European Journal of Rheumatology
Invited Review

Sex Difference in OA: Should We Blame Estrogen?


Department of Biostatistics and Epidemiology, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States


Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom


Academic Primary Care, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom

Eur J Rheumatol 2024; 11: Supplement S7-S14
DOI: 10.5152/eurjrheum.2023.20193
Read: 1310 Downloads: 1238 Published: 23 January 2023

Osteoarthritis (OA) is a leading cause of chronic pain and disability, not only in the United States but also worldwide. The burden of OA is higher in women than in men. Estrogen as a possible explanation for observed sex differences in OA has not been definitively established. The purpose of this review was to summarize the results from studies of estrogen, estrogen depletion and treatment, and their impact on knee, hip, hand, and spine OA. We conducted a targeted review of the literature using PubMed. Although several studies show that hormone replacement therapy has the potential to be protective of OA for some joints, there are studies that showed no protective effect or even adverse effect. Taken together, the evidence for the protective effect of estrogen therapy depends on OA joint, OA outcome, and study design. Although this area has been studied for decades, more exclusively since the 1990s, there is a lack of high-quality experimental research in this topic. The lack of definitive conclusion on whether estrogen can play a role in the development in OA of either the knee, hip, spine, or hand is often in part due to the noncomparability of studies existing within the literature. Differences in diagnostic criteria, imaging modalities, populations studied, study designs, and outcome measures, as well as random error, have all contributed to inconclusive evidence. Future research on the role of estrogen in OA is needed, particularly as global demographic shifts in increasing overweight/obesity prevalence and ageing populations may contribute to widening OA-related health inequalities.

Cite this article as: Nguyen USDT, Saunders FR, Martin KR. Sex difference in OA: Should we blame estrogen? Eur J Rheumatol. 2024;11(suppl 1):S7-S14

EISSN 2148-4279