Calcified Tissue International

, Volume 84, Issue 4, pp 249–256 | Cite as

Osteoarthritis and Risk of Fractures



We conducted a case–control study on the effects of osteoarthritis (OA) on the risk of fractures. There were 124,655 fracture cases and 373,962 age- and gender-matched controls. The main exposure was OA, and the main confounders were use of diuretics, antihypertensive drugs, and pain medication. OA was associated with a decreased risk of any fracture and of hip, forearm, and spine fractures. In general a decreasing trend in the risk of fractures was present with increasing time sine diagnosis of OA. The effect on fractures in areas rich in cortical bone such as the hip in general was larger than effects on skeletal sites rich in trabecular bone such as the spine. OA in the hip and knee, in general, was associated with a decreasing risk of fractures with time since diagnosis of OA, while this was not the case for OA in other locations. OA seems to be associated with a decreased risk of fractures at multiple skeletal sites as well as sites far from the location of OA. This may indicate systemic effects on bone strength, especially in areas rich in cortical bone.


Osteoarthritis Fracture Hip Knee Analgesic 


  1. 1.
    Cooper C, Cook P, Osmond C et al (1991) Osteoarthritis of the hip and osteoporosis of the proximal femur. Ann Rheum Dis 50:540– 542PubMedCrossRefGoogle Scholar
  2. 2.
    Belmonte-Serrano M, Bloch D, Lane N et al (1993) The relationship between spinal and peripheral osteoarthritis and bone density measurements. J Rheumatol 20:1005–1013PubMedGoogle Scholar
  3. 3.
    Schneider D, Barrett-Connor E, Morton D et al (2002) Bone mineral density and clinical hand osteoarthritis in elderly men and women: the Rancho Bernardo study. J Rheumatol 29:1467–1472PubMedGoogle Scholar
  4. 4.
    Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259PubMedGoogle Scholar
  5. 5.
    Dequeker J, Mokassa L, Aerssens J et al (1997) Bone density and local growth factors in generalized osteoarthritis. Microsc Res Tech 37:358–371PubMedCrossRefGoogle Scholar
  6. 6.
    Abdin-Mohamed M, Jameson K, Dennison E, et al (2009) Volumetric bone mineral density of the tibia is not increased in subjects with radiographic knee osteoarthritis. Osteoarthritis Cartilage 17(2):174–177PubMedCrossRefGoogle Scholar
  7. 7.
    Dequeker J, Johnell O (1993) Osteoarthritis protects against femoral neck fracture: the MEDOS study experience. Bone 14(Suppl 1):S51–S56PubMedCrossRefGoogle Scholar
  8. 8.
    Roux C, Fechtenbaum J, Briot K et al (2008) Inverse relationship between vertebral fractures and spine osteoarthritis in postmenopausal women with osteoporosis. Ann Rheum Dis 67:224–228PubMedCrossRefGoogle Scholar
  9. 9.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with use of nonsteroidal anti-inflammatory drugs, acetylsalicylic acid, and acetaminophen and the effects of rheumatoid arthritis and osteoarthritis. Calcif Tissue Int 79:84–94PubMedCrossRefGoogle Scholar
  10. 10.
    Arden NK, Crozier S, Smith H et al (2006) Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum 55:610–615PubMedCrossRefGoogle Scholar
  11. 11.
    Sornay-Rendu E, Munoz F, Duboeuf F et al (2004) Disc space narrowing is associated with an increased vertebral fracture risk in postmenopausal women: the OFELY Study. J Bone Miner Res 19:1994–1999PubMedCrossRefGoogle Scholar
  12. 12.
    Juhakoski R, Heliövaara M, Impivaara O et al (2009) Risk factors for the development of hip osteoarthritis: a population-based prospective study. Rheumatology (Oxford) 48:83–87CrossRefGoogle Scholar
  13. 13.
    Messier SP (2009) Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Med Clin North Am 93:145–159PubMedCrossRefGoogle Scholar
  14. 14.
    Vestergaard P, Emborg C, Stoving R et al (2002) Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders—a nation-wide register study. Int J Eat Disord 32:301–308PubMedCrossRefGoogle Scholar
  15. 15.
    Andersen T, Madsen M, Jorgensen J et al (1999) The Danish National Hospital Register. Dan Med Bull 46:263–268PubMedGoogle Scholar
  16. 16.
    Mosbech J, Jorgensen J, Madsen M et al (1995) The Danish National Patient Register: evaluation of data quality [in Danish]. Ugeskr Laeger 157:3741–3745PubMedGoogle Scholar
  17. 17.
    Vestergaard P, Rejnmark L, Mosekilde L (2004) Fracture risk associated with use of anti-epileptic drugs. Epilepsia 45:1330–1337PubMedCrossRefGoogle Scholar
  18. 18.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health 34:371–377PubMedCrossRefGoogle Scholar
  19. 19.
    Kanis J, Johansson H, Johnell O et al (2005) Alcohol intake as a risk factor for fracture. Osteoporos Int 16:737–742PubMedCrossRefGoogle Scholar
  20. 20.
    Klotzbuecher C, Ross P, Landsman P et al (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  21. 21.
    Munk-Jorgensen P, Mortensen P (1997) The Danish Psychiatric Central Register. Dan Med Bull 44:82–84PubMedGoogle Scholar
  22. 22.
    Vestergaard P, Mosekilde L (2002) Fracture risk in patients with celiac disease, Crohn’s disease, and ulcerative colitis: a nation-wide follow-up study in 16, 416 patients in Denmark. Am J Epidemiol 156:1–10PubMedCrossRefGoogle Scholar
  23. 23.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Fracture risk associated with use of morphine and opiates. J Intern Med 260:76–87PubMedCrossRefGoogle Scholar
  24. 24.
    Lethbridge-Cejku M, Tobin JD, Scott WWJ et al (1996) Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol 23:1943–1947PubMedGoogle Scholar
  25. 25.
    Jones G, Nguyen T, Sambrook PN et al (1995) A longitudinal study of the effect of spinal degenerative disease on bone density in the elderly. J Rheumatol 22:932–936PubMedGoogle Scholar
  26. 26.
    De Laet C, Kanis J, Oden A et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporosis Int 16:1330–1338CrossRefGoogle Scholar
  27. 27.
    Vestergaard P, Rejnmark L, Mosekilde L (2005) Fracture risk associated with systemic and topical corticosteroids. J Intern Med 257:374–384PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Peter Vestergaard
    • 1
    • 2
  • Lars Rejnmark
    • 1
  • Leif Mosekilde
    • 1
  1. 1.Department of Endocrinology and Metabolism CAarhus Amtssygehus, Aarhus University HospitalAarhusDenmark
  2. 2.The Osteoporosis ClinicAarhus Amtssygehus, Tage Hansens Gade 2Aarhus CDenmark

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