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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
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
0049-0172
380-386
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
EPOSA Research Group
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), 380-386. (doi:10.1016/j.semarthrit.2020.02.006).

Record type: Article

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
Keywords: Elderly, Hip, Knee, Medication, Osteoarthritis

Identifiers

Local EPrints ID: 439039
URI: http://eprints.soton.ac.uk/id/eprint/439039
ISSN: 0049-0172
PURE UUID: 35073a99-5f74-411f-bfd8-0b66f1b4c18f
ORCID for Elaine Dennison: ORCID iD orcid.org/0000-0002-3048-4961
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 02 Apr 2020 16:30
Last modified: 28 Jan 2022 02:35

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Contributors

Author: Natasja M. van Schoor
Author: Elaine Dennison ORCID iD
Author: Maria Victoria Castell
Author: Cyrus Cooper ORCID iD
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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