Osteoarthritis and Frailty in Elderly Individuals Across Six European Countries

Results From the European Project on OSteoArthritis (EPOSA)

Maria Victoria Castell; Suzan van der Pas; Angel Otero; Paola Siviero; Elaine Dennison; Michael Denkinger; Nancy Pedersen; Mercedes Sanchez-Martinez; Rocio Queipo; Natasja van Schoor; Sabina Zambon; Mark Edwards; Richard Peter; Laura Schaap; Dorly Deeg


BMC Musculoskelet Disord. 2015;16(359) 

In This Article


Osteoarthritis (OA) is thought to be the most prevalent chronic joint disease in the world and one of the most common sources of pain and disability in the elderly.[1] Half of the world's population aged 65 and older suffer from OA, and 80 % of people with symptomatic OA have limitations in movement, while 25 % cannot perform their normal daily activities.[2] The prevalence of OA varies widely depending on the whether the criteria adopted are based on self-report, clinical report and/or radiologic imaging.[3–8] It clearly increases with age, and may even triple in frequency in persons age 70 or over and in those with obesity.[3,4]

Because OA occurs in older adults who also have age-related changes in muscle, bone, fat and the nervous system, it is likely that a more general and systemic approach will be needed to better understand the link between aging and OA.[9]

Frailty is a physiological state characterized by the deregulation of multiple physiologic systems of an aging organism determining the loss of homeostatic capacity, which exposes the elderly to disability, diseases, and finally death.[10–12] The clinical phenotype of frailty manifests as multi-system pathologies characterized by low physical activity, global weakness with low muscle strength, exhaustion, overall slowness and loss of weight.[10,11] The worldwide prevalence of frailty ranges between 6.9 % and 42.6 %.[10,13–17] There is also a documented heterogeneity in the quality of aging among different geographic areas, which suggests the need for a frailty classification approach providing population-specific results.[15] Pre-frailty occurs at an earlier stage of the frailty spectrum and is associated with the later development of frailty. Thus, pre-frailty might be a better target of screening and implementation of early interventions.[12,17]

Frailty as a geriatric syndrome it has its pathophysiological substrate in sarcopenia;[18] it involves loss of functionality and is a prognostic factor for disability.[16] OA is not purely a mechanical problem. In addition to age, genetic and nutritional factors are also important; obesity predisposes individuals to OA both for mechanical reasons and through inflammatory or metabolic mechanisms.[4,8] Some studies have found a relationship between OA and frailty, using different diagnostic criteria in both processes[19–21] but, to our knowledge, in Europe there are no population-based studies that relate the two concepts. The EPOSA project is a population-based study using pre-harmonized data across six European countries on older community-dwelling persons aged 65 to 85 years, and it includes clinical data on OA and frailty.[22] This project provides an opportunity for in-depth study of the association between OA and frailty across Europe in an elderly population.

Accordingly, the objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project.