Osteoarthritis of the Hip and Knee: Sex and Gender Differences

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Epidemiology: how does the incidence of osteoarthritis differ between men and women?

OA is the most common chronic illness in the United States; it affects 59% of Americans 65 years of age or older. The overall prevalence of OA is higher in women as compared with men [2]. Reasons for this are not clear. Although genetics has been shown to influence OA, sex differences also may influence this prevalence.

Meta-analysis and meta-regression have been used to better define site-specific sex differences in prevalence, incidence, and severity of OA [3]. Table 1 details these findings.

Anatomy and physiology: how do they differ between men and women?

Given this sex difference in burden of disease, investigations have focused on the role of sex hormones on the development of OA. Estrogen receptors are found in many cell types, including human articular cartilage and bone [4], [5], [6]. Thus, human articular cartilage is hormonally sensitive.

Studies have focused on estrogen receptor genes. Investigating individuals in the Rotterdam Study (a large, population-based study of elderly white individuals living in the Netherlands), Bergink and

Risk factors and prevention: do they differ between men and women?

Various factors may influence the risk for development of OA. Generally, accepted risk factors include advancing age, hip dysplasia, obesity, and previous joint injury. Other factors that may influence OA development are use of postmenopausal estrogen, level of exercise, and osteoporosis (OP). Some of these factors clearly differ between men and women.

Diagnosis: do men and women present the same or differently?

The diagnosis of OA of the hip or knee does not differ between genders. Patients who have severe hip or knee OA typically present with significant joint pain, painful and limited ambulation, discomfort that is exacerbated with weight-bearing activities, and marked joint space narrowing and osteophyte formation.

Men and women may present differently in terms of severity of symptoms, however. Studies have suggested a discrepancy in health care interventions between genders. Investigating

Are treatment methods different between men and women?

Joint replacement surgery is the treatment for severe, disabling hip and knee OA. There is consensus that such procedures are effective and consistently relieve pain and improve function. In a study of preoperative functional status before and 6 months following total hip or knee arthroplasty, patients with lower preoperative physical function did not improve following surgery to the same degree as did patients with less impairment before surgery [65]. The investigators noted this was most

Summary

Sex and gender differences exist in OA. Our understanding of these differences is at a preliminary stage. Further research, specifically to address sex and gender differences, is needed. With the current knowledge, an effort should be made to decrease the burden of disease that is related to OA. These efforts should focus on improved education of patients, particularly women, to decrease the risk for OA and progression of degenerative changes, as well as optimal outcomes following joint

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