Pain Medications

Some researchers believe the risk of falls and fractures in patients with OA may have less to do with the arthritis itself than the medications used for pain relief, citing an increase in falls and fractures among OA patients since the COX-2 inhibitor rofecoxib (Vioxx) was taken off the market in 2004 and the discovery of cardiovascular risks associated with NSAID use prompted the prescription of narcotic analgesics instead.

In a study presented at the 2011 scientific meeting of the American College of Rheumatology, researchers at New York University (NYU) reviewed the medical records of 10,000 patients diagnosed with osteoarthritis between 2001 and 2009, and found that the percentage of study patients who received prescriptions for narcotic analgesics increased from 8 percent in 2002 to 40 percent in 2009. During the same time frame, the incidence of falls and fractures more than quadrupled.

Specifically the researchers found the prescription narcotic analgesics was associated with a 3.7-times greater risk for falls and fractures than he prescription off COX-2 inhibitors and a 4.4-times greater risk than non-COX-2 inhibitor NSAIDs from 2005 to 2009.

“We couldn’t prove cause and effect,” says Lydia Rolita, MD a geriatric researcher at NYU and the study’s lead author.  “We couldn’t prove that people were actually taking what was prescribed to them, but it’s reasonable to guess that’s what was going on.”

In a separate large study of Medicare beneficiaries in Pennsylvania and New Jersey, investigators at Brigham and Women’s Hospital in Boston identified those with rheumatoid arthritis or osteoarthritis who were started on a nonselective NSAID, a COX-2-selective NSAID, or a narcotic analgesic during 1999-2005 and then calculated the fracture risk. The composite incidence of nonvertebral fracture – those of the hip, pelvis, humerus (upper arm bone) or wrist -- 26 per 1,000 person-years among patients on nonselective NSAIDs, 19 with COX-2-selective NSAIDs, and 101 with narcotic analgesics.    

While Brigham and Women’s study, like the NYU study, clearly showed a connection between the prescription of narcotic analgesics and fall risk, the study was not designed to explain the connection. 

Preventing Falls

Regardless of the cause of falls and fractures, research points to the need to more efforts to prevent them. A study by Arnold published in the Journal of Aging and Physical Activity suggests an aquatic exercise and education program can help. In the study, 79 adults age 65 and older with hip OA and at least one other fall risk factor were randomly assigned into one of three groups: aquatic exercise twice a week plus a once weekly education; aquatic exercise twice weekly or a usual activity control group. Factors like balance, falls efficacy (the feeling of confidence that you are able to move better), walking performance and functional performance were measured before and after the study. The combination of aquatic exercise and education was more effective in improving fall risk factors than exercise alone, says Arnold.

To reduce your risk of falling, Arnold recommends taking an exercise class such as those offered by the Arthritis Foundation with an educational aspect to it. “Look for a program that teaches how to use good biomechanics when doing activities at home and talks a bit about falls education,” she says.  “Certainly individual attention and getting that advice from a physical therapist would be helpful as well.”

Taking another look at medications, too, could help reduce fall risk, says Dr. Rolita. “I think we need to think more carefully about pain medication regiments and take into consideration people’s risk factors,” she says.

For example, if someone doesn’t have significant cardiovascular risk factors that might make an NSAID inadvisable, their doctors might do well to pay a little more attention to fall risk, she says. “I think it’s important to just kind of weigh the risks and benefits on a more individual level.”