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. 2020 Jun;50(3):380-386.
doi: 10.1016/j.semarthrit.2020.02.006. Epub 2020 Feb 19.

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

N M van Schoor  1 , E Dennison  2 , M V Castell  3 , C Cooper  2 , M H Edwards  2 , S Maggi  4 , N L Pedersen  5 , S van der Pas  6 , J J M Rijnhart  7 , P Lips  8 , D J H Deeg  7 ; EPOSA research group
Affiliations

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

N M van Schoor et al. Semin Arthritis Rheum. 2020 Jun.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Elderly; Hip; Knee; Medication; Osteoarthritis.

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Conflict of interest statement

Declarations of Competing Interest Professor Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB. Professor Dennison reports payment for lecture by Pfizer and UCB. Dr. Edwards reports travel/accommodation/meeting expenses paid by Eli Lilly, Pfizer, UCB, Chugai and Abbvie. All other authors: none.

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