Article PDF


osteoarthritis, women, gender, estrogens

Abstract views: 257
PDF Downloads: 156

How to Cite

Iaremenko, O., & Koliadenko, D. (2019). OSTEOARTHRITIS IN WOMEN: ARE THERE ANY DIFFERENCES? Review. Medical Science of Ukraine (MSU), 15(1-2), 93-100. https://doi.org/10.32345/2664-4738.1-2.2019.14


Relevance. Female gender is known to be a major risk factor for osteoarthritis (OA). In addition, women with OA are characterized by some differences in the context of etiopathogenesis, clinical course and prognosis, and the question of clarifying the causes of these differences remains relevant.

Objective: to review the literature data on the epidemiological, etiopathogenic and clinical features of OA in women, as well as the peculiarities of treatment and prognosis based on gender.

Materials and methods. Analysis of scientific publications in the international electronic scientometric database PubMed using keywords "osteoarthritis", "women", "gender", "estrogens" over the period 1989-2019 years.

Results. The incidence of OA is on average almost twice as high among women compared with men. Smoking, alcohol and heavy exercise are significant risk factors of OA for men, while the role of genetic factors is more significant for women. High concentrations of estradiol in women are associated with a lower degree of cartilage destruction, less significant productive synovitis and a lower rate of total arthroplasty. Women with knee OA are characterized by significantly higher pain intensity during walking and knee extension. The strength of quadriceps femoris muscle is significantly lower in women than in men, regardless of the severity of OA. Women with OA are characterized by a higher concentration of C-reactive protein, which is associated with a larger number of painful joints. Women are more likely than men to take non-steroidal anti-inflammatory drugs and use topical agents. The frequency of total arthroplasty among women is much higher, but early rehabilitation after it is relatively more favorable than in men.

Conclusions. Sex hormones, genetic factors, lower extremity muscle strength, anatomical and kinematic features of the knee joints play an important role in the etiopathogenesis of OA in women. Women with OA are characterized by more intense and diffuse character of pain, more significant functional impairments compared to men.

Article PDF


Bartley E. J., King C.D., Sibille K.T., Cruz-Almeida Y., Riley J.L., Glover T.L., et al. Enhanced Pain Sensitivity Among Individuals With Symptomatic Knee Osteoarthritis: Potential Sex Differences in Central Sensitization // Arthritis Care & Research. 2016; 68 (4): 472-80. DOI: 10.1002 / acr.22712

Сross M., Smith E., Hoy D., Nolte S., Ackerman I., Fransen M., et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study // Ann Rheum Dis. 2014; 73 (7): 1323-30. DOI: 10.1136 / annrheumdis-2013-204763.

Glass N., Segal N.A., Sluka K.A., Torner J.C., Nevitt M.C., Felson D.T., et al. Examining sex differences in knee pain: the Multicenter Osteoarthritis Study // Osteoarthritis and Cartilage. 2014; 22 (8): 1100-6. DOI: 10.1016 / j.joca.2014.06.030.

Hame S.L., Alexander R.A. Knee osteoarthritis in women // Curr Rev Musculoskelet Med. 2013; 6 (2): 182-7. DOI: 10.1007 / s12178-013-9164-0

Hochberg M.C., Lawrence R.C., Everett D.F., Cornoni-Huntley J. Epidemiologic associations of pain in osteoarthritis of the knee: data from the national health and nutrition examination survey and the national health and nutrition examination-I epidemiologic follow-up survey // Semin. Arthritis Rheum. 1989; 18 (4 Suppl 2): 4-9. https://doi.org/10.1016/0049-0172(89)90008-5

Hoxha F., Tafaj A., Roshi E., Burazeri G. Distribution of Risk Factors in Male and Female Primary Health Care Patients with Osteoarthritis in Albania // Med Arch. 2015; 69 (3): P. 145-8. DOI: 10.5455 / medarh.2015.69.145-148

Hussain S.M., Cicuttini F.M., Bell R.G., Robinson P.G., Davis S.R., Giles G.G., et al. Incidence of Total Knee and Hip Replacement for Osteoarthritis in Relation to Circulating Sex Steroid Hormone Concentrations in Women // Arthritis&Rheumatology. 2014; 66 (8): 2144-51. DOI: 10.1002/art.38651.

