Impact of osteoporotic vertebral fractures in older women

  • Usama Al-Sari

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


Health-related quality of life (HRQoL) in patients with vertebral fracture is of increasing interest, but relevant studies have yielded debatable results. Also, little is known about the long-term impact of vertebral fractures on both physical and mental/psychological activities which may affect HRQoL. There is also uncertainty over the clinical significance of mild fracture compared with those without and with moderate/ severe vertebral fractures.
1. To assess the association between vertebral fracture and general HRQoL.
2. To assess the association between vertebral fracture and different types of physical activities.
3. To evaluate the prospective association between vertebral fracture and future physical activity.
4. To evaluate the prospective association between vertebral fracture and future mental/ psychological activity.
This thesis used two different methods to answer the research questions: to answer question one and two, a systematic review and meta-analysis was used. To answer question three and four, a five-year prospective study of a mixed community and secondary care cohort of women aged > 50 from the UK was used.
After adjusting for age, the meta-analysis showed worse physical (SMD = 0.39, 95 % confidence interval (CI) (0.06 to 0.73); P= 0.023) but not mental (SMD = 0.04, 95 % CI (0.32 to 0.41); P = 0.822) HRQoL in osteoporotic older people with vertebral fracture compared to those without fracture. Meta-analysis also showed that women with vertebral fracture also had 27% to 127% increase in difficulty doing different physical activities compared to those without vertebral fracture. From the prospective study of 395 patients, women with moderate/severe fracture self-reported shorter walking duration compared to those without fracture, even after adjusting for potential confounders (OR 2.96, 95%CI (1.11 to 7.88), P = 0.030) and reported more fear of falling and less confidence.
The results of this thesis show for the first time that women with moderate/severe osteoporotic vertebral fractures have reduced physical health status compared to those without vertebral fracture as shown by meta-analysis of existing literature and a new prospective study. These women also more likely to be afraid of falling and have reduced general confidence.
Date of Award23 Jan 2019
Original languageEnglish
Awarding Institution
  • The University of Bristol
SupervisorJonathan H Tobias (Supervisor) & Emma M Clark (Supervisor)

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