Osteoarthritis and Knee Pain Increase Risk of Falls in Elderly

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When I think back to my geriatrics classes in medical school, I can vividly recall the lectures by one of the most charismatic teachers at my university.  He was a geriatrician and an associate clinical professor at my medical school

He had a concept that he called, “the giants of geriatrics.”  What the “giants of geriatrics” were composed of were common medical issues pertaining to the elderly.  To my recollection, the list of common medical issues that he lectured about included:  delirium, dementia, incontinence, pneumonia, and falls.  Not really much to look forward to as we all age…

Falls can have a devastating impact on the quality of life of elderly people.  A single hip fracture can result in cascade of medial treatments and disability including the need for surgery, a hip replacement, a lengthy hospital stay, several risks related to immobility including blood clots, muscle wasting, and significant surgical risks including infections as well as bleeding.  For this reason, it’s important to try to take measures to reduce the risk of falling.

A recent study related to my previous post suggests that both osteoarthritis as well as knee pain independently increase the risk of non-vertebral and hip fractures.  The study authors hypothesis that this increased risk is due to the actual severity of falls, not simply the increased risk of falling. My previous post suggested that low levels of vitamin D may increase both knee pain and difficulty walking.  For this reason, if you are an elderly person with osteoarthritis and knee pain, ensure you receive adequate treatment from both your health care provider as well as your dietitian.

Study Objective:

“Patients with osteoarthritis (OA) have increased bone mineral density; however, the association between knee OA and fracture is controversial. Few data exist on the association between knee pain and fracture. We examined the association of knee OA and knee pain with fracture and falls in elderly men and women. “

Study Methods:

“The study group comprised 6,641 men and women ages > or =75 years who participated in a 3-year randomized controlled trial of intramuscular vitamin D therapy. Patients completed a questionnaire about knee pain and OA.”

Results:

“Prevalent knee pain was associated with an increased risk of falls (hazard ratio [HR] 1.26, 95% confidence interval [95% CI] 1.17-1.36) and hip fracture (HR 2.0, 95% CI 1.18-3.37). Increasing severity of knee pain was associated with a greater risk of falls and hip fracture. “

Study Conclusions:

“Patients with a clinical diagnosis of knee OA and with knee pain have an increased risk of non vertebral and hip fracture. This is not explained by the increased risk of falls, but is more likely to be due to the severity of falls sustained.Knee pain and OA should be regarded as independent risk factors for fracture.”

In short, this study found that both knee pain and osteoarthritis each should be considered independent risk factors for fracture in the elderly.

Reference:

1. Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, Cooper C.  Knee pain, knee osteoarthritis, and the risk of fracture.  Arthritis Rheum. 2006 Aug 15;55(4):610-5.

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