Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative

Smith, Toby; Higson, Emma; Pearson, Matthew; Mansfield, Michael

doi:10.1111/1756-185x.12871

Cited by 52 publications

(52 citation statements)

References 25 publications

(30 reference statements)

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“…[9] Previously, falls and FOF have been thoroughly studied in the elderly population [12,13] and patients with chronic musculoskeletal pain [14] and knee osteoarthritis. [15] However, limited data exists in the literature about falls or FOF in patients with RA [16][17][18] and results from these studies are conflicting due to the marked heterogeneity of the RA population, different designs of the studies, and the variability in outcome measures used. [19] Moreover, falls and FOF have been evaluated together in a very few number of studies.…”

mentioning

confidence: 99%

Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls

Akyol

Ulus

Tander

et al. 2018

Turk J Phys Med Rehab

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Objectives: This study aims to compare fall history and fear of falling (FOF) in patients with rheumatoid arthritis (RA) and healthy controls and to evaluate associated factors for fall risk and FOF in patients with RA. Materials and methods: Between March 2016 and July 2016, a total of 120 patients with RA and 60 age-and sex-matched healthy volunteers were included in the study. The presence of FOF (Yes/No), fall history, and the number of falls within the past 12 month were questioned. All participants were assessed with the Falls Efficacy Scale-International (FES-I), 10 Meter Walk Test (10MWT), One-Leg Stand Test (OLST), Berg Balance Scale (BBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Pain Severity and Patient Global Assessment (PGA) by Visual Analog Scale (VAS), disability by the Health Assessment Questionnaire (HAQ), and disease activity by Disease Activity Score in 28 joints (DAS28) were evaluated in patients with RA. Results: There was no statistically difference between the RA patients and healthy controls in terms of presence of fall history, while the presence of FOF and FES-I scores were significantly higher in the RA patients (p<0.05). In the patient group, the FES-I score was positively correlated with pain VAS, PGA, DAS-28, HAQ, BAI, BDI, and 10MWT and negatively BBS and OLST (p<0.05). The number of falls, HAQ, BBS, and BDI scores were found to be significant independent risk factors affecting variations in the FES-I scores (p<0.001). Conclusion: Fear of falling seems to be an important problem in patients with RA, and patients without fall history may also have FOF. The most important factors associated with FOF were impaired balance, increased disability and depression, and number of falls in RA patients. Strategies for preventing falls, maintaining balance, improving emotional status and against FOF are of utmost importance in patients with RA.

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confidence: 99%

Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls

Akyol

Ulus

Tander

et al. 2018

Turk J Phys Med Rehab

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“…As reported by Mahmoudian et al [4], OAK is highly prevalent in people above the age of 60, and it is typically associated with pain, stiffness, muscle weakness, and proprioceptive deficits. These proprioceptive deficits increase the risk of falls and other injuries in OAK patients, leading to disability and worsening of quality of life [5,6]. Some authors claim that proprioceptive deficits trigger OAK [7,8].…”

Section: Introductionmentioning

confidence: 99%

Wireless Motion Sensors—Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis—Preliminary Report

Goślińska

Wareńczak

Miedzyblocki

et al. 2020

Sensors

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Osteoarthritis of the knee (OAK) is characterized by pain, limitation of joint mobility, and significant deterioration of proprioception resulting in functional decline. This study assessed proprioception in OAK patients following two ten-day rehabilitation programs using the Orthyo® system. Fifty-four study participants with clinical symptoms and radiological signs of OAK were randomly divided into an exercise group (n = 27) or a manual therapy group (n = 27). The control group consisted of 27 volunteers with radiological signs of OAK, but with no clinical symptoms or prior history of rehabilitation. The following parameters were assessed: knee proprioception using inertial sensors and a mobile application, patients’ function using Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and pain intensity using the visual analog scale (VAS). Following rehabilitation, knee proprioception tests did not improve in either study group. Both study groups showed significant improvement of the WOMAC-assessed function (exercise group: p < 0.01, manual therapy group: p = 0.01) and a significant decrease (p < 0.01) of VAS-assessed pain following rehabilitation, but the post-therapy results did not differ significantly between the aforementioned groups. The Orthyo® system provided a quick and accurate assessment of the knee joint position sense. There was no direct relationship between functionality, pain, and proprioception threshold in the knee joint.

