Hormone therapy may be best defense against knee osteoarthritis

7 January 2019: 

There is an ongoing debate regarding the relationship between knee osteoarthritis and hormone therapy (HT), with small-scale studies providing mixed results. A new large-scale study from Korea shows that women receiving HT had a significantly lower prevalence of symptomatic knee osteoarthritis compared with women who did not take hormones. Study results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

Osteoarthritis is the most common musculoskeletal disorder in older persons and is the leading cause of pain and physical disability. Caused by degenerative changes in the joints, it affects more women than men, and its incidence is particularly elevated in menopause. Because estrogen has an anti-inflammatory effect at high concentrations, it has been hypothesized that hormone changes in women, especially decreasing estrogen levels, may lead to an increase in osteoarthritis after menopause.

Because the knee is the most commonly affected joint, knee osteoarthritis has been the focus of a number of studies relative to the effectiveness of HT. The most common treatments for knee osteoarthritis include surgery or nonsteroidal anti-inflammatory drugs, both of which are associated with risks such as surgical complications or gastrointestinal disorders.

Several small studies have shown that HT not only reduces histologic changes in the cartilage involved in osteoarthritis, but it also reduces the chronic pain. To date, however, no large-scale studies have examined symptomatic knee osteoarthritis and HT. This latest study out of Korea is based on data from nearly 4,800 postmenopausal women. It concluded that the prevalence of knee osteoarthritis was significantly lower in participants using HT than those not taking hormones. The authors did note, however, that additional research is warranted to adjust for such other variables such as age and body mass index.

Abstract

Objective:
The incidence of osteoarthritis (OA) increases after menopause, and may be related to hormonal changes in women. Estrogen deficiency is known to affect the development of OA, and menopausal hormone therapy (MHT) is suggested to be related to the development of OA. However, the relationship between knee OA and MHT remains controversial. The association between knee OA prevalence and MHT was investigated using large-scale national data.

Methods:
Data were collected from 4,766 postmenopausal women from the Korea National Health and Nutrition Examination Survey (2009-2012). MHT was defined as regular hormone medication for ≥1 year, and demographic and lifestyle variables were compared between the MHT and non-MHT groups. Knee OA was defined according to symptoms and radiographic findings.

Results:
In the multiple logistic regression models, the OA odds ratio was 0.70 for the MHT group (95% confidence interval 0.50-0.99), compared with the non-MHT group.

Conclusions:
The prevalence of knee OA was lower in participants with MHT than in those without MHT.

Reference

Jung JH, Bang CH, Song GG, Kim C, Kim JH, Choi SJ. Knee osteoarthritis and menopausal hormone therapy in postmenopausal women: a nationwide cross-sectional study. Menopause. 2018 Dec 21. doi: 10.1097/GME.0000000000001280. [Epub ahead of print]