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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 1/2023

Open Access 01-12-2023 | Osteoarthrosis | Research

Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis

Authors: Youyou Zhang, Xiaoxi Li, Yining Wang, Liru Ge, Faming Pan, Tania Winzenberg, Guoqi Cai

Published in: Arthritis Research & Therapy | Issue 1/2023

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Abstract

Objective

Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures.

Methods

We conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.

Results

Of 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71).

Conclusion

Symptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.
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Literature
1.
2.
Dennison E, Cooper C. The epidemiology of fracture: why treatment matters. In: Dennison E, editor. Osteoporosis treatment: a clinical overview. Cham: Springer International Publishing; 2021. p. 1–16.
3.
Laurence BD, Michel L. The fall in older adults: physical and cognitive problems. Curr Aging Sci. 2017;10(3):185–200.PubMed
4.
Quintana JM, Arostegui I, Escobar A, Azkarate J, Goenaga JI, Lafuente I. Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med. 2008;168(14):1576–84.PubMed
5.
Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham osteoarthritis study. Arthritis Rheum. 1987;30(8):914–8.PubMed
6.
Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, Fang F, Schwartz TA, Abbate LM, Callahan LF, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007;34(1):172–80.PubMed
7.
Song R, Roberts BL, Lee EO, Lam P, Bae SC. A randomized study of the effects of t’ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis. J Altern Complement Med. 2010;16(3):227–33.PubMedPubMedCentral
8.
Matsumoto H, Okuno M, Nakamura T, Yamamoto K, Hagino H. Fall incidence and risk factors in patients after total knee arthroplasty. Arch Orthop Trauma Surg. 2012;132(4):555–63.PubMed
9.
Rouzi AA, Ardawi MS, Qari MH, Bahksh TM, Raddadi RM, Ali AY, Jalal MM, Taha AA, Kary HS. Risk factors for falls in a longitudinal cohort study of Saudi postmenopausal women: the center of excellence for osteoporosis research study. Menopause. 2015;22(9):1012–20.PubMed
10.
van Schoor NM, Dennison E, Castell MV, Cooper C, Edwards MH, Maggi S, Pedersen NL, van der Pas S, Rijnhart JJM, Lips P, et al. Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication. Semin Arthritis Rheum. 2020;50(3):380–6.PubMedPubMedCentral
11.
Cai G, Li X, Zhang Y, Wang Y, Ma Y, Xu S, Shuai Z, Peng X, Pan F. Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2021;30(3):436–42.PubMed
12.
Bergink AP, van der Klift M, Hofman A, Verhaar JA, van Leeuwen JP, Uitterlinden AG, Pols HA. Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum. 2003;49(5):648–57.PubMed
13.
Dore AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res. 2015;67(5):633–9.
14.
Arden NK, Griffiths GO, Hart DJ, Doyle DV, Spector TD. The association between osteoarthritis and osteoporotic fracture: the Chingford Study. Br J Rheumatol. 1996;35(12):1299–304.PubMed
15.
Castano-Betancourt MC, Rivadeneira F, Bierma-Zeinstra S, Kerkhof HJ, Hofman A, Uitterlinden AG, van Meurs JB. Bone parameters across different types of hip osteoarthritis and their relationship to osteoporotic fracture risk. Arthritis Rheum. 2013;65(3):693–700.PubMed
16.
Soh SE, Barker AL, Morello RT, Ackerman IN. Applying the international classification of functioning, disability and health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the osteoarthritis initiative. BMC Musculoskelet Disord. 2020;21(1):138.PubMedPubMedCentral
17.
Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, Pressman AR, Cummings SR. Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Arthritis Rheum. 1999;42(7):1378–85.PubMed
18.
Franklin J, Ingvarsson T, Englund M, Ingimarsson O, Robertsson O, Lohmander LS. Natural history of radiographic hip osteoarthritis: a retrospective cohort study with 11–28 years of followup. Arthritis Care Res. 2011;63(5):689–95.
19.
Yamamoto Y, Turkiewicz A, Wingstrand H, Englund M. Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population. J Rheumatol. 2015;42(11):2055–8.PubMed
20.
Deng ZH, Xu J, Long LJ, Chen F, Chen K, Lu W, Wang DP, Peng LQ. Association between hip and knee osteoarthritis with falls: a systematic review and meta-analysis. Int J Clin Pract. 2021;75(10):e14537.PubMed
21.
Hall M, van der Esch M, Hinman RS, Peat G, de Zwart A, Quicke JG, Runhaar J, Knoop J, van der Leeden M, de Rooij M, et al. How does hip osteoarthritis differ from knee osteoarthritis? Osteoarthr Cartil. 2022;30(1):32–41.
22.
Fuss FK, Bacher A. New aspects of the morphology and function of the human hip joint ligaments. Am J Anat. 1991;192(1):1–13.PubMed
23.
Kim C, Nevitt MC, Niu J, Clancy MM, Lane NE, Link TM, Vlad S, Tolstykh I, Jungmann PM, Felson DT, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983.PubMedPubMedCentral
