Falls and pathology of the musculoskeletal system in the older age groups

Khovasova N.O.; Moroz V.I.; Tkacheva O.N.

doi:https://doi.org/10.17116/jnevro20201200217

Close metadata

Recommended articles:

Painful diabetic polyneuropathy in patients with cerebrovascular diseases. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(7):64-72

Comparative evaluation of oral chondroprotectors effectiveness in patients with low back pain. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(7):98-103

Myoadaptive overload syndromes of lower extremities in multiple sclerosis patients. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(7-2):89-93

Ways to optimize the management of lower back pain patients at the outpatient stage. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(12):148-153

Frailty in patients with atrial fibrillation: diagnosis, management, prevention and influence on prognosis. Russian Cardiology Bulletin. 2025;(1):5-12

Sarcopenia index for detecting of the decreased muscle strength and mass in patients with the non-alcoholic fatty liver disease. Russian Journal of Preventive Medicine. 2025;(7):68-74

Current concepts of pathogenesis, diagnosis and treatment of patients with odontogenic facial pain. Russian Journal of Stomatology. 2025;(3):13-18

Circulating cytokine profile in patients with obesity depending on the sarcopenia presence. Russian Journal of Preventive Medicine. 2025;(11):66-71

The role of protein in the elderly patients nutrition. Russian Journal of Preventive Medicine. 2026;(2):90-96

Abstract:

Background. Fall in the elderly is considered as a geriatric syndrome, which increases the risk of new falls, decreases physical functioning and autonomy and is associated with other geriatric syndromes. One of the most common risk factors for falls is the pathology of the musculoskeletal system, including osteoarthritis, sarcopenia, osteopenia and osteoporosis, as well as chronic pain. Objective. To characterize diseases of the musculoskeletal system in elderly patients with falls. Materials and methods. The study included 289 patients (mean age 75,8±7,9 years, 224 women) who underwent falls during the last year. All patients had polymorbid pathology (mean number of diseases 5,13±2,3, the Charlson index 5,63±1,8 points). All patients underwent general clinical studies, a comprehensive geriatric assessment, X-ray examination of the joints, dual-energy X-ray absorptiometry. Results and Conclusion. The risk of falls assessed with a self-assessment scale as 7,45±3 points had 90,3% of patients, 34,6% of patients had the high hospital risk of falls. All patients had aggravated geriatric status (on average 7 geriatric syndromes). Among the risk factors for falls, one of the most common was the condition associated with the pathology of the musculoskeletal system: chronic pain (84,7%), physical inactivity (56,1%), disorders of balance (60,2%) and gait (35,9%), the use of mobility aids (30,4%), orthopedic pathology (9,7%) and vitamin D deficiency (86,1%). Osteoarthritis prevailed (75,8%) among nosological forms. One hundred and forty-two (64,8%) patients had pain in the joints, the duration of pain was 6,2±5,6 days, the pain intensity was 47,2±20,7 mm on a visual analogue scale and 106,3±112,3 points by WOMAC. The neuropathic component was diagnosed on DN4 scale in 34 (23,9%) patients. Dynapenia was detected in 109 (37,7%) patients, and sarcopenia in 28 (25,6%) of them. The risk of osteoporotic fractures was 17,4±7,9%. The significantly higher incidence of dynapenia, insufficiency and deficiency of vitamin D and a higher risk of osteoporotic fractures was observed in 289 patients with falls compared to 213 people without falls.

Keywords:

falls

geriatric syndrome

senile asthenia

chronic pain syndrome

sarcopenia

chondroitin sulfate

Chondroguard

glucosamine sulfate

Sustaguard Artro

Authors:

Khovasova N.O.

Pirogov Russian National Research Medical University, Moscow, Russia;
Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University, Moscow, Russia

Moroz V.I.

Russian Clinical and Research Center of Gerontology of Pirogov Russian National Research Medical University, Moscow, Russia

Tkacheva O.N.

Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia

SPIN RSCI: 6129-5809
Scopus AuthorID: 6602941818
ResearcherID: M-4510-2014
ORCID: 0000-0002-4193-688X

Close metadata

References:

