Health-related quality of life instruments for older persons with osteoporosis: a WHO-BOHEG systematic review of measurement properties for use in clinical trials and routine practice. - 2026
Health-related quality of life instruments for older persons with osteoporosis: a WHO-BOHEG systematic review of measurement properties for use in clinical trials and routine practice.
Gamble, Clair M; Sabico, Shaun; Honvo, Germainet al.
ageing; measurement instruments; older persons; osteoporosis; quality of life; reliability; responsiveness; systematic review; validity; Humans; Aged; Reproducibility of Results; Clinical Trials as Topic; Surveys and Questionnaires; Aged, 80 and over; Psychometrics; Quality of Life; Osteoporosis/psychology; Osteoporosis/diagnosis; Osteoporosis/therapy
Abstract :
[en] [en] BACKGROUND: Osteoporosis increases fracture risk in older adults and is associated with impaired health-related quality of life (HRQoL). Osteoporosis-specific HRQoL instruments are widely used, but their measurement performance in older populations has not been comprehensively synthesised.
OBJECTIVE: To systematically identify and synthesise development and validation studies of osteoporosis-specific HRQoL instruments for older adults, and to appraise their measurement properties using COSMIN criteria and a modified GRADE approach to inform instrument selection for clinical trials, routine care, and research.
DESIGN: Systematic review.
SETTING: Community-dwelling; Long-term care facility; Primary care facility.
SUBJECTS: Older persons aged 60 years or over.
METHODS: We searched Medline (Ovid), Embase, PsycINFO (Ovid), and AMED (Ovid) from inception to August 2024. We extracted and appraised evidence for COSMIN-defined measurement properties: content validity, structural validity, internal consistency, cross-cultural validity or measurement invariance, reliability, measurement error, criterion validity, hypothesis testing for construct validity, and responsiveness. Methodological quality was assessed using the COSMIN Risk of Bias checklist, measurement properties were rated against COSMIN criteria for good measurement properties, and certainty of evidence was graded using a modified GRADE approach.
RESULTS: Forty-three studies reported the development and/or validation of nine osteoporosis-specific HRQoL instruments; language and version adaptations resulted in 15 instrument variants. Content validity was the most prominent limitation: only OPTQoL and the English Mini-OQLQ demonstrated sufficient evidence for multiple content validity components, while most widely used instruments lacked adequate evidence on item relevance, comprehensiveness, or comprehensibility. Evidence for internal structure was limited, with structural validity sufficient for ECOS-16 and QoLOS-NVFX, insufficient for QUALEFFO-41, and indeterminate for most other instruments. Cross-cultural validity and measurement invariance were almost entirely unexamined. By contrast, reliability and hypothesis testing for construct validity were more consistently supported, often with moderate-to-high certainty. Measurement error, interpretability, and responsiveness were poorly reported across instruments.
CONCLUSIONS: The evidence base supports purpose-driven selection of osteoporosis-specific HRQoL instruments rather than a single preferred instrument. Across included studies, ECOS-16 shows the most consistently supported measurement properties in older adults for longitudinal assessment, although important evidence gaps remain (notably measurement error and cross-cultural validity). When brevity is the primary feasibility constraint in routine care, the Mini-OQLQ may be considered; however, evidence for responsiveness is limited.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Gamble, Clair M; School of Health Sciences, University of Dundee, Dundee DD1 4HJ, United Kingdom
Sabico, Shaun ; Biochemistry, King Saud University, Riyadh 11451, Saudi Arabia
Honvo, Germain ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Consultant to the Department of Sexual, Reproductive, Maternal, Child and Adolescent Health and Ageing, World Health Organization, Geneva 1211, Switzerland
Abubakar, Salisu; School of Health Sciences, University of Dundee, Dundee DD1 4HJ, United Kingdom
Boehnke, Jan R; School of Health Sciences, University of Dundee, Dundee DD1 4HJ, United Kingdom
De Baets, Stijn; Ghent University Faculty of Sciences, 9000 Ghent, Flanders, Belgium
Veronese, Nicola; Department of Internal Medicine,University of Palermo, Via del Vespro 133, 90127, Palermo, Sicily, Italy
Cooper, Cyrus ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; MRC Lifecourse Epidemiology Centre, University of Southampton, SO16 6YD Southampton, United Kingdom
Brandi, Maria Luisa; Department of Endocrinology, Vita-Salute San Raffaele University, 20132 Milan, Lombardy, Italy
Harvey, Nicholas C ; MRC Lifecourse Epidemiology Unit, University of Southampton, SO16 6YD Southampton, United Kingdom
Matijevic, Radmila; Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
Beaudart, Charlotte ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie générale ; Biomedical Sciences, University of Namur, B-5000 Namur, Belgium
Ngozi, Rosemary; Department of Radiation Medicine, University of Nigeria, Ihe Nsukka 410001, Nsukka, Enugu, Nigeria
Hough, Tereza; National Osteoporosis Foundation of South Africa (NOFSA), Durbanville 7550, South Africa
Campusano, Claudia; Department of Internal Medicine, Clínica Universidad de los Andes, Av Plaza 2501, Las Condes, Chile
Lazaretti-Castro, Marise; Metabolic Bone and Mineral Diseases Research Center, Federal University of Sao Paulo, São Paulo, CEP 01246904, Brazil
Chandran, Manju; Department of Endocrinology, Singapore General Hospital, Singapore 169608
Mithal, Ambrish; Endocrinology & Diabetes, Max Super Speciality Hospital, Dwarka, Delhi 110075, India
Al-Saleh, Yousef; Department of Medicine, Health Oasis Hospital, Riyadh 12451, Saudi Arabia
Al-Daghri, Nasser ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Protein Research Chair, Biochemistry Department, King Saud University, Riyadh 11451, Saudi Arabia
Dawson-Hughes, Bess ; Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, Massachusetts, USA
Burlet, Nansa ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Cavalier, Etienne ; Université de Liège - ULiège > Département de pharmacie > Chimie médicale
McCloskey, Eugene ; Mellanby Centre for Bone Research, The University of Sheffield, S10 2RX Sheffield, United Kingdom ; Department of Medicine, School of Clinical Sciences, Monash University, 3004 Melbourne, Victoria, Australia
Bruyere, Oliver; Department of Public Health, Epidemiology and Health Economics, University of Liege, 4000 Liège, Walloon Region, Belgium
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique
Diaz, Theresa; Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva 1211, Switzerland
Rizzoli, René ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals, Geneva 1205, Switzerland
Amuthavalli Thiyagarajan, Jotheeswaran ; Science, Innovation, Monitoring Unit, Department of Sexual, Reproductive, Maternal, Child, Adolescent Health and Ageing, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
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