 3 4 5 6 7 C. Bottomley 0 1 2 3 4 5 6 7 S. Shingler 0 1 2 3 4 5 6 7 L. Giangregorio 0 1 2 3 4 5 6 7 H. M. de Freitas 0 1 2 3 4 5 6 7 C. Patel 0 1 2 3 4 5 6 7 S. Randall 0 1 2 3 4 5 6 7 D. T. Gold 0 1 2 3 4 5 6 7 0 University of Waterloo, 200 University Avenue West , Waterloo, ON N2L 3G1 , Canada 1 ICON Patient Reported Outcomes , W. Diamond Avenue, Suite 1000, Gaithersburg, MD 20878 , USA 2 H. M. de Freitas 3 Duke University Medical Center , Durham, NC 27710 , USA 4 National Osteoporosis Foundation , 251 18th Street South, Suite 630, Arlington, VA 22202 , USA 5 Mapi , Translation and Innovation Hub Building, 80 Wood Lane, White City, London W12 0BZ , UK 6 Research Institute for Aging , Waterloo, ON , Canada 7 Geriatric Education and Research in Aging Sciences Centre , Hamilton, ON , Canada Summary There is increasing need to understand patient outcomes in osteoporosis. This article discusses that fracture in osteoporosis can lead to a cycle of impairment, driven by complex psychosocial factors, having a profound impact on physical function/activity which accumulates over time. More information is required on how treatments impact physical function. Introduction There is increasing need to understand patientcentred outcomes in osteoporosis (OP) clinical research and Health-related quality of life; Osteoporosis; Patient-centred outcomes; Physical function; Psychological outcomes; Social outcomes - Catherine Bottomley, Cicely Kerr, Sarah Shingler, Hayley M. de Freitas, and Chloe Patel were employees of ICON at the time the research was completed. management. This multi-method paper provides insight on the effect of OP on patients’ physical function and everyday activity. Methods Data were collected from three sources: (1) targeted literature review on OP and physical function, conducted in MEDLINE, Embase and PsycINFO; (2) secondary thematic analysis of transcripts from patient interviews, conducted to develop a patient-reported outcome instrument. Transcripts were re-coded to focus on OP impact on daily activities and physical function for those with and without fracture history; and (3) discussions of the literature review and secondary qualitative analysis results with three clinical experts to review and interpret the importance and implications of the findings. Results Results suggest that OP, particularly with fracture, can have profound impacts on physical function/activity. These impacts accumulate over time through a cycle of impairment, as fracture leads to longer term detriments in physical function, including loss of muscle, activity avoidance and reduced physical capacity, which in turn leads to greater risk of fracture and potential for further physical restrictions. The cycle of impairment is complex, as other physical, psychosocial and treatment-related factors, such as comorbidities, fears and beliefs about physical activity and fracture risk influence physical function and everyday activity. Conclusion More information on how treatments impact physical function would benefit healthcare professionals and persons with OP in making treatment decisions and improving treatment compliance/persistence, as these impacts may be more salient to patients than fracture incidence. Introduction Osteoporosis (OP) is a growing public health concern and affects more than 200 million people worldwide [ 1 ]. Individuals living with OP are at greater risk of experiencing a fragility fracture. In developed countries, lifetime risk for a wrist, hip or vertebral fracture has been estimated at 30–40 % [ 2 ]. For individuals aged 50 years and over, approximately one in two women and up to one in four men will experience an osteoporotic fracture [ 3 ]. Worldwide, the disease has been reported to account for more than 8.9 million fractures annually [ 4 ]. Due to the importance of fracture in the progression of OP, clinical trials investigating novel therapeutic agents have focused on endpoints relating to bone health and fracture incidence. The US Food and Drug Administration (FDA) approval requirements for new therapies emphasise reducing the risk of vertebral fracture along with maximising drug safety [ 5 ]. While fracture incidence is clearly of clinical importance in OP, the extent to which it sufficiently captures outcomes that are patient-centred remains unclear, particularly given the potential impact of fracture on patients’ everyday lives such as mobility and other types of physical activity. Initially OP is considered asymptomatic, but this situation can change dramatically once a fracture has occurred. Fractures can result in reduced mobility and physical function. They can also result in chronic pain or affect the ability to self-care. Fractures can also have long-term consequences on physical function and greatly affect patients’ health-related quality of life (HRQL) [ 6–9 ]. The importance of (...truncated)


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C. Kerr, C. Bottomley, S. Shingler, L. Giangregorio, H. M. de Freitas, C. Patel, S. Randall, D. T. Gold. The importance of physical function to people with osteoporosis, Osteoporosis International, 2017, pp. 1597-1607, Volume 28, Issue 5, DOI: 10.1007/s00198-017-3911-9