WHO Global report on falls Prevention in older Age, 2007. http://www.whogis.com
Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged medicare population. American Journal of Preventive Medicine. 2012;43:59-62. https://doi.org/10.1016/j.amepre.2012.03.008
Hoops M, Rosenblatt N, Hurt C, Crenshaw J, Grabiner M. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? Womens Health (Lond Engl) Health. 2012;8:685-698. https://doi.org/10.2217/whe.12.53
Zhao S, Cao Y, Lei Y, Liu F, Shao S, Liu J, Nie D, Yang N, Liu M. Population ageing and injurious falls among one million elderly people who used emergency medical services from 2010 to 2017 in Beijing, China: a longitudinal observational study. BMJ Open. 2019;9:e028292. https://doi.org/10.1136/bmjopen-2018-028292
Pasquett P, Apicell L, Mangone G. Pathogenesis and treatment of falls in elderly. Clinical Cases in Mineral and Bone Metabolism. 2014;11(3):222-225. https://doi.org/10.11138/ccmbm/2014.11.3.222
Yogi RR, Sammy I, Paul JF, Nunes P, Robertson P, Maharaj VR. Falls in older people: comparing older and younger fallers in a developing country. Eur J Trauma Emerg Surg. 2018;44:567. https://doi.org/10.1007/s00068-017-0818-2
Spaniola K, Chang J, Getstring M, Sangosanya A, Stassen N, Bankey P. Ground level falls are associated with significant mortality in elderly patients. J Trauma. 2010;69(4):821-825. https://doi.org/10.1097/TA.0b013e3181efc6c6
Grossman MD, Miller D, Scaff DW, Arcona S. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma. 2002;52(2):242-246. https://doi.org/10.1097/00005373-200202000-00007
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Injury Prevention. 2006;12:290-295. https://doi.org/10.1136/ip.2005.011015
Centers for Disease Control and Prevention. Cost of fall injury in older persons in the United States, 2005. 2011. URL: http://www.cdc.gov/homeandrecreationalsafety/falls/data/cost-estimates.html
Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken). 2015;67(5):633-639. https://doi.org/10.1002/acr.22499
Barbour KE, Stevens JA, Helmick CG, Luo YH, Murphy LB, Hootman JM, Theis K, Anderson LA, Baker NA, Sugerman DE; Centers for Disease Control and Prevention (CDC). Falls and fall injuries among adults with arthritis — United States, 2012. MMWR Morb Mortal WklyRep. 2014;63:379-383.
Sahli Hana, Ben Tekaya Aicha, Daas Selim, Mahmoud Ines, Tekaya Rawdha. Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients. Current Rheumatology Reviews. 2018;14:2. https://doi.org/10.2174/1573397113666170425150133
Nikolic G, Nedeljkovic B, Trajkovic G, Rasic D, Mirkovic Z, Pajovic S, Grbic R, Sipetic S, Vujcic I. Pain, Physical Function, Radiographic Features, and Quality of Life in Knee Osteoarthritis Agricultural Workers Living in Rural Population. Pain Res Manag. 2019;7684762. Published 2019 Sep 29. https://doi.org/10.1155/2019/7684762
Foley S, Lord S, Srikanth V, Cooley H, Jones G. Falls risk is associated with pain and dysfunction but not radiographicosteoarthritis in older adults: Tasmanian Older Adult Cohort study. Osteoarthritis Cartilage. 2006;14:533-539. https://doi.org/10.1016/j.joca.2005.12.007
Yang M, Liu Y, Zuo Y, Tang H. Sarcopenia for predicting falls and hospitalization in community-dwelling older adults: EWGSOP versus EWGSOP2. Sci Rep. 2019;9:17636. https://doi.org/10.1038/s41598-019-53522-6
Sepúlveda-Loyola W, Phu S, Hassan EB, Brennan-Olsen SL, Zanker J, Vogrin S, Conzade R, Kirk B, Saedi AA, Probst V, Duque G. The Joint Occurrence of Osteoporosis and Sarcopenia (Osteosarcopenia): Definitions and Characteristics. Journal of the American Medical Directors Association. Published online: October 25, 2019. https://doi.org/10.1016/j.jamda.2019.09.005
Gadelha AB, Neri SGR, Vainshelboim B, Ferreira AP, Lima RM. Dynapenic abdominal obesity and the incidence of falls in older women: a prospective study. Aging Clin Exp Res. 2019. https://doi.org/10.1007/s40520-019-01318-z
Verghese J, Wang C, Lipton RB, Holtzer R. Motoric cognitive risk syndrome and the risk of dementia. J Gerontol A Biol Sci Med Sci. 2013;68:412-418. https://doi.org/10.1093/gerona/gls191
Harvey NC, Oden A, Orwoll E, Lapidus J, Kwok T, Karlsson MK Rosengren BE, Ljunggren Ö, Cooper C, McCloskey E, Kanis JA, Ohlsson C, Mellström D, Johansson H. Falls predict fractures independently of FRAX probability: a meta-analysis of the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2017. https://doi.org/10.1002/jbmr.3331
Smulders E, van Lankveld W, Laan R, Duysens J, Weerdesteyn V. Does osteoporosis predispose falls? A study on obstacle avoidance and balance confidence. BMC Musculoskelet Disord. 2011;12:1. Published 2011 Jan 3. https://doi.org/10.1186/1471-2474-12-1
Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y. Spinal curvature and postural balance in patients with osteoporosis. Osteoporosis Int. 2009;20:2049-2053. https://doi.org/10.1007/s00198-009-0919-9
