Health Service Use and Quality of Life Recovery 12-months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS).

Major osteoporotic fractures (MOFs) are associated with a rapid decline of health-related quality of life (HRQoL), however there is limited knowledge about which health care services positively affect HRQoL post-fracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12-months post-MOF. The analyses included 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) - a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, 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 including in-hospital care; outpatient care; community services and medication use. Data analyses involved two stages: 1) latent class analyses to identify different combinations of health service use ("classes"); and 2) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non-hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their pre-fracture HRQoL at 12-month follow-up; this proportion was higher for non-hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range: 2-5 classes). Classes that were associated with increased odds of HRQoL recovery at 12-months were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non-opioid analgesic use. Similar classes were observed for non-hip MOFs. Understanding country-specific health care service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve post-fracture care on a global scale. This article is protected by copyright. All rights reserved.