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“…The state of damage is related to the loading history; most typically, damage is related to a scalar measure of deformation, known as equivalent strain , computed from components of the strain tensor. In a nonlocal model, damage is related to a weighted volume average of equivalent strains, computed from Equation 26:…”

Section: A Gradient-enhanced Damage Model For Bonementioning

confidence: 99%

“…In addition to understanding factors which contribute to bone strength, it is also necessary to understand situations which may cause bone to fail. The majority of the research has been focused on falls as the primary cause of fracture [20]- [26]. This is because most fractures are 'associated' with a fall, based on patient interviews or questionnaires [27], [28], and it is assumed that the patient falls and then breaks their hip from the impact.…”

Section: Chapter 1: Introductionmentioning

confidence: 99%

“…Significant attention has been given to falls as the primary cause of hip fracture [20]- [26], and medical studies commonly refer to hip fractures as 'fall related injuries' [149]. The assumption is based on evidence that the majority of hip fractures are associated with a fall [27], [28], and it is assumed that the patient falls and then breaks their hip from the impact.…”

Section: Introductionmentioning

confidence: 99%

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An Investigation on the Influence of Stumbling Loads on Femoral Fracture Risk, Using a Novel Gradient Enhanced Quasi-Brittle Finite Element Model

Haider¹

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Stumbling is associated with large hip contact forces, but it remains unclear whether these events contribute to osteoporotic hip fracture risk. We hypothesized that stumbling may increase risk, either causing fracture directly, or damaging the femur leaving it susceptible to future loading. This hypothesis can be tested in-silico, but previously published finite element (FE) models are susceptible to large errors in predicted fracture load and pattern. We developed and validated a novel gradient enhanced quasi-brittle damage model, for improved fracture prediction, and used the model to assess the influence of stumbling on fracture risk. Preliminary FE models were used to explore relevant physics and boundary conditions (BC's) needed to accurately model the femur in fall and stumbling configurations. The study investigated the influence of different BCs, viscoelasticity, inertial dynamics, and biphasic (pore fluid) effects; the potential importance of these phenomenon had been discussed, but not well-explored, in literature. After implementation, the gradient enhanced quasi-brittle damage model was validated through experimental testing. Average fracture load prediction error was 9.6%, compared to 10%-20% errors reported in previous models and fracture pattern was correctly predicted for all cases, compared to the 60-80% accuracy of previous models. This validated model predicted that four of six specimens had a moderate risk of fracture due to stumbling alone, and risk increased significantly with simulated advanced osteoporosis. The model also predicted compaction of the subcapital region, a pattern consistent with impacted fractures observed in clinical settings.Finally, we investigated if progressive damage accumulation from combinations of stumble and fall could increase fracture risk. Most specimens were resilient to accumulated damage and only one experienced reductions in strength (5-15%) from repeat loading. However, two specimens II experienced moderate (20-30%) increase in fracture load, for some load cases; this was a novel finding. In these cases, initial damage accumulation caused the load to be more evenly distributed upon subsequent loading events. These results suggest that stumbling alone can result in hip fracture and therefore future preventative intervention strategies may be more effective if they target both fall and stumbling induced fractures. III

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Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative

Abstract: There is an increased risk of falls and fractures in early-diagnosed knee and hip osteoarthritis compared to those without osteoarthritis. International guidelines on the management of hip and knee osteoarthritis should consider the management of falls risk.

Cited by 52 publications

References 25 publications

Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls

Falls, fear of falling, and associated factors in ambulatory patients with rheumatoid arthritis: A comparative study with healthy controls

Wireless Motion Sensors—Useful in Assessing the Effectiveness of Physiotherapeutic Methods Used in Patients with Knee Osteoarthritis—Preliminary Report

An Investigation on the Influence of Stumbling Loads on Femoral Fracture Risk, Using a Novel Gradient Enhanced Quasi-Brittle Finite Element Model

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