24.
Parsons C, Fuggle NR, Edwards MH, Goulston L, Litwic AE, Jagannath D, van der Pas S, Cooper C, Dennison EM, Group ER. Concordance between clinical and radiographic evaluations of knee osteoarthritis. Aging Clin Exp Res. 2018;30(1):17–25.PubMed
25.
Iijima H, Aoyama T. Increased recurrent falls experience in older adults with coexisting of sarcopenia and knee osteoarthritis: a cross-sectional study. BMC Geriatr. 2021;21(1):698.PubMedPubMedCentral
26.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.CrossRefPubMedPubMedCentral
27.
Tassé M. International classification of diseases, 10th ed. (ICD-10); 2017.
28.
Conaghan PG, Peloso PM, Everett SV, Rajagopalan S, Black CM, Mavros P, Arden NK, Phillips CJ, Rannou F, van de Laar MA, et al. Inadequate pain relief and large functional loss among patients with knee osteoarthritis: evidence from a prospective multinational longitudinal study of osteoarthritis real-world therapies. Rheumatology (Oxford). 2015;54(2):270–7.PubMed
29.
Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Feldman D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum. 1991;34(5):505–14.PubMed
30.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039–49.PubMed
31.
Wells G. The Newcastle-Ottawa Scale (NOS) for Assessing the quality of non-randomised studies in meta-analyses. In: Symposium on systematic reviews: beyond the basics; 2014.
32.
Lo CK-L, Mertz D, Loeb M. Newcastle-Ottawa scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014;14(1):45.PubMedPubMedCentral
33.
Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, Williams JW Jr, Kunz R, Craig J, Montori VM, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336(7653):1106–10.PubMedPubMedCentral
34.
Walter SD, Cook RJ. A comparison of several point estimators of the odds ratio in a single 2 x 2 contingency table. Biometrics. 1991;47(3):795–811.PubMed
35.
Deeks JJ Higgins J, Altman DG. Chapter 10: analysing data and undertaking meta-analyses. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane. 2022. Available from https://​www.​training.​cochrane.​org/​handbook.
36.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.PubMed
37.
Jacob L, Kostev K. Osteoarthritis and the incidence of fracture in the United Kingdom: a retrospective cohort study of 258,696 patients. Osteoarthritis Cartilage. 2021;29(2):215–21.PubMed
38.
Vestergaard P, Rejnmark L, Mosekilde L. Osteoarthritis and risk of fractures. Calcif Tissue Int. 2009;84(4):249–56.PubMed
39.
Usova E, Raskina T, Malyshenko O, Letaeva M, Koroleva M, Averkieva J. Frequency of osteopenic syndrome and low-energy fractures in postmenopausal women with osteoarthritis of the knee joint. Ann Rheum Dis. 2022;81(Supplement 1):1619–20.
40.
Barbour KE, Sagawa N, Boudreau RM, Winger ME, Cauley JA, Nevitt MC, Fujii T, Patel KV, Strotmeyer ES. Knee osteoarthritis and the risk of medically treated injurious falls among older adults: a community-based us cohort study. Arthritis Care Res. 2019;71(7):865–74.
41.
Bergink AP, Rivadeneira F, Bierma-Zeinstra SM, Zillikens MC, Ikram MA, Uitterlinden AG, van Meurs JBJ. Are bone mineral density and fractures related to the incidence and progression of radiographic osteoarthritis of the knee, hip, and hand in elderly men and women? The Rotterdam Study. Arthritis Rheumatol. 2019;71(3):361–9.PubMed
42.
Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, Cooper C. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheumatol. 2006;55(4):610–5.
43.
Cumming RG, Klineberg RJ. Epidemiological study of the relation between arthritis of the hip and hip fractures. Ann Rheum Dis. 1993;52(10):707–10.PubMedPubMedCentral
44.
Muraki S, Akune T, Ishimoto Y, Nagata K, Yoshida M, Tanaka S, Oka H, Kawaguchi H, Nakamura K, Yoshimura N. Risk factors for falls in a longitudinal population-based cohort study of Japanese men and women: the ROAD Study. Bone. 2013;52(1):516–23.PubMed
45.
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMed
46.
Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ. Fall risk assessment measures: an analytic review. J Gerontol A Biol Sci Med Sci. 2001;56(12):M761-766.PubMed
47.
Albert SM, King J, Boudreau R, Prasad T, Lin CJ, Newman AB. Primary prevention of falls: effectiveness of a statewide program. Am J Public Health. 2014;104(5):e77-84.PubMedPubMedCentral
48.
Kurtoglu P, Tastan S, Tunay S. How falls and fear of falling affect the performance of daily activities in individuals with knee osteoarthritis. Central Eur J Nurs Midwifery. 2020;11:25–33.
Metadata
Title
Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis
Authors
Youyou Zhang
Xiaoxi Li
Yining Wang
Liru Ge
Faming Pan
Tania Winzenberg
Guoqi Cai
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 1/2023
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/s13075-023-03179-4

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