Osteoarthritis or degenerative joint disease is characterized by the breakdown of articular cartilage, which leads to rubbing and friction of adjacent bones and consequent local inflammation, pain and impaired movement. Osteoarthritis is associated with aging and is more prevalent in menopausal women, suggesting a role for female hormone deficiency in its etiology . A recent review by Christiansen’s group pointed at the direct and indirect effects of estrogen on articular cartilage, as well as the importance of hormone therapy for maintaining not only bone but also cartilage health in postmenopausal women . However, another systematic review now published in [i]Rheumatology[/i] concluded that there is no clear association between female sex hormones and osteoarthritis of the hand, hip and knee . The review used the Medline and EMBASE search engines to search for articles that assess the association between osteoarthritis of the hand, hip or knee and female sex hormones. The determinants included endogenous hormones, age at menarche and/or menopause, duration of fertile period, menopausal status, years since menopause and surgical menopause.
Concerning age at menarche, only two studies [4, 5] have found that a younger age increased the risk of osteoarthritis, but other studies did not find such an association. There was no association between osteoarthritis and the duration of the fertile period. Endogenous early follicular phase estradiol concentration did not correlate with radiological knee osteoarthritis, but data are limited concerning the association of low blood estradiol levels and the incidence of knee osteoarthritis. There were conflicting data on the relation of age at menopause with hand osteoarthritis; for hip or knee osteoarthritis, there was overall moderate evidence suggesting no relationship. In addition, years since menopause did not correlate with knee or hand osteoarthritis. Interestingly, the data concerning surgical menopause are conflicting; those reported by Spector and colleagues indicated that the rate of hip osteoarthritis was lower in those women who had both ovaries removed , whereas the other report demonstrated a protective effect for radiological hip osteoarthritis following bilateral oophorectomy .
Khunying Kobchitt Limpaphayom
President of Thai Menopause Society, Department of Obstetrics & Gynaecology, Faculty of Medicine, Chulalongkorn University, Thailand