¹Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
²Orthopädisches Forschungszentrum, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland

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Objectives and questions: Osteoarthritis (OA) is the most common joint disease, leading to pain, stiffness, and reduced mobility. These impairments may increase the risk of falls and fractures that are exacerbated by comorbidities. Understanding the relationship among OA, falls, fractures, and associated risk factors is crucial for improving risk stratification and targeted prevention. This study investigated whether individuals with hip or knee OA, or both, experience a higher incidence of falls and fractures than those without OA. In addition, this study explored other possible OA-associated risk factors that may contribute to falls and fractures in patients with OA.

Material and methods: This study employed a retrospective analysis of the Osteoarthritis Initiative database of the Open Archives Initiative (OAI) in individuals with and without hip and knee OA. Falls and fractures were documented through self-reports within 12 months of OA diagnosis. Potential influencing factors included functional test results, quality of life assessments, depressive symptoms, physical activity levels, and sociodemographic variables. Correlation and logistic regression analyses were conducted to identify predictive factors for falls and fractures, with a focus on hip and/or knee OA.

Results: Of the 4,796 OAI participants, 4,427 were included (58.6% female, 41.4% male). Among them, 19.9% (n=880) had knee OA exclusively, 3.6% (n=159) had hip OA exclusively, and 3.7% (n=165) were affected by both conditions. OA (hip, knee, or both) was not significantly associated with an increased risk of falls or fractures. Although quality of life and functional assessments, including the Short Form Health Survey (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS), revealed significant differences between individuals with knee and hip osteoarthritis (OA) and those without OA, these assessments were not found to be significant predictors of fall or fracture risk. However, a higher depression score, female sex (p < 0.01), and advanced age (p < 0.001) were associated with increased fall and fracture risks, respectively.

Discussion and conclusions: These findings indicate that hip and/or knee OA does not increase the likelihood of falls or fractures. Instead, mental health, sex, and age-related functional decline play critical roles in individuals with OA. A comprehensive clinical approach to OA management should address both the physical and mental health issues. Prevention strategies to reduce the risk of falls and fractures should focus on alleviating depressive symptoms, improving physical function, and raising physician awareness of these important risk factors to improve the care and education of patients with OA.