***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Health-related quality of life ( HRQOL ; “ QOL ” hereafter ) was evaluated in Japanese osteoporotic patients using three question naires ; the SF-36 ( MOS 36-Item Short-Form Health Survey ; generic , profile-type ) , the EQ-5D ( Euro Qol-5 Dimensions ; generic , preference-based ) , and the JOQOL ( Japanese Osteoporosis Quality of Life 1999 ; disease-targeted ) . The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex . The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain , which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients . Although the QOL scores did not correlate with bone mineral density , they were markedly influenced by the presence of vertebral fractures . In particular , the presence of two or more vertebral fractures greatly decreased the QOL scores . We then evaluated the QOL scores before and after treatment . The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin ( Elcitonin , Asahi Kasei Pharma , Tokyo , Japan ) injection . Elcatonin treatment markedly improved diverse aspects of the QOL , whereas calcium alone did not . The current data suggest that osteoporosis , especially in the presence of vertebral fracture , is associated with compromised QOL , and therapeutic intervention for osteoporosis should be evaluated in terms of QOL , as well as in terms of increases in bone mineral density and fracture prevention Fractures and subsequent morbidity determine the impact of established postmenopausal osteoporosis .  Health-related quality of life ( HRQOL ) has become an important outcome criterion in the assessment and follow-up of osteoporotic patients . As part of the baseline measurements of the Multiple Outcomes of Raloxifene Evaluation ( MORE ) study , HRQOL was assessed in 751 osteoporotic ( bone mineral density [ BMD ] T score > or = -2.5 ) women from Europe with or without vertebral fractures ( VFX ) . This was done using the  quality of life question naire of the European Foundation for Osteoporosis ( QUALEFFO ) , Nottingham Health Profile ( NHP ) and the EQ-5D ( former EuroQol ) . QUALEFFO contains questions in five domains : pain , physical function , social function , general health perception , and mental function . Each domain score and QUALEFFO total scores are expressed on a 100-point scale , with 0 corresponding to the best HRQOL . In comparison with patients without VFX , those with VFX were older ( 66.2 + /- 5.9 years vs. 68.8 + /- 6.3 years ; p < 0.001 ) , had higher prevalence of nonvertebral fractures ( 25 % vs. 36 % ; p = 0.002 ) , and higher QUALEFFO scores ( worse HRQOL ; total score , 26 + /- 14 vs. 36 + /- 17 ; p < 0.001 ) . QUALEFFO scores increased progressively with increasing number of VFX , especially lumbar fractures ( p < 0.001 ) . Patients with a single VFX already had a significant increase in QUALEFFO scores ( p < 0.05 ) . Similar , though weaker , associations were seen for NHP and EQ-5D scores . This study confirms decreased HRQOL for patients with prevalent VFX . In osteoporotic patients , QUALEFFO scores change in relation to the number of VFX . QUALEFFO is suitable for clinical studies in patients with postmenopausal osteoporosis OBJECTIVE Vertebral fractures are a common complication of osteoporosis and may have a negative effect on health-related quality of life ( HRQOL ) . We investigated the effect of prevalent vertebral fractures on HRQOL in patients with osteoporosis . METHODS A cross-sectional multicenter study was carried out among postmenopausal women with primary osteoporosis attending primary care centers and hospital outpatient clinics : 234 women with vertebral fractures and 244 asymptomatic women . Women with secondary osteoporosis or taking medications that affect bone metabolism were excluded . All patients were question ed using the  mini-Osteoporosis Quality of Life Question naire ( mini-OQLQ ) , Medical Outcomes Study Short Form-36 ( SF-36 )  , and the  EuroQuol-5D  , after assessment of all clinical variables and anthropometric data . To assess comorbidity we used the Self-Administered Comorbidity Question naire ( SCQ ) . Diagnosis of osteoporosis was confirmed in all patients by bone mineral density using dual energy x-ray absorptiometry . Radiographic evaluation was performed by a musculoskeletal radiologist . A total of 483 postmenopausal women , r and omly matched for age out of 1579 healthy controls , were chosen to compare the SF-36 scores with respect to patients with and without vertebral fractures due to osteoporosis . A multivariable regression analysis was conducted to identify the strongest determinant for low HRQOL , adjusted for potential confounding variables such as comorbid conditions , education level , and psychosocial status . RESULTS The vertebral fracture group had significantly lower scores than patients without fractures and controls in all domains of the generic and specific question naires . Women with only 1 prevalent fracture had statistically significantly lower HRQOL scores than those without fractures on SF-36 measures of bodily pain , physical functioning , and role function physical ( all p < 0.01 ) . HRQOL scores were lower in women with lumbar fractures compared with women with thoracic fractures only when the physical functioning and bodily pain dimensions approached statistical significance . Based on the multivariate analysis , the strongest determinant for low HRQOL was physical functioning ( explained by number of vertebral fractures ) followed by comorbidity score and age . Adjusted R2 in the final model was 35.9 % . Using the SF-36 summary scales , comorbid conditions predominantly affected either mental or physical health ( p < 0.0001 ) . A significant correlation ( p < 0.0001 ) was found between total score on the mini-OQLQ and the mean SCQ comorbidity score . CONCLUSION Our results confirm previous findings that HRQOL , assessed by generic and osteoporosis-specific instruments , is decreased in patients with vertebral fractures due to osteoporosis as a function of the number of vertebral fractures , presence of comorbid conditions , and age 
    Output:
    
Similar differences were observed for physical HRQoL in further analyses accounting for possible confounding effects of age .
Osteoporotic older people with vertebral fracture have worse physical HRQoL than osteoporotic older people without vertebral fracture , even after accounting for age differences