Soh S-E1,2, Morello R2, Barker A2,3, Ackerman I2
1Monash University, Department of Physiotherapy, Melbourne, Australia, 2Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia, 3Medibank Private, Member Health, Melbourne, Australia
Background: Osteoarthritis (OA) is the most common form of arthritis and growing evidence suggests that people with OA are at a higher risk of falls and fall-related injuries including fractures. While studies have demonstrated a link between OA and falls, relatively little is known about the risk factors most pertinent to this population. Understanding the modifiable and non-modifiable risk factors for falls and fractures will inform the development of tailored falls prevention activities to meet the specific needs of people with OA.
Purpose: To determine risk factors for falls and fractures in people with OA and compare to those known for the broader older population.
Methods: A secondary analysis of data obtained from the US-based Osteoarthritis Initiative (OAI) cohort was undertaken. All participants diagnosed with knee or hip OA by a medical practitioner within 12 months of the corresponding data collection period were included in this analysis. Outcomes were self-reported falls and fractures. Potential predictors of falls and fractures were classified using the International Classification of Functioning framework. Poisson regression models were used to examine the association between OA and falls and fracture risk, and to determine the risk factors for falls and fractures in people with knee and/or hip OA.
Results: Of the 4,796 participants in the OAI, 2,270 (47%) were diagnosed with knee and/or hip OA over the 8-year study period. Over half were women (59%) with a mean age of 61 years (SD 9.2). Analysis of falls and fracture data indicated that there was a significantly higher proportion of fallers among those with knee or hip OA compared to those without (72% vs 63%; p 0.000). There was also a significantly higher proportion of participants with knee or hip OA that reported having had a fracture (17% vs 14%; p=0.012). After controlling for potential covariates such as age and sex, the presence of OA was not a significant independent predictor of increased falls risk. The strongest predictor of falls was a prior history of falls (IRR 1.50; 95%CI 1.40, 4.60), which was also a significant predictor of increased fracture risk (IRR 1.38; 95%CI 1.13, 1.69). Other predictors of increased fracture risk included bisphosphonate use (IRR 1.78; 95%CI 1.40, 2.27) and having one or more co-morbidity (IRR 1.45; 95% CI 1.17, 1.81). The presence of OA (in particular knee OA) was significantly associated with fracture risk, but appeared to have a protective effect (IRR 0.73; 95% CI 0.56, 0.94).
Conclusion(s): The findings of this study highlight the importance of assessing falls and fracture risk in this population by including questions about previous falls, past medical history and medication use as part of routine OA care. Understanding a person's risk for falls and fractures will enable clinicians to implement individualised strategies to mitigate this risk.
Implications: Greater attention could be given to falls risk screening in routine OA care. Improved awareness of falls risk in this population could translate to greater uptake of falls prevention activities, with potential downstream impacts on quality of life, falls prevalence and healthcare costs.
Keywords: falls, fractures, osteoarthritis
Funding acknowledgements: The present work was supported by an Arthritis Australia Project Grant.
Purpose: To determine risk factors for falls and fractures in people with OA and compare to those known for the broader older population.
Methods: A secondary analysis of data obtained from the US-based Osteoarthritis Initiative (OAI) cohort was undertaken. All participants diagnosed with knee or hip OA by a medical practitioner within 12 months of the corresponding data collection period were included in this analysis. Outcomes were self-reported falls and fractures. Potential predictors of falls and fractures were classified using the International Classification of Functioning framework. Poisson regression models were used to examine the association between OA and falls and fracture risk, and to determine the risk factors for falls and fractures in people with knee and/or hip OA.
Results: Of the 4,796 participants in the OAI, 2,270 (47%) were diagnosed with knee and/or hip OA over the 8-year study period. Over half were women (59%) with a mean age of 61 years (SD 9.2). Analysis of falls and fracture data indicated that there was a significantly higher proportion of fallers among those with knee or hip OA compared to those without (72% vs 63%; p 0.000). There was also a significantly higher proportion of participants with knee or hip OA that reported having had a fracture (17% vs 14%; p=0.012). After controlling for potential covariates such as age and sex, the presence of OA was not a significant independent predictor of increased falls risk. The strongest predictor of falls was a prior history of falls (IRR 1.50; 95%CI 1.40, 4.60), which was also a significant predictor of increased fracture risk (IRR 1.38; 95%CI 1.13, 1.69). Other predictors of increased fracture risk included bisphosphonate use (IRR 1.78; 95%CI 1.40, 2.27) and having one or more co-morbidity (IRR 1.45; 95% CI 1.17, 1.81). The presence of OA (in particular knee OA) was significantly associated with fracture risk, but appeared to have a protective effect (IRR 0.73; 95% CI 0.56, 0.94).
Conclusion(s): The findings of this study highlight the importance of assessing falls and fracture risk in this population by including questions about previous falls, past medical history and medication use as part of routine OA care. Understanding a person's risk for falls and fractures will enable clinicians to implement individualised strategies to mitigate this risk.
Implications: Greater attention could be given to falls risk screening in routine OA care. Improved awareness of falls risk in this population could translate to greater uptake of falls prevention activities, with potential downstream impacts on quality of life, falls prevalence and healthcare costs.
Keywords: falls, fractures, osteoarthritis
Funding acknowledgements: The present work was supported by an Arthritis Australia Project Grant.
Topic: Older people; Disability & rehabilitation; Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Monash University
Ethics committee: Monash University Human Research Ethics Committee
Ethics number: MUHREC Project Number 11755
All authors, affiliations and abstracts have been published as submitted.
