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

TY - JOUR

T1 - 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

AU - Gamble, Clair M

AU - Sabico, Shaun

AU - Honvo, Germain

AU - Abubakar, Salisu

AU - Boehnke, Jan R

AU - De Baets, Stijn

AU - Veronese, Nicola

AU - Knoop, Veerle

AU - Cooper, Cyrus

AU - Brandi, Maria Luisa

AU - Harvey, Nicholas C

AU - Matijevic, Radmila

AU - Beaudart, Charlotte

AU - Ngozi, Rosemary

AU - Hough, Tereza

AU - Campusano, Claudia

AU - Lazaretti-Castro, Marise

AU - Chandran, Manju

AU - Mithal, Ambrish

AU - Al-Saleh, Yousef

AU - Al-Daghri, Nasser

AU - Dawson-Hughes, Bess

AU - Burlet, Nansa

AU - Cavalier, Etienne

AU - McCloskey, Eugene

AU - Bruyere, Oliver

AU - Reginster, Jean-Yves

AU - Diaz, Theresa

AU - Rizzoli, René

AU - Amuthavalli Thiyagarajan, Jotheeswaran

N1 - Publisher Copyright: © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

PY - 2026/5/11

Y1 - 2026/5/11

N2 - 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.

AB - 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.

KW - Psychometrics

KW - Quality of life

KW - Health-related quality of life

KW - ageing

KW - measurement instruments

KW - reliability

KW - validity

KW - osteoporosis

KW - quality of life

KW - systematic review

KW - older persons

KW - responsiveness

UR - https://www.scopus.com/pages/publications/105038475910

U2 - 10.1093/ageing/afag124

DO - 10.1093/ageing/afag124

M3 - Article

C2 - 42117739

SN - 0002-0729

VL - 55

JO - Age and Ageing

JF - Age and Ageing

IS - 5

M1 - afag124

ER -