Dionyssiotis Y, Skarantavos G, Papagelopoulos P. Modern rehabilitation in osteoporosis, falls, and fractures. Clin Med Insights Arthritis Musculoskelet Disord. 2014;7:33-40. Published 2014 Jun 12. https://doi.org/10.4137/CMAMD.S14077
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Systematic Rev. 2012;9. https://doi.org/10.1002/14651858.cd007146.pub3
Pasquetti P, Apicell L, Mangone G. Pathogenesis and treatment of falls in elderly. Clinical Cases in Mineral and Bone Metabolism. 2014;11(3):222-225. https://doi.org/10.11138/ccmbm/2014.11.3.222
Klinicheskie rekomendacii ministerstva zdravoohranenija Rossijskoj federacii «Starcheskaja astenija». 2018. (In Russ.)
Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing; 2018.
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2019.06.011
Bruyère O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier J-P, Rannou F, Rizzoli R, Roth R, Uebelhart D, Cooper C, Reginster J-Y. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Seminars in Arthritis and Rheumatism. 2019;49:3:337-350. https://doi.org/10.1016/j.semarthrit.2019.04.008
Persiani S, Roda E, Rovati LC et al (2005) Glucosamine oral bioavailability and plasmapharmacokinetics after increasing doses of crystalline glucosamine sulfate in man. Osteoarthr Cartil13:1041–1049.
Zhang W, Nuki G, Moskowitz RW et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 18:476–499. Bjordal JM, Klovning A, Ljunggren AE (2007) Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials. Eur J Pain 11:125–138.
Rovati LC, Girolami F, D’Amato M, Giacovelli G. Effects of glucosamine sulfate on the use of rescue non-steroidal anti-inflammatory drugs in knee osteoarthritis: results from the Pharmaco-Epidemiology of GonArthroSis (PEGASus) study. Semin Arthritis Rheum. 2016;45:3:34-41. https://doi.org/10.1016/j.semarthrit.2015.10.009
Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, Vaghi P, Rovati LC. Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis: a systematic review and metaanalysis. JAMA. 2018;320:24:2564-2579. https://doi.org/10.1001/jama.2018.19319
Reginster JY, Dudler J, Blicharski T, Pavelka K. Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017;76:9:1537-1543. https://doi.org/10.1136/annrheumdis-2016-210860
Pelletier JP, Raynauld JP, Beaulieu AD, Bessette L, Morin F, Ade Brum-Fernandes AJ, Delorme P, Dorais M, Paiement P, Abram F, Martel-Pelletier J. Chondroitin sulfate efficacy versus celecoxib on knee osteoarthritis structural changes using magnetic resonance imaging: a 2-year multicentre exploratory study. Arthritis Res Ther. 2016;18:1:256. https://doi.org/10.1186/s13075-016-1149-0
Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, Vaghi P, Rovati LC. Association of pharmacological treatments with long-term pain control in patients with knee osteoarthritis: a systematic review and metaanalysis. JAMA. 2018;320:24:2564-2579. https://doi.org/10.1001/jama.2018.19319
Shang Q, Yin Y, Zhu L, Li G, Yu G, Wang X. Degradation of chondroitin sulfate by the gut microbiota of Chinese individuals. In International Journal of Biological Macromolecules, Volume. 2016;86:112-118. https://doi.org/10.1016/j.ijbiomac.2016.01.055
Alekseeva LI, Sharapova EP, Kashevarova NG, Taskina EA, Lila AM, Bogdanov AN, Bozhkova SA, Bagretsova AA, Noskov SM, Grunina EA. Comparative study of the efficacy and safety of Chondroguard® during its combined (intra-articular and intramuscular) and intramuscular injection in patients with knee osteoarthritis. Sovremennaja revmatologija. 2018;12(2):44-49. (In Russ.)
Stabler TV, Huang Z, Montell E, Vergés J, Kraus VB. Chondroitin sulphate inhibits NF-κB activity induced by interaction of pathogenic and damage associated molecules. Osteoarthritis and Cartilage. 2017;25(1):166-174. https://doi.org/10.1016/j.joca.2016.08.012
Ngoc Hoan Le, Chu-Sook Kim, Taesun Park, Jung Han Yoon Park, Mi-Kyung Sung, Dong Gun Lee, Sun-Myung Hong, Suck-Young Choe, Tsuyoshi Goto, Teruo Kawada, Rina Yu. Quercetin protects against obesity-induced skeletal muscle inflammation and atrophy. Mediators of Inflammation. 2014;2014:1-10. https://doi.org/10.1155/2014/834294
Fioravanti A, Collodel G. In Vitro Effects of Chondroitin Sulfate. Advances in Pharmacology. 2006;53:449-465. https://doi.org/10.1016/s1054-3589(05)53022-9
Takeuchi S, Nakano S-I, Nakamura K, Ozoe A, Chien P, Yoshihara H, Hakuno F, Matsuwaki T, Saeki Y, Takahashi S-I, Yamanouchi K, Nishihara M. Roles of chondroitin sulfate proteoglycan 4 in fibrogenic/adipogenic differentiation in skeletal muscle tissues. Experimental Cell Research. 2016;347(2):367-377. https://doi.org/10.1016/j.yexcr.2016.08.023
Petersen SG, Beyer N, Hansen M, Holm L, Aagaard P, Mackey AL, Kjaer M. Nonsteroidal anti-inflammatory drug or glucosamine reduced pain and improved muscle strength with resistance training in a randomized controlled trial of knee osteoarthritis patients. Arch Phys Med Rehabil. 2011;92(8):1185-1193.