Quality of life



Contact: Jan Poppelaars, Natasja van Schoor 

The Qualeffo-41 has been developed by the Working Party of the European Foundation for Osteoporosis (including Prof. dr. P. Lips from the LASA-study). The Qualeffo-41 is a specific quality of life instrument, which is developed for patients with vertebral compression fractures (1).Vertebral compression fractures are a consequence of osteoporosis and influence functioning and quality of life (2,3). The development and validation of Qualeffo-41 are described in several studies (1,4,5).

Measurement instruments in LASA
The Qualeffo-41 consists of 41 items and includes five domains: A) pain; (B, C, D) physical function; (E) social function; (F) general health perception; and (G) mental function.

Domain scores and total score are calculated as follows:

  1. All answers were standardized so that 1 represents the best.
  2. Answers with 3 and 4 answer options (disregard “not applicable”) were recoded, so that all variables have a range 1-5.
  3. Domain scores and total score were calculated by averaging all answers and transforming them to a 0-100 scale.

A syntax with the scoring algorithm, which is developed by prof. dr. P. Lips and prof. dr. C. Cooper, is available (pdf). This scoring algorithm is also shortly described elsewhere (5). Two alternative scoring logarithms, as used by Oleksik et al. (3) are also available in the pdf-file.

LASAEo81 (self-administered questionnaire, in Dutch, in preparation)

Variable information

Availability of information per wave1  
To measure quality of life in persons with vertebral compression fractures, the Qualeffo-41 was assessed in a subpopulation of the LASA-study. The data on the Qualeffo-41 are obtained in 2000/2001 by a self-administered questionnaire in patients who had 2 valid spinographs in 1995/1996 and 1998/1999 (n=339). Of these, 26 persons were deceased, 22 refused and 24 were ineligible. The response rate, after subtraction of the persons who deceased, was 267 / (339-26) = 85.3%.

LASAEo80 includes the response rate.
LASAEo81 includes the item scores (including 2 items belonging to the pain drawing)
LASAEo82 includes the domain scores, the total score and the number of item missing values per domain and for the total questionnaire. Both the domain scores and the total score can be used in the analyses.


























 1 More information about the LASA data collection waves is available on:

* 2B=baseline second cohort;
  3B=baseline third cohort;
  MB=migrants: baseline first cohort (Under Construction
  I=Under Construction

Sa=data was collected in self-administered questionnaire

Previous use in LASA
In a study by Van Schoor et al. (2005), the Qualeffo-41 was used to assess the impact of vertebral deformities on quality of life. It was found that after adjustment for age, sex and other chronic diseases, severe osteoporosis of the vertebrae significantly reduces quality of life in the general population. In a study by Van Schoor et al. (2006), a shorter version of the Qualeffo-41 was developed by removing redundant questions. The scale characteristics, reliability, and validity of this shorter version are described in Van Schoor et al. (2006).

  • Van Schoor NM, Smit JH, Twisk JW, Lips P. Impact of vertebral deformities, osteoarthritis,  and other chronic diseases on quality of life: a population-based study. Osteoporos Int. 2005 Jul;16(7):749-56. Epub 2004 Oct 12.
  • Van Schoor NM, Knol DL, Glas CA, Ostelo RW, Leplège A, Cooper C, Johnell O, Lips P.  Development of the Qualeffo-31, an osteoporosis-specific quality-of-life questionnaire. Osteoporos Int. 2006;17(4):543-51.


  1. Lips P, Agnusdei D, Caulin F, et al. The development of a European questionnaire for quality of life in patients with vertebral osteoporosis. Scand J Rheumatol Suppl. 1996;103:84-5; discussion 86-8.
  2. Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P. Consequences of vertebral deformities in older men and women. J Bone Miner Res. 2000;15:1564-72.
  3. Oleksik A, Lips P, Dawson A, et al. Health-related quality of life in postmenopausal women with low BMD with or without prevalent vertebral fractures. J Bone Miner Res. 2000;15:1384-92.
  4. Lips P, Cooper C, Agnusdei D, et al. Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis. Osteoporos Int. 1997;7:36-8.
  5. Lips P, Cooper C, Agnusdei D, et al. Quality of life in patients with vertebral fractures. Validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Osteoporos Int. 1999;10:150-60.