Evaluating health related quality of life in older people at risk of osteoporotic fracture: a head-to-head comparison of the EQ-5D-5L and AQoL-6D

Lei Si, Liudan Tu, Ya Xie, Gang Chen, Mickaël Hiligsmann, Mingcan Yang, Yanli Zhang, Xi Zhang, Yutong Jiang, Qiujing Wei, Jieruo Gu, Andrew J. Palmer

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)


We aimed to conduct a head-to-head comparison of the five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Assessment of Quality of Life-6D (AQoL-6D) in measuring health-related quality of life (HRQoL) of older people at risk of osteoporotic fracture. Participants (n = 291) were recruited from the Third Affiliated Hospital of Sun Yat-Sen University. Study participants were asked to complete the EQ-5D-5L and the AQoL-6D and the results were converted to health-state utilities (HSUs) using population-specific scoring algorithms. The agreement among HSUs was evaluated using the intraclass correlation coefficient and illustrated using Bland–Altman plots. The minimally important difference (MID) for the EQ-5D and AQoL was set at 0.074 and 0.06. Information on socio-demographic background, socio-economic status and clinical risk factors in FRAX® was collected. Nonparametric statistics were used to explore the known-group validity measured by fracture risk. Mean (median) EQ-5D-5L and AQoL-6D HSUs were 0.73(0.83) and 0.74(0.79) for the study population. The EQ-5D-5L and the AQoL-6D HSUs strongly agreed and the HSU difference reached the MID level in both instruments. While a decreasing trend of AQoL-6D utilities was observed with worsening bone mineral density, EQ-5D-5L HSUs were similar in individuals with normal and osteopenic bone mineral densities. The AQoL-6D was also effective for measuring difference in independent living, relationships, mental health, coping and pain. Both instruments showed good known-group validity. The EQ-5D-5L and AQoL-6D are all valid measures for older people at risk of osteoporotic fracture.

Original languageEnglish
Pages (from-to)809-824
Number of pages16
JournalSocial Indicators Research
Publication statusPublished - 2022


  • Assessment of quality of life
  • Chinese
  • EQ-5D
  • Health-related quality-of-life
  • Osteoporosis

Cite this