For an older person who falls, the pain can go far beyond the impact of the fall or the immediate injuries resulting from it.  A broken hip, for example, may necessitate the surgery with all its inherent risks in addition to the risks related to immobility including blood clots and muscle atrophy.  A fractured wrist may permanently interfere with the ability to perform daily tasks such as carrying heavy items, turning door knobs or keys, cutting food or pouring a drink.

While fractures have long been attributed to the brittle bone disease, osteoporosis, increasingly scientists are considering the role that osteoarthritis may play in the risk of falling and/or the type and severity of resulting injuries. 

For example, an analysis of the 51,386 women in the Global Longitudinal Study of Osteoporosis in Women (GLOW), a large international study designed to improve care of patients who are at risk of osteoporosis-related fractures, revealed those who had osteoarthritis (about 40 percent of the study population) experienced 30 percent more falls and had a 20 percent greater risk of facture than those without OA.

While it is not completely understood why people with OA would be more likely to fall or experience more fractures, new research is providing some clues. Here’s what doctors are learning about how and why OA may affect falls and fracture risk—and what you can do to reduce that risk.

The Problem with Pain

Several studies have shown an association between pain and fall risk.  One 2009 study of 749 adults aged 70 years and older, for example, found that those who reported two or more locations of musculoskeletal pain, severe pain or pain that interfered with their ability to perform daily activities were significantly more likely to fall than those with no pain or low levels of pain. The study was published in the Journal of the American Medical Association.

A separate study of 6,641 men and women 75 or older who participated in a three-year trial of intramuscular vitamin D therapy found that those who reported prevalent knee pain had a 25 percent increased risk of falls and almost twice the risk of hip fractures compared to those without prevalent pain. Increasing severity of knee pain was associated with a greater risk of falls and hip fracture. Authors of the study, which was published in Arthritis & Rheumatism, say the increased risk of fractures could not be explained by the increased risk of falls, but was likely due to the severity of the falls suffered by those with knee OA. 

Decreased Function

Another explanation for the OA-fall connection is that people with OA have risk factors such as decreased function, muscle weakness and impaired balance that make them more likely to fall, says Catherine Arnold, professor of physical therapy at the University of Saskatchewan, Canada. “Those are all very common in individuals that have arthritis in their lower extremities like their hips and knees.” 

Adding to the problem is that OA makes exercise difficult, she says, so that many people with OA tend to be less active. “They are not as engaged in physical activity and therefore that is a bit of a spiral in terms of their confidence in their ability to balance, says Arnold, whose research expertise is focused on educational and exercise programs to decrease fall risk in the older and other vulnerable populations. “Their balance deteriorates more and puts them at higher risk. ”

In a cross-sectional, population-based study published in Osteoarthritis and Cartilage, researchers used several tools including the Western Ontario McMasters Osteoarthritis Index (WOMAC) to measure pain, stiffness and functional ability of 850 randomly selected men and women aged 50 to 80. WOMAC is a score derived from patients’ answers to a questionnaire concerning arthritis symptoms, including pain and stiffness, and how those symptoms affect their ability to function. While the group as a whole had a low risk of falls, those who had higher WOMAC scores – which significantly associated with factors such as reaction time, balance, proprioception (the ability to sense the position and location and orientation and movement of the body and its parts) – had a greater risk of falling compared to those with lower scores.