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)

作者：Prieto Alhambra Daniel; Nogues Xavier; Javaid M Kassim; Wyman Allison; Arden Nigel K; Azagra Rafael; Cooper Cyrus; Adachi Jonathan D; Boonen Steven; Chapurlat Roland D; Compston Juliet E; Gehlbach Stephen H; Greenspan Susan L; Hooven Frederick H; Netelenbos J Coen; Pfeilschifter Johannes; Rossini Maurizio; Sambrook Philip N; Silverman Stuart; Siris Ethel S; Watts Nelson B; Diez Perez Adolfo^*

来源：Annals of the Rheumatic Diseases, 2013, 72(6): 911-917.

DOI：10.1136/annrheumdis-2012-201451

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. %26lt;br%26gt;Methods The Global Longitudinal Study of Osteoporosis in Women is a prospective multinational cohort of 60 393 non-institutionalised women aged %26gt;= 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, %26apos;Has a doctor or other health provider ever said that you had osteoarthritis or degenerative joint disease?%26apos;, 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. %26lt;br%26gt;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%26lt;0.0001) and the adjusted RR for falls was 1.24 (95% CI 1.22 to 1.26; p%26lt;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)). %26lt;br%26gt;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.

• 出版日期2013-6