Osteoporosis is a public health issue worldwide. The patients with osteoporosis have limited physical and mental functions. The pain, insomnia, fatigue, and reduced mobility caused by osteoporosis can lead to social isolation and depression and consequently poor HRQoL in these patients (Bianchi, Orsini et al. 2005, Garip, Eser et al. 2015, Al-Sari, Tobias et al. 2016, Drozd, Mazur et al. 2016).
Our findings highlighted that weekly walking hours, disease duration, and the number of pregnancies were important determinants of physical QoL. On the other hand, age and weekly walking hours influenced mental QoL in our patients. In other studies, patients’ awareness of reduced BMD has been highlighted as a factor intensifying anxiety, as well as fear of falling and bone fractures in osteoporotic patients which in turn results in reduced independence and poorer HRQoL (Wilson, Sharp et al. 2012). Align with this, the HRQoL scores in all the four domains were low in osteoporotic women in our study indicating the lower fear of illness in these patients.
In present study, mental QoL reduced with increasing age which is in parallel with previous studies. The physical functioning of older women has also been limited due to the fear of falling and possible fractures (Al-Sari, Tobias et al. 2016, Bączyk, Samborski et al. 2016).
Weekly walking hours has been associated with longer life span, lower risk of diseases and more desirable HRQoL in osteoporotic patients (http://www.who.int/dietphysicalactivity/factsheet_olderadults/en). In line with other studies (Moriyama, Oneda et al. 2008, Bączyk, Samborski et al. 2016), we also found that weekly walking hours had a positive impact on both physical and mental QoL of osteoporotic women.
The number of pregnancies negatively affected the physical QoL of osteoporotic women in our study which is consistent with a previous report noting that women with more pregnancies had lower HRQoL (Singh and Kaur 2015). Women’s health is substantially decreased during and after pregnancy. In fact, maternal BMD decreases by about 3 percent during each pregnancy (Michaëlsson, Baron et al. 2001). After delivery, other activities and problems including breastfeeding, child-rearing, limited physical activity due to obesity, postpartum stress, low back pain, pelvic pain, and other issues in parous woman exaggerate the reduced maternal health leading to poorer HRQoL (Singh and Kaur 2015).
A negative association has been reported between BMI and HRQoL in some studies. Actually, interventions for weight loss improved HRQoL over time (Heo, Allison et al. 2003, Fontaine, Barofsky et al. 2004, Papaioannou, Kennedy et al. 2006). In the present study, BMI negatively correlated with physical and mental QoL; however, the correlations were not statistically significant.
Women with higher education have probably more knowledge and better understanding of their disease which make them to adhere to their medical regimen more effectively. Furthermore, educated women are expected to have higher coping capabilities with the condition (Abourazzak, Allali et al. 2009). Accordingly, higher education has been noted as a mitigating factor toward HRQoL in multiple studies (Badia, Díez-Pérez et al. 2004, Bączyk, Samborski et al. 2016, Morfeld, Vennedey et al. 2017).
In our study, higher BMI, history of fractures in the past year and being single were associated with lower scores of physical and mental QoL. Nevertheless, these associations were statistically insignificant which might be due to the high variance in QoL sub-categories.
One of the limitations in our study included self-reported data collection. Although self-reporting is a routine approach in medical research (Moradzadeh, Mansournia et al. 2018), there may be potential risk of misclassification bias on the findings (Moradzadeh R, Golmohammadi P et al. 2018) which can be decreased by applying bias analysis methods (Moradzadeh, Mansournia et al. 2018, Moradzadeh, Mansournia et al. 2019). On the other hand, selection bias is another committed bias. The included patients were recruited from a rheumatology clinic; however, some patients might refer to other specialists such as internists, or orthopedist. So, we didn’t have access to some patients that might lead to selection bias. Furthermore, there were a number of other variables that we could not assess them, and it is suggested to include these in future studies. Also, the impact of the mediators and interactions between the variables should be considered deeper.