van Schoor N M, Dennison E, Castell M V, Cooper C, Edwards M H, Maggi S, Pedersen N L, van der Pas S, Rijnhart J J M, Lips P, Deeg D J H
Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.
University of Southampton, Southampton General Hospital, Southampton, United Kingdom.
Semin Arthritis Rheum. 2020 Jun;50(3):380-386. doi: 10.1016/j.semarthrit.2020.02.006. Epub 2020 Feb 19.
Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships.
Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65-85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report.
Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10-2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not.
Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medications.
多项研究发现骨关节炎（OA）患者跌倒风险增加。然而，大多数前瞻性研究并未采用OA的临床定义。此外，尚不清楚哪些因素可解释这种风险。我们的目标是：（1）确认髋部和膝部临床OA与跌倒之间的前瞻性关联；（2）研究性别对这种关联的调节作用；（3）研究身体机能低下、身体活动量少以及使用止痛药物是否介导了这些关系。
使用来自欧洲骨关节炎项目（EPOSA）的基线数据和1年随访数据，这些数据来自五项基于欧洲人群的队列研究（年龄65 - 85岁，n = 2535）的预协调数据。临床OA根据美国风湿病学会（ACR）标准定义。跌倒情况通过自我报告进行评估。
在随访期间，27.7%的参与者跌倒过一次或更多次（定义为跌倒者），9.8%跌倒过两次或更多次（反复跌倒者）。在对混杂因素进行调整后，临床膝OA与成为反复跌倒者的风险相关（相对风险 = 1.55；95%置信区间：1.10 - 2.18），但与成为跌倒者的风险无关。在对混杂因素进行调整后，未观察到临床髋OA与（反复）跌倒之间的关联。阿片类药物和镇痛药介导了临床OA与（反复）跌倒之间的关联，而身体机能和身体活动量则未介导这种关联。
患有临床膝OA的个体反复跌倒的风险增加。这种关系由止痛药物介导，尤其是阿片类药物。在讨论开具这些药物的风险效益比时，需要考虑跌倒风险。
