Hormone therapy may be a way for women to prevent knee osteoarthritis later in life, according to a study published in menopause In December 2018.
Osteoarthritis of the knee is common, especially among elderly women
Osteoarthritis (OA) is the most common musculoskeletal disorder among the elderly, and it most commonly affects the knees, hips, lower back, and neck. While it’s an equal opportunity condition, affecting nearly 27 million people in the United States, after age 45, symptoms of knee osteoarthritis are more common in women than men, according to the Arthritis Foundation.
Given that the increased prevalence of knee osteoarthritis in women coincides with the transition to menopause, clinicians and researchers have long wondered whether hormonal changes play a role. More recently, some small studies have investigated the effects of hormone therapy (HT) on osteoarthritis of the knee among postmenopausal women, with mixed results.
Now a new large-scale study from Korea, published in the December 2018 issue of the journal menopause, the image is changed. Using data from 4,766 postmenopausal women, the researchers found that the prevalence of knee osteoarthritis was 30 percent lower in participants who used HT for menopause for a year or more than in women who did not use HT.
Muscle joint damage caused by wear and tear over time
To be clear, arthritis is caused by degenerative changes in the joints, not hormonal changes per se. Degenerative changes “wear and tear” include the breakdown of cartilage, which can lead to pain, swelling, and difficulty moving the affected joint. However, since high concentrations of estrogen are known to have an anti-inflammatory effect, it has been hypothesized that hormonal changes in middle age, especially lower estrogen levels, may lead to an increased risk of postmenopausal osteoporosis.
Does estrogen help protect the joints of women?
“Estrogen receptors are found in joint tissues, and their presence suggests that estrogen may play a role by protecting their structure and biomechanical function,” he explains. Joan Pinkerton, MD, executive director of the North American Menopause Society (NAMS) and professor of obstetrics and gynecology at the University of Virginia Health System in Charlottesville. “Several studies have shown that joint pain worsens during menopause and that maintaining normal levels of the reproductive hormones estrogen and progesterone appears to reduce joint pain in women” who use HT. This study suggests that taking estrogen during menopause may prevent cartilage damage and reduce knee deterioration. [that’s] Seen on X-ray,” Dr. Pinkerton says.
How hormones may help prevent joint pain
“Hormones influence the development of osteoarthritis — we see women report more arthritis pain in their joints around menopause,” he says. Cordelia Carter, MD, an orthopedic surgeon and director of the Women’s Sports Center at NYU Langone Health in New York City. “But osteoarthritis is very common with aging, and the way people report their arthritis pain may really be different.”
Related: What is the feeling of arthritis pain?
Other factors about joint pain and hormone therapy to consider
In short, Dr. Carter says, the story of HT-OA is more than the study from Korea reveals. She notes that the use of hormone therapy for menopause is linked to lower rates of obesity and diabetes among older women. This is important when it comes to OA because “diabetes is associated with chronic inflammation, and obesity puts more stress on joints,” she says. On the other hand, Carter adds, “Other symptoms associated with menopause — such as sleep interruption and mood disturbances — can make knee pain from osteoarthritis worse.” If using HT relieves sleep disturbances and mood problems, these may be other mechanisms by which it improves symptoms caused by knee osteoarthritis.
Related: 13 Natural Remedies for Osteoporosis
Who Should Consider Using Hormone Therapy?
Of course, not every woman with arthritis is a candidate for HT, due to other health considerations (if she has a high risk of developing breast cancer, for example), Carter notes. Your best bet is to talk to your doctor about the potential risks and benefits of HT that apply to you.
Related: Menopause treatments and premenopausal symptoms