Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication

Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clin...

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Bibliographic Details
Published in:	Seminars in arthritis and rheumatism 2020-06, Vol.50 (3), p.380-386
Main Authors:	van Schoor, N.M., Dennison, E., Castell, M.V., Cooper, C., Edwards, M.H., Maggi, S., Pedersen, N.L., van der Pas, S., Rijnhart, J.J.M., Lips, P., Deeg, D.J.H.
Format:	Article
Language:	eng
Subjects:	Accidental Falls - statistics & numerical data Aged Aged, 80 and over Analgesics, Opioid - adverse effects Case-Control Studies Elderly Female Hip Humans Knee Male Medication Medicin och hälsovetenskap Osteoarthritis Osteoarthritis, Hip - complications Osteoarthritis, Hip - drug therapy Osteoarthritis, Knee - complications Osteoarthritis, Knee - drug therapy Prospective Studies Risk Assessment
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Summary:	Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships. Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65–85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report. Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10–2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not. Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medications.
ISSN:	0049-0172 1532-866X 1532-866X