Clinical Determinants of Quality of Life in Paget’s Disease of Bone
Tóm tắt
Paget’s disease of bone (PDB) can adversely affect quality of life, but relatively little is known about the clinical predictors of reduced quality of life in patients with the disease. Here, we studied quality of life and its determinants in a large cohort of PDB patients who had been enrolled into the PRISM study, a randomized comparative trial of intensive versus symptomatic treatment for PDB. Health-related quality of life was assessed using the Short-Form 36 (SF36) questionnaire and other validated assessment instruments in 1,324 subjects with PDB. Clinical predictors of quality of life were identified by multivariate regression analysis. The physical summary (mean ± standard deviation) score of the SF36 was substantially reduced in PDB to 36.3 ± 11.3 compared with the expected population norm of 50 (P < 0.001). The mental summary score was only slightly reduced, to 48.7 ± 11.8, in PDB; but this was statistically significant (P < 0.001). Bone pain due to PDB, previous bisphosphonate therapy, and increasing age were identified as negative predictors of the SF36 physical summary score (P < 0.001); but serum levels of total alkaline phosphatase (ALP) did not predict physical summary score. We conclude that PDB has a substantial negative impact on health-related quality of life, which mainly affects physical functioning. The lack of correlation between ALP and quality of life observed in this study emphasizes the importance of addressing quality-of-life issues when treating PDB and not just focussing on response of ALP levels.
Tài liệu tham khảo
Daroszewska A, Ralston SH (2005) Genetics of Paget’s disease of bone. Clin Sci (Lond) 109:257–263
van Staa TP, Selby P, Leufkens HG, Lyles K, Sprafka JM, Cooper C (2002) Incidence and natural history of Paget’s disease of bone in England and Wales. J Bone Miner Res 17:465–471
Siris ES (1998) Paget’s disease of bone. J Bone Miner Res 13:1061–1065
Melton LJ III, Tiegs RD, Atkinson EJ, O’Fallon WM (2000) Fracture risk among patients with Paget’s disease: a population-based cohort study. J Bone Miner Res 15:2123–2128
Gold DT, Boisture J, Shipp KM, Pieper CF, Lyles KW (1996) Paget’s disease of bone and quality of life. J Bone Miner Res 11:1897–1904
Altman RD, Johnston CC, Khairi MR, Wellman H, Serafini AN, Sankey RR (1973) Influence of disodium etidronate on clinical and laboratory manifestations of Paget’s disease of bone (osteitis deformans). N Engl J Med 289:1379–1384
Miller PD, Brown JP, Siris ES, Hoseyni MS, Axelrod DW, Bekker PJ (1999) A randomized, double-blind comparison of risedronate and etidronate in the treatment of Paget’s disease of bone. Paget’s Risedronate/Etidronate Study Group. Am J Med 106:513–520
Ralston SH, Boyce BF, Cowan RA, Fogelman I, Smith ML, Jenkins AS, Boyle IT (1987) The effect of one alpha hydroxyvitamin D3 on the mineralisation defect in disodium etidronate treated Paget’s disease - a double-blind randomised study. J Bone Miner Res 2:5–12
Reid IR, Miller P, Lyles K, Fraser W, Brown JP, Saidi Y, Mesenbrink P, Su G, Pak J, Zelenakas K, Luchi M, Richardson P, Hosking D (2005) Comparison of a single infusion of zoledronic acid with risedronate for Paget’s disease. N Engl J Med 353:898–908
Siris ES, Weinstein RS, Altman R, Conte JM, Favus M, Lombardi A, Lyles K, McIlwain H, Murphy WA Jr, Reda C, Rude R, Seton M, Tiegs R, Thompson D, Tucci JR, Yates AJ, Zimering M (1996) Comparative study of alendronate versus etidronate for the treatment of Paget’s disease of bone. J Clin Endocrinol Metab 81:961–967
Fergusson D, Aaron SD, Guyatt G, Hebert P (2002) Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis. Br Med J 325:652–654
Selby PL, Davie MW, Ralston SH, Stone MD (2002) Guidelines on the management of Paget’s disease of bone. Bone 31:366–373
Ziebland S, Fitzpatrick R, Jenkinson C, Mowat A, Mowat A (1992) Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ. Ann Rheum Dis 51:1202–1205
Ware JE Jr, Gandek B (1998) Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 51:903–912
Ware JEJ, Keller SD, Hatoum HT, Kong SX (1999) The SF-36 Arthritis-Specific Health Index (ASHI): I. Development and cross-validation of scoring algorithms. Med Care 37:MS40-MS50
Kelly MH, Brillante B, Kushner H, Gehron RP, Collins MT (2005) Physical function is impaired but quality of life preserved in patients with fibrous dysplasia of bone. Bone 37:388–394
Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, Donaldson C, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA (2005) Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365:1621–1628
Picavet HS, Hoeymans N (2004) Health related quality of life in multiple musculoskeletal diseases: SF-36 and EQ-5D in the DMC3 study. Ann Rheum Dis 63:723–729
Collins MT, Kushner H, Reynolds JC, Chebli C, Kelly MH, Gupta A, Brillante B, Leet AI, Riminucci M, Robey PG, Bianco P, Wientroub S, Chen CC (2005) An instrument to measure skeletal burden and predict functional outcome in fibrous dysplasia of bone. J Bone Miner Res 20:219–226
Jakobsson U, Hallberg IR (2002) Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. J Clin Nurs 11:430–443
Bowling A, Bond M, Jenkinson C, Lamping DL (1999) Short Form 36 (SF-36) Health Survey questionnaire: which normative data should be used? Comparisons between the norms provided by the Omnibus Survey in Britain, the Health Survey for England and the Oxford Healthy Life Survey. J Public Health Med 21:255–270
Sokka T, Kankainen A, Hannonen P (2000) Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 43:386–389
Lyles KW, Siris ES, Singer FR, Meunier PJ (2001) A clinical approach to diagnosis and management of Paget’s disease of bone. J Bone Miner Res 16:1379–1387