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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)
  1. Daniel Prieto-Alhambra1–,3,
  2. Xavier Nogues1,
  3. M Kassim Javaid3,
  4. Allison Wyman4,
  5. Nigel K Arden3,
  6. Rafael Azagra2,
  7. Cyrus Cooper3,5,
  8. Jonathan D Adachi6,
  9. Steven Boonen7,
  10. Roland D Chapurlat8,
  11. Juliet E Compston9,
  12. Stephen H Gehlbach4,
  13. Susan L Greenspan10,
  14. Frederick H Hooven4,
  15. J Coen Netelenbos11,
  16. Johannes Pfeilschifter12,
  17. Maurizio Rossini13,
  18. Philip N Sambrook14,
  19. Stuart Silverman15,
  20. Ethel S Siris16,
  21. Nelson B Watts17,
  22. Adolfo Díez-Pérez1
  1. 1Department of URFOA-Internal Medicine, Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, RETICEF, FEDER, ISCIII Madrid, Spain
  2. 2Department of IDIAP Jordi Gol i Gurina, Institut Català de la Salut, Barcelona, Spain
  3. 3Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
  4. 4Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  5. 5MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  6. 6St Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
  7. 7Division of Geriatric Medicine, Leuven University Centre for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
  8. 8Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France
  9. 9Department of Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Cambridge, UK
  10. 10Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  11. 11Department of Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands
  12. 12Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany
  13. 13Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy
  14. 14Department of Rheumatology, University of Sydney-Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
  15. 15Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  16. 16Medical Center, Columbia University, New York, New York, USA
  17. 17Mercy Health Osteoporosis and Bone Health Services, 4760 E Galbraith Road, Suite 212, Cincinnati, Ohio, USA
  1. Correspondence to Professor Adolfo Díez-Pérez, Departament de Medicina Interna, Parc de Salut Mar, C/Doctor Aiguader, Barcelona, Catalonia 88 08003, Spain; ADiez{at}parcdesalutmar.cat

Abstract

Objectives 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.

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Footnotes

  • Funding Financial support for the GLOW study is provided by Warner Chilcott Company LLC and Sanofi-Aventis to the Center for Outcomes Research, University of Massachusetts Medical School.

  • Competing interests DP-A, XN, MKJ, AW, NKA, and RA declare no competing interests. CC has received consulting fees from and lectured for Amgen, The Alliance for Better Bone Health (Sanofi-Aventis and Warner Chilcott), Lilly, Merck, Servier, Novartis and Roche-GSK. JDA has been a consultant/speaker for Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, Sanofi-Aventis, Servier, Warner Chilcott and Wyeth and has conducted clinical trials for Amgen, Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi-Aventis, Warner Chilcott, Wyeth and Bristol-Myers Squibb. SB has received research grants from Amgen, Lilly, Novartis, Pfizer, Procter & Gamble, Sanofi-Aventis, Roche and GlaxoSmithKline and has received honoraria from and served on Speakers’ Bureaus for and acted as a consultant/Advisory Board member for Amgen, Lilly, Merck, Novartis, Procter & Gamble, Sanofi-Aventis and Servier. RDC has received funding from the French Ministry of Health, the French Ministry of Research, Merck, Servier and Lilly, has received honoraria from Amgen, Servier, Novartis, Lilly, and Roche and has acted as a consultant/Advisory Board member for Amgen, Merck, Servier and Novartis. JEC has been paid for consultancy work by Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gamble, Wyeth, Pfizer, The Alliance for Better Bone Health, Roche and GlaxoSmithKline; has been a paid speaker and received reimbursement, travel and accommodation from Servier, Procter & Gamble and Lilly; and received research grants from Servier R&D and Procter & Gamble. SHG has received funding from The Alliance for Better Bone Health (Sanofi-Aventis and Warner Chilcott). SLG has been paid for consultancy work by and is on the scientific advisory boards for Amgen, Lilly and Merck; and has received research grants from the Alliance for Better Bone Health (Sanofi-Aventis and Proctor & Gamble) and Lilly. FHH has received funding from The Alliance for Better Bone Health (Sanofi-Aventis and Warner Chilcott). JCN has undertaken paid consultancy work for Roche Diagnostics, Daiichi-Sankyo, Procter & Gamble and Nycomed, has been a paid speaker for and received reimbursement, travel and accommodation from Roche Diagnostics, Novartis, Daiichi-Sankyo, and Procter & Gamble, and has received research grants from The Alliance for Better Bone Health and Amgen. JP has received research grants from Amgen, Kyphon, Novartis, and Roche, has received other research support (equipment) from GE Lunar, has served on Speakers’ Bureaus for Amgen, Sanofi-Aventis, GlaxoSmithKline, Roche, Lilly Deutschland, Orion Pharma, Merck, Merckle, Nycomed and Procter & Gamble, and has acted as an Advisory Board member for Novartis, Roche, Procter & Gamble and Teva. MR has served on Speakers’ Bureaus for Roche, Merck Sharp & Dohme and GlaxoSmithKline. PNS has received honoraria from and acted as a consultant/Advisory Board member for Merck, Sanofi-Aventis, Roche and Servier. SS has received research grants from Wyeth, Lilly, Novartis and Alliance, has served on Speakers’ Bureaus for Lilly, Novartis, Pfizer and Procter & Gamble, has received honoraria from Procter & Gamble and has acted as a consultant/Advisory Board member for Lilly, Argen, Wyeth, Merck, Roche and Novartis. ESS has acted as a consultant for Amgen, Lilly, Novartis and The Alliance for Better Bone Health and has served on Speakers’ Bureaus in the past year for Amgen and Lilly. NBW has received honoraria for lectures in the past year from Amgen, Novartis and Warner Chilcott, has acted as a consultant in the past year for Amgen, Arena, Baxter, InteKrin, Johnson & Johnson, Lilly, Medpace, Merck, NPS, Orexigen, Pfizer/Wyeth, Takeda, Vivus and Warner Chilcott; has received research support (through University) from Amgen, Merck and NPS; and co-founded, has stock options in and is a director of OsteoDynamics. AD-P has received consulting fees and lectured for Eli Lilly, Amgen, Procter & Gamble, Servier and Daiichi-Sankyo; has been an expert witness for Merck; and is a consultant/Advisory Board member for Novartis, Eli Lilly, Amgen and Procter & Gamble.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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