Clinical osteoarthritis of the hip and knee and fall risk: the role of low physical functioning and pain medication
Clinical osteoarthritis of the hip and knee and fall risk: the role of low physical functioning and pain medication
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.
Elderly, Hip, Knee, Medication, Osteoarthritis
380-386
van Schoor, Natasja M.
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Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Castell, Maria Victoria
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Cooper, Cyrus
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Edwards, Mark
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Maggi, Stefania
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Pedersen, Nancy L.
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van der Pas, Suzan
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Rijnhart, J.J.M
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Lips, P.
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Deeg, Dorly J.H.
09f588f6-3441-4d48-a7ff-26b4b21ebac2
June 2020
van Schoor, Natasja M.
3a59a196-b132-414f-81de-2ad3b21f7a74
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Castell, Maria Victoria
7d2663d6-552c-47b8-ae98-5c1f5fdb9380
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Edwards, Mark
b81ff294-1d16-4a1b-af14-9374c5989d4c
Maggi, Stefania
57e7e62a-b7dd-4291-82e3-efc8c9a7e12a
Pedersen, Nancy L.
22ca166b-d76d-401c-be51-a81c86bc1f4a
van der Pas, Suzan
eeed262d-8106-4a78-8439-826b2d99bc78
Rijnhart, J.J.M
6e2a3ea3-35ec-49fb-a8c6-9c178c0e4756
Lips, P.
c17c31d2-f4d8-457f-99ad-fa5af27723ca
Deeg, Dorly J.H.
09f588f6-3441-4d48-a7ff-26b4b21ebac2
van Schoor, Natasja M., Dennison, Elaine, Castell, Maria Victoria, Cooper, Cyrus, Edwards, Mark, Maggi, Stefania, Pedersen, Nancy L., van der Pas, Suzan, Rijnhart, J.J.M, Lips, P. and Deeg, Dorly J.H.
,
EPOSA Research Group
(2020)
Clinical osteoarthritis of the hip and knee and fall risk: the role of low physical functioning and pain medication.
Seminars in Arthritis and Rheumatism, 50 (3), .
(doi:10.1016/j.semarthrit.2020.02.006).
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.
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Accepted/In Press date: 1 February 2020
e-pub ahead of print date: 19 February 2020
Published date: June 2020
Additional Information:
Funding Information:
Sources of support: The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports (grant no 311669, grant recipient D.J.H. Deeg). The Pe?agrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (grant no FIS PI 05/1898; FIS RETICEF RD06/0013/1013 and FIS PS09/02143, grant recipients A. Otero, M.V. Castell). The Hertfordshire Cohort Study is supported by the Medical Research Council of Great Britain, Versus Arthritis, the British Heart Foundation and the International Osteoporosis Foundation (grant no MRC_MC_UP_A620_1014, grant recipients C. Cooper, E. Dennison). The Italian cohort was supported by the National Research Council of Italy (CNR), Research Project ?Aging: molecular and technological innovations for improving the health of the elderly population" (Prot. MIUR 2867, grant recipient: S. Maggi). The Swedish Twin Registry is managed by Karolinska Institutet and receives funding through the Swedish Research Council (grant no 2017-00641, grant recipient Karolinska Institutet). The funders were not involved in the study design, data collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Publisher Copyright:
© 2020 The Authors
Keywords:
Elderly, Hip, Knee, Medication, Osteoarthritis
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Local EPrints ID: 439039
URI: http://eprints.soton.ac.uk/id/eprint/439039
ISSN: 0049-0172
PURE UUID: 35073a99-5f74-411f-bfd8-0b66f1b4c18f
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Date deposited: 02 Apr 2020 16:30
Last modified: 18 Mar 2024 02:46
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Contributors
Author:
Natasja M. van Schoor
Author:
Maria Victoria Castell
Author:
Mark Edwards
Author:
Stefania Maggi
Author:
Nancy L. Pedersen
Author:
Suzan van der Pas
Author:
J.J.M Rijnhart
Author:
P. Lips
Author:
Dorly J.H. Deeg
Corporate Author: EPOSA Research Group
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