What’s the deal with osteoarthritis?

  • Osteoarthritis (OA) is the most common joint disease globally, hitting the knees, hips, and hands the hardest.
  • As of 2021, around 600 million people were living with OA—up from ~303 million in 2017—making it a fast-growing epidemic
  • OA doesn’t just cause joint pain. It’s a whole joint disorder: think cartilage breakdown, inflamed fat pads, and bone changes. It leads to stiffness, slower movement, and weaker muscles—and that combo sets the stage for… falls.

Falls: not just embarrassing, but deadly serious

  • Falling is the #1 cause of fatal injuries in people age 65+ in the U.S., and has spiked 41% since 2012
  • For older adults, a fall isn’t just bruising—it can spiral into fractures, mobility loss, and an expensive healthcare rollercoaster.

OA and falls: is there a real connection?

Honestly—it’s complicated. Previous research has been all over the place due to differences in how OA is defined and how falls are tracked.

  • A big review (862,000+ people) found:
    • Symptomatic knee and hip OA → 55% higher risk of recurrent falls.
    • Radiographic knee OA (X-rays only) → ~28% greater chance of any fall, but not repeat incidents.
    • Interestingly, radiographic hip OA had a lower chance of repeated falls—but data quality varied widely.
  • Another study of older women reported a staggering ~45% fall rate in the year before hip joint replacement—and hip pain was blamed for over a third of these falls.

But here’s the scoop: hip OA, paracetamol, and genetic insight

A brand-new study used Mendelian randomization (MR)—a fancy genetic tool that works like nature’s own randomized trial—to dig into whether hip OA causes falls, and if paracetamol (Tylenol) mediates this link.

  • Genetic risk for hip OA was causally linked to higher fall risk (Odds Ratio ~1.053).
  • Knee OA showed no causal link to falling.
  • Paracetamol use explained about 21.7% of the risk—suggesting pain relief behavior might make people wobbly.
  • There was no evidence that falling causes OA, ruling out reverse causality.

Why this matters

  1. Hip OA is more than sore joints—it inches you toward falling
  2. Paracetamol might help pain but could harm balance, contributing to falls
  3. Knee OA? Not so much—at least genetically. Hip OA is the bigger culprit

So what can you do?

  • Fall-proof homes: eliminate trip hazards, install grab bars, wear sturdy, supportive footwear.
  • Strength and balance training: think leg exercises, tai chi, physical therapy.
  • Pain meds—use smart: if hip OA causes risky paracetamol use, consult on alternatives like NSAIDs, therapy, or injections.
  • Clinicians: screen hip OA patients for falls. Educate on safe movement and medicinal tradeoffs.

Recap

  • OA affects hundreds of millions worldwide and is especially prevalent in older adults.
  • While knee OA isn’t genetically linked to falling, hip OA is—and paracetamol use is a partial mediator.
  • A holistic approach—pain management, home safety, strength training—can help OA patients stay upright and mobile.

Huang J, Hu X, Wang T, Zhang Y, Wang L. The causal link between osteoarthritis and falls: the mediating role of paracetamol. Aging Clin Exp Res. 2025 Jul 25;37(1):232. doi: 10.1007/s40520-025-03138-w. PMID: 40711723; PMCID: PMC12296754.