Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures

Arden, N K; Nevitt, Michael C.; Lane, Nancy E.; Gore, L. Robert; Hochberg, Marc C.; Scott, Jean C.; Pressman, Alice; Cummings, '

doi:10.1002/1529-0131(199907)42:7<1378::aid-anr11>3.0.co;2-i

Cited by 174 publications

(135 citation statements)

References 35 publications

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“…Other studies have analyzed the relationship between peripheral OA and fragility fractures and have demonstrated either an increased risk of fracture (18), no change (14,16), or a decreased risk (11,13). OA was reported either at the hip, knees, or hands, or sometimes with a global evaluation without specifying the site.…”

Section: Discussionmentioning

confidence: 99%

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Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Sornay‐Rendu

Allard

Munoz

et al. 2006

Arthritis & Rheumatism

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Objective. In a previous cross-sectional analysis, we found a positive association between disc space narrowing (DSN) and vertebral fracture. The aim of the present study was to analyze prospectively the risk of vertebral and nonvertebral fractures in women with spine osteoarthritis (OA).Methods. Using radiographs, spine OA was evaluated in 634 postmenopausal women from the OFELY (Os des Femmes de Lyon) cohort (mean ؎ SD age 61.2 ؎ 9 years). Prevalence and severity of spine OA were assessed by scoring osteophytes and DSN. Incidental clinical fractures were prospectively registered during annual followup, and vertebral fractures were evaluated by radiography every 4 years.Results. During an 11-year followup, fractures occurred in 121 women, including 42 with vertebral fractures. No association was found between osteophytes and the risk of fracture. In contrast, DSN was associated with an increased risk of vertebral fractures but not of nonvertebral fractures. After adjusting for confounding variables, the presence of DSN was associated with a marked increased risk of vertebral fractures, with an odds ratio of 6.59 (95% confidence interval 1.36-31.9). In addition, 95% of incident vertebral fractures were located above the disc with the most severe narrowing.Conclusion. This longitudinal study shows that, despite a higher bone mineral density (BMD), women with spine OA do not have a reduced risk of fracture and that DSN is significantly associated with vertebral fracture risk. The location of DSN and of incident vertebral fractures suggests that disc degeneration impairs the biomechanics of the above spine, which leads to the increased risk of vertebral fractures, independent of BMD. We suggest that DSN is a newly identified risk factor for vertebral fracture that should be taken into consideration when assessing vertebral fracture risk in postmenopausal women.

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Section: Discussionmentioning

confidence: 99%

“…A protective effect of OA on hip fracture risk was suggested by case-control studies of patients with self-reported OA (12,13). Prospective studies failed to show any decrease in fracture incidence in OA patients (14)(15)(16). Other studies have shown an increased fracture risk associated with OA evaluated by radiography (17,18).…”

mentioning

confidence: 99%

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Sornay‐Rendu

Allard

Munoz

et al. 2006

Arthritis & Rheumatism

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“…A positive association between BMD and OA would imply that individuals with OA should have a reduced risk of fracture; however, several studies have instead observed either no difference in fracture incidence between OA affected individuals and controls 39,49 or an increase in fracture risk, 50 although it should be noted that the type of OA definition used in these studies has varied. It has long been speculated that this may relate to an increased risk of falls in OA cases, 50 and indeed a recent large prospective study supported this hypothesis, showing that an association between (selfreported) OA and fracture was largely attenuated by adjusting for incident falls.…”

Section: Bmd and Oa: The Epidemiological Evidence For An Associationmentioning

confidence: 96%

“…Studies examining the relationship between OA and rates of bone loss, also inversely related to BMD, have reached similarly opposing conclusions, with bone loss in individuals with OA found to be reduced, 16 increased, 8,38 or variable depending upon the site of assessment of both OA and BMD. 39 In a longitudinal study, more rapid bone loss over an 8-year period was associated with an increased risk of progressive OA at the knee. 17 Findings from prospective studies that greater bone loss and turnover may be associated with more rapid OA progression would seem at odds with those discussed earlier, suggesting that higher, rather than lower, BMD is a risk factor for OA.…”

Section: Bmd and Oa: The Epidemiological Evidence For An Associationmentioning

confidence: 99%

Osteoarthritis and bone mineral density: are strong bones bad for joints?

et al. 2015

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Osteoarthritis (OA) is a common and disabling joint disorder affecting millions of people worldwide. In OA, pathological changes are seen in all of the joint tissues including bone. Although both cross-sectional and longitudinal epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and OA, suggesting that increased BMD is a risk factor for OA, the mechanisms underlying this observation remain unclear. Recently, novel approaches to examining the BMD-OA relationship have included studying the disease in individuals with extreme high bone mass, and analyses searching for genetic variants associated with both BMD variation and OA, suggesting possible pleiotropic effects on bone mass and OA risk. These studies have yielded valuable insights into potentially relevant pathways that might one day be exploited therapeutically. Although animal models have suggested that drugs reducing bone turnover (antiresorptives) may retard OA progression, it remains to be seen whether this approach will prove to be useful in human OA. Identifying individuals with a phenotype of OA predominantly driven by increased bone formation could help improve the overall response to these treatments. This review aims to summarise current knowledge regarding the complex relationship between BMD and OA.

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“…[5][6][7] The reason for this is not known, but may be related to an increased incidence of falling in older adults with lower extremity OA, which exposes them to greater risk of fracture. In a review of 16 fall-risk studies, 8 one of the priority risks identified was the presence of any type of arthritis, which had a higher mean relative risk (RR) of predicting future falls than either age or cognitive status.…”

Section: Ré Sumémentioning

confidence: 99%

Risk Factors for Falls in Older Adults with Lower Extremity Arthritis: A Conceptual Framework of Current Knowledge and Future Directions

Arnold

Gyurcsik

2012

Physiotherapy Canada

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Purpose: As the numbers of Canadians aged 65 years and over increases over the next 20 years, the prevalence of chronic conditions, including arthritis, will rise as will the number of falls. Although known fall-risk factors are associated with hip and knee osteoarthritis (OA), minimal research has evaluated fall and fracture risk and/or rates in this population. Thus, the purpose was to summarize research on fall and fracture risk in older adults with hip or knee OA and to develop a conceptual framework of fall-risk screening and assessment. Method: The International Classification of Functioning, Disability and Health, clinical practice guidelines for fall-risk screening, and a selected literature review were used. Results: Gaps exist in our knowledge of fall and fracture risk for this population. Muscle performance, balance, and mobility impairments have been identified, but little is known about whether personal and environmental contextual factors impact fall and fracture risk. Physical activity may help to prevent falls, but non-adherence is a problem. Conclusion: A need exists to assess fall risk in older adults with hip and knee OA. Promoting regular physical activity by focusing on disease-and activity-specific personal contextual factors may help direct treatment planning.

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Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures

Cited by 174 publications

References 35 publications

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Disc space narrowing as a new risk factor for vertebral fracture: The OFELY study

Osteoarthritis and bone mineral density: are strong bones bad for joints?

Risk Factors for Falls in Older Adults with Lower Extremity Arthritis: A Conceptual Framework of Current Knowledge and Future Directions

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