An increased rate of falling leads to a rise in fracture risk in postmenopausal women with self-reported osteoarthritis: a prospective multinational cohort study (GLOW).
OBJECTIVE
Patients with osteoarthritis have increased bone mass but no decrease in fractures. The association between self-reported osteoarthritis and incident falls and fractures was studied in postmenopausal women.


METHODS
The Global Longitudinal Study of Osteoporosis in Women is a prospective multinational cohort of 60,393 non-institutionalised women aged ≥55 years who had visited primary care practices within the previous 2 years. Questionnaires were mailed at yearly intervals. Patients were classified as having osteoarthritis if they answered yes to the question, 'Has a doctor or other health provider ever said that you had osteoarthritis or degenerative joint disease?', and this was validated against primary care records in a subsample. Information on incident falls, fractures and covariates was self-reported. Cox and Poisson models were used for incident fractures and number of falls, respectively, to compute hazard ratios (HRs) and rate ratios (RRs) for baseline osteoarthritis status.


RESULTS
Of 51 386 women followed for a median of 2.9 years (interquartile range 2.1-3.0), 20 409 (40%) reported osteoarthritis. The adjusted HR for osteoarthritis predicting fracture was 1.21 (95% CI 1.13 to 1.30; p<0.0001) and the adjusted RR for falls was 1.24 (95% CI 1.22 to 1.26; p<0.0001). However, the association between osteoarthritis and fracture was not significant after adjustment for incident falls (HR 1.06 (95% CI 0.98 to 1.15; p=0.13)).


CONCLUSIONS
Postmenopausal women with self-reported osteoarthritis have a 20% increased risk of fracture and experience 25% more falls than those without osteoarthritis. These data suggest that increased falls are the causal pathway of the association between osteoarthritis and fractures.
Department of URFOA-Internal Medicine, Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, RETICEF, FEDER, ISCIII Madrid, Spain.
Daniel
D
Prieto-Alhambra
Xavier
X
Nogues
M Kassim
MK
Javaid
Allison
A
Wyman
Nigel K
NK
Arden
Rafael
R
Azagra
Cyrus
C
Cooper
Jonathan D
JD
Adachi
Steven
S
Boonen
Roland D
RD
Chapurlat
Juliet E
JE
Compston
Stephen H
SH
Gehlbach
Susan L
SL
Greenspan
Frederick H
FH
Hooven
J Coen
JC
Netelenbos
Johannes
J
Pfeilschifter
Maurizio
M
Rossini
Philip N
PN
Sambrook
Stuart
S
Silverman
Ethel S
ES
Siris
Nelson B
NB
Watts
Adolfo
A
Díez-Pérez
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology*; D016012:Poisson Distribution; D017698:Postmenopause; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D057566:Self Report; D011795:Surveys and Questionnaires