Pain Increases the Risk of Developing Frailty in Older Adults with Osteoarthritis

Objective. While osteoarthritis (OA)-related pain increases the risk of physical inactivity, disability, and falls, less is known about whether pain increases the risk of frailty. We investigated if people with OA reporting pain are more likely to develop frailty than people with OA without pain. Design. Population-based prospective cohort study with a follow-up of 4.4 years. Setting. Community. Subjects. The subjects were 1,775 older men and women with osteoarthritis, enrolled in the Progetto Veneto Anziani. Methods. Pain was ascertained according to medical records, symptoms/signs, and use of analgesics. Participants were considered frail if they met three out of five criteria of Fried's Index. Results. Cross-sectional analysis at baseline demonstrated that after adjusting for potential confounders (age, gender, anthropometric and demographic data, comorbidities), people with OA and pain (n=568) were significantly more likely to have frailty compared with those with OA without pain (n=1,207; hand OA, OR = 1.86, 95% CI=1.6-2.09; hip OA, OR=1.62, 95% CI=1.44-1.83; knee OA, OR=1.42, 95% CI=1.26-1.60; all p < 0.0001). Prospective analysis of 1,152 nonfrail subjects at baseline demonstrated that 19.9% developed incident frailty. A fully-adjusted logistic regression analysis demonstrated that lower limb OA-related pain was associated with an increased risk of developing frailty compared with people with OA and no pain. Conclusions. Pain related to OA might be an important factor influencing the relationship between OA and the development of frailty.