An increased rate of falling leads to a rise in fracture risk in postmenopausal women with self-reported osteoarthritis: a prospective multinational cohort study (GLOW)

Abstract

Objective Patients with osteoarthritis have increased bone mass, but no decrease in fractures. We studied the association between self-reported osteoarthritis and incident falls and fractures in postmenopausal women. Methods GLOW is a prospective, multinational cohort of 60 393 non-institutionalised women aged ≥55 years who had visited primary care practices within the previous 2 years. Questionnaires were mailed at yearly intervals. Patients were classified as osteoarthritic if they answered yes to the question “Has a doctor or other health provider ever said that you had osteoarthritis or degenerative joint disease?”, and this was validated against primary care records. Information on incident falls, fractures, and covariates was self-reported. Cox and Poisson models were used for incident fractures and number of falls, respectively, to compute hazard ratios (HRs) and rate ratios (RRs) for baseline osteoarthritis status. Results Of 51 386 women followed for a median of 2.9 (interquartile range 2.1 to 3.0) years, 20 409 (40%) reported osteoarthritis. The adjusted HR for osteoarthritis predicting fracture was 1.21 (95% CI 1.13 to 1.30; p<0.0001) and the adjusted RR for falls was 1.24 (95% CI 1.22 to 1.26; p<0.0001). However, the association between osteoarthritis and fracture was not significant after adjustment for incident falls: HR 1.06 (95% CI 0.98 to 1.15; p=0.13). Conclusion Postmenopausal women with self-reported osteoarthritis have a 20% increased risk of fracture and experience 25% more falls than osteoarthritis-free peers. Our data suggest that increased falls are the causal pathway of the association between osteoarthritis and fractures.

Fall Risk and Related Factors in Knee Osteoarthritis

“…Our results showing higher fall risk in patients with KOA with an objective technique is compatible with several previous studies highlighting the high incidence of falls in these patients (17)(18)(19). OA has been reported to be associated with an increased risk of falling, with fall rates up to 50% of individuals with OA, compared to 30% of healthy older adults (1).…”

Osteoarthritis and bone mineral density: are strong bones bad for joints?

“…It has long been speculated that this may relate to an increased risk of falls in OA cases, 50 and indeed a recent large prospective study supported this hypothesis, showing that an association between (selfreported) OA and fracture was largely attenuated by adjusting for incident falls. 51 Finally, and intriguingly, longitudinal studies have suggested that, in contrast to incident OA, progression of pre-existing OA may be inversely related to BMD. This finding was particularly striking in a paper by Zhang et al 17 studying the Framingham population, in whom a clear association between increasing age-specific femoral neck BMD quartiles and reduced risk of knee OA progression over the 8-year study period was seen.…”

Socioeconomic status and its association with the risk of developing hip fractures: A region-wide ecological study

“…The information recorded includes demographic information, clinical diagnoses (International Classification of Diseases 10th revision [ICD-10]), hospital referrals, laboratory tests and treatments (drug dispensed in community pharmacies). GPs meeting predefined standards of quality were allowed to contribute to the SIDIAP [21] database, providing reliable clinical data for biomedical research [23,24]. The quality of these data has been previously documented [21][22][23][24], and SIDIAP has been widely used to study the epidemiology of a number of health outcomes including osteoporotic fractures [23].…”