Osteoarthritis May Increase Risk of Falling: OA linked to more fractures in women.

CHICAGO – Postmenopausal women with osteoarthritis appear to be at a greater risk of falls and subsequent fractures, compared to their counterparts without the joint disease, based on an analysis of survey data.

Among the 51,386 women in GLOW (Global Longitudinal Study of Osteoporosis in Women), 40% had osteoarthritis (OA). Women with OA experienced almost 30% more falls and had a 20% greater risk of fracture than did those without OA, Dr. Daniel Prieto-Alhambra said at the meeting.

“If falls explain the increased risk of fracture, we need to work out why these people are falling and have public health interventions to reduce those risks of falls – through physiotherapy, nutrition, and help around the home,” said Dr. Nigel Arden, Dr. Prieto-Alhambra's coauthor in the study.

“We also need to worry that when we do an osteoporosis estimation that we [consider] osteoarthritis as an extra risk factor.”

“We need to pay more attention to pain relief, exercise, and support around the home … and when we assess osteoporosis risk we need to think that bone density measures may be falsely reassuring,” Dr. Arden said.

“Patients with osteoarthritis have bigger bones, and some have actually suggested that these bones are more resistant,” said Dr. Prieto-Alhambra, who is a postdoctoral research fellow at the Hospital del Mar and Municipal Institute of Medical Research in Barcelona.

Dr. Arden noted that recent research indicates patients with osteoarthritis experience more falls than the general population. “What was new here was that the falls would actually explain the increased risk of fracture, whereas in other cohorts, it hasn't explained it.”

Bones may appear to be bigger in patients with OA, but this measure can be deceiving. “The bone density measurement is a two-dimensional measure of a three-dimensional bone,” said Dr. Arden in an interview. Individuals with OA have up to an 8% greater BMD when viewed two dimensionally. However, “when you look at volumetric density, as we've done in another cohort, the density is the same [as in those without OA].

“Therefore, we were concerned that people were being falsely reassured by inaccurate bone density measurements,” Dr. Arden added.

In addition, osteoarthritis is associated with increased rates of bone loss, which again is an independent risk factor for fracture, said Dr. Arden, who is a professor of rheumatology at the University of Oxford (England).

The study included 60,393 women who were aged 55 years or older and visited a medical practice within the previous 2 years. At baseline and annually for 3 years, participants from several countries, including the United States, Canada, Australia, United Kingdom, Spain, and others, were mailed a self-administered questionnaire. Participants were asked if a doctor or other health care provider had told them that they had osteoarthritis or degenerative joint disease. Information on incident falls and fractures and potential confounders were self-reported. For this analysis, women with missing baseline information on OA or fractures, as well as those with celiac disease or rheumatoid arthritis, were excluded.

The unadjusted hazard ratio for fracture among OA patients was 1.40 and this remained significant after multivariable adjustment (HR, 1.21). Falls were also more likely in women with OA (adjusted HR, 1.27). The association between OA and fracture remained significant even after adjusting for baseline falls (HR, 1.16).

To watch a video interview with Dr. Arden, use the QR Code at right or visit www.rheumatologynews.com.