Is there an increased risk of falls and fractures in people with
early diagnosed hip and knee osteoarthritis? Data from the
Toby O. SMITH,
and Michael MANSFIELD
Faculty of Medicine and Health Sciences, School of Health Sciences, University of East Anglia, Norwich, UK,
Physiotherapy Group, Crystal Palace, London, UK,
Hinchingbrooke Hospital, Cambridgeshire Community Services, Huntingdon,
Guy’s and St Thomas’ Hospitals NHS Foundation Trust and Academic Department of Physiotherapy, King’s College,
Aims: To assess the probability of individuals with early-diagnosed hip or knee osteoarthritis experiencing a fall
and/or fracture compared to a cohort without osteoarthritis.
Methods: Data were analyzed from the Osteoarthritis Initiative dataset. We identiﬁed all people who were diag-
nosed with hip or knee osteoarthritis within a 12 month period, compared to those without osteoarthritis. We
determined whether there was a difference in the occurrence of falls, with or without consequential fractures,
between people newly diagnosed with hip or knee osteoarthritis compared to those who had not, using odd
ratios (OR) and 95% conﬁdence intervals (95% CI).
Results: Five hundred and ﬁfty-two individuals with hip osteoarthritis were compared to 4244 individuals with-
out hip osteoarthritis; 1350 individuals with knee osteoarthritis were compared to 3445 individuals without
knee osteoarthritis. People with knee osteoarthritis had a 54% greater chance of experiencing a fall compared to
those without (OR: 1.54; 95% CI: 1.35–1.77). People with hip osteoarthritis had a 52% greater chance of experi-
encing a fall compared to those without hip osteoarthritis (OR: 1.52; 95% CI: 1.26–1.84). People with knee and
hip osteoarthritis demonstrated over an 80% greater chance of experiencing a fracture in the ﬁrst 12 months of
their diagnosis compared to those without hip or knee osteoarthritis (total knee arthroplasty: OR 1.81; total hip
arthroplasty: OR 1.84).
Conclusions: There is an increased risk of falls and fractures in early-diagnosed knee and hip osteoarthritis com-
pared to those without osteoarthritis. International guidelines on the management of hip and knee osteoarthritis
should consider the management of falls risk.
Key words: arthritis, falls, injury, joint degenerative, lower limb, older people.
Falls are a serious threat to the wellbeing of older peo-
ple. They are a signiﬁcant cause of morbidity and mor-
It has been estimated that approximately 30% of
community-dwelling individuals aged 65 years and
older, and 50% aged 85 years and older, will experience
a fall annually.
This can have a number of conse-
quences, including fall-related injury with associated
fractures, reduced conﬁdence and functional indepen-
dence and ultimately a greater need for long-term care.
Falls-related fracture is considered the most serious of
Kannegaard et al.
estimated that the cumu-
lative mortality among hip fracture patients is 37.1% in
Correspondence: Dr Toby O. Smith, Queen’s Building, Faculty
of Medicine and Health Sciences, University of East Anglia,
Norwich Research Park, Norwich, NR4 7TJ, UK.
© 2016 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1193–1201