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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}


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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