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Title: Impact of osteoporotic vertebral fractures in older women
Author: Al-Sari, Usama
ISNI:       0000 0004 7961 6683
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2019
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Background: 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. Aims: 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. Methods: 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. Results: 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. Conclusion: 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.
Supervisor: Tobias, Jonathan ; Clark, Emma Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available