Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Osteoarthritis Is Related to An Increased Risk of Falls and Fractures: A Prospective Multinational Cohort Study (the GLOW study).
Prieto-Alhambra1, Daniel, Nogues2, Xavier, Javaid3, M. Kassim, Arden3, Nigel K., Cooper4, Cyrus, Wyman5, Allison, Diez-Perez6, Adolfo
URFOA-IMIM, Parc de Salut Mar; Idiap Jordi Gol i Gurina-Institut Català de la Salut; Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK, Barcelona, Spain
Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona; and RETICEF, ISCIII Madrid; Spain, Barcelona, United Kingdom
Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK, Oxford, United Kingdom
Southampton General Hospital, Southampton, United Kingdom
Center for Outcomes Research, UMass Medical School, Worcester, MA
Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, Barcelona; and RETICEF, ISCIII Madrid; Spain, Barcelona, Spain
Although patients with osteoarthritis (OA) have increased bone mass, no corresponding decrease in fractures has been observed. We therefore studied the association between OA and incident falls and fractures in postmenopausal women.
The Global Longitudinal Study of Osteoporosis in Women (GLOW) is a prospective, multinational, observational cohort study. Practices that were typical of each region were identified through primary care networks organized for administrative, research, or educational purposes. Non-institutionalized women aged >=55 years who visited a practice within the previous 2 years were eligible. A total of 60,393 women agreed to participate. Participants were mailed a self-administered questionnaire at baseline; follow-up questionnaires were sent at 12-month intervals for 3 years. Patients were classified as having OA or not according to their answer to the following question in the baseline survey: "Has a doctor or other health provider ever said that you had osteoarthritis or degenerative joint disease?" Information on incident falls and fractures, and potential confounders were self-reported by participants. For this analysis, women with missing baseline OA or fracture information, as well as those with celiac disease or rheumatoid arthritis, were excluded. The cumulative fracture incidence was calculated by the Kaplan-Meier method. Unadjusted and multivariable Cox models for incident fractures and falls were used to compute hazard ratios (HRs) according to baseline OA status. A Kaplan-Meier curve was computed on the subset of women with complete follow-up data.
Of 51,386 women who were followed up for a median time of 1072 days (interquartile range 772 to 1095 days), 20,409 (39.7%) were classified as having OA. The unadjusted HR for fracture among OA patients was 1.40 (95% CI 1.321.48; p<0.0001), and this remained significant after multivariable adjustment (HR 1.21; 95% CI 1.131.30; p<0.0001; Figure). Falls were also more likely in women with OA (adjusted HR 1.27; 95% CI 1.231.30; p<0.0001). The association between OA and fracture remained significant even after adjusting for baseline falls (HR 1.16; 95% CI 1.081.25; p<0.0001).
Figure 1. Kaplan-Meier curve predicting fracture by year 3, by baseline OA status, with 95% CIs (women with all 4 years of survey data only, n = 40132).
Postmenopausal women with OA have a 20% higher risk of fracture and experience almost 30% more falls than those without OA. Although incident falls may partially explain the increased risk of fracture observed in women with OA, our data suggest that the association between OA and fracture is independent of the number of falls.
To cite this abstract, please use the following information:
Prieto-Alhambra, Daniel, Nogues, Xavier, Javaid, M. Kassim, Arden, Nigel K., Cooper, Cyrus, Wyman, Allison, et al; Osteoarthritis Is Related to An Increased Risk of Falls and Fractures: A Prospective Multinational Cohort Study (the GLOW study). [abstract]. Arthritis Rheum 2011;63 Suppl 10 :829