Jawahar R., Yang S., Eaton C.B., McAlindon T., Lapane K.L. Gender-specific correlates of complementary and alternative medicine use for knee osteoarthritis // Journal of women's health. 2012; 21 (10): 1091-9. DOI: 10.1089 / jwh.2011.3434

Jin X., Wang B.H., Wang X., Antony B., Zhu Z., Han W., et al. Associations between Endogenous Sex Hormones and MRI Structural Changes in Patients with Symptomatic Knee Osteoarthritis // Osteoarthritis and Cartilage. 2017; 25 (7): 1100-6. DOI: 10.1016 / j.joca.2017.01.015.

Kim S.M., Cheon J.Y., Park Y.G., Kim H.R., Shin J.C., Ko H.S. The associations between parity, other reproductive factors, and osteoarthritis in women aged over 50 years; data from the Korean National Health and Nutrition Examination Survey V (2010-2012) // Taiwanese Journal of Obstetrics & Gynecology. 2017; 56 (2): 153-8. DOI: 10.1016/j.tjog.2016.09.006.

Kosir M., Wolfe P., Falvey J.R., Eckhoff D.G., Toth M.G., Stevens-Lapsley J.E. Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty // Arch Phys Med Rehabil. 2016; 97 (7): 1154-62. DOI: 10.1016 / j.apmr.2016.03.007.

Logerstedt S.D., Zeni J., Snyder-Mackler L. Sex Differences in Patients With Different Stages of Knee Osteoarthritis // Archives of Physical Medicine and Rehabilitation. 2014; 95 (12): 2376-81. DOI: 10.1016 / j.apmr.2014.07.414.

Lou C., Xiang G., Weng Q., Chen Z., Wang Q., Zhang D., et al. Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women // Menopause: The Journal of The North American Menopause Society. 2016; 23 (11): 1239-46. https://doi.org/10.1097/GME.0000000000000697

Macrini T.E., Coan H.B., Levine S.M., Lerma T., Saks C.D., Araujo D.J., et al. Reproductive status and sex show strong effects on knee OA in a baboon model // Osteoarthritis and Cartilage. 2013; 21 (6): 839-48. DOI: 10.1016 / j.joca.2013.03.003

Martín-Millán M., Castaneda S. Estrogens, osteoarthritis and inflammation // Joint Bone Spine. 2013; 80 (4): 368-73. DOI: 10.1016 / j.jbspin.2012.11.008.

Panahi Y., Beiraghdar F., Kashani N., Baharie J. N., Dadjo Y. Comparison of piascledine (avocado and soybean oil) and hormone replacement therapy in menopausal-induced hot flashing // Iran J Pharm Res. 2011; 10 (4): 941-51. PMCID: PMC3813060.

Pereira D., Severo M., Ramos E., Branco J., Santos R.A., Costa L., et al. Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis // International Journal of Rheumatic Diseases. 2017; 20 (2): 190-8. DOI: 10.1111 / 1756-185X.12611.

Perruccio A.V., Chandran V., Power J.D., Kapoor M., Mahomed N.N., Gandhi R. Systemic inflammation and painful joint burden in osteoarthritis: a matter of sex? // Osteoarthritis and Cartilage. 2017; 25 (1): 53-9. DOI: 10.1016 / j.joca.2016.08.001.

Phinyomark A., Osis S.T., Hettinga B.A., Kobsar D., Ferber R. Gender differences in gait kinematics for patients with knee osteoarthritis // BMC Musculoskeletal Disorders. 2016; 17: 157. DOI: 10.1186 / s12891-016-1013-z.

Prieto-Alhambra D., Judge A., Javaid M.K., Cooper C., Diez-Perez A., Arden N.K. Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints // Ann Rheum Dis. 2014; 73 (9): 1659-64. DOI: 10.1136 / annrheumdis-2013-203355.

Sims E.L., Carland J.M., Keefe F.J., Kraus V.B., Guliak F., Schmitt D. Sex Differences in Biomechanics Associated with Knee Osteoarthritis // Journal of Women & Aging. 2009; 21 (3): 159-70. DOI: 10.1080 / 08952840903054856

Skousgaard S.G., Skytthe A., Moller S., Overgaard S., Brandt L.P. Sex differences in risk and heritability estimates on primary knee osteoarthritis leading to total knee arthroplasty: a nationwide population based follow up study in Danish twins // Arthritis Research & Therapy. 2016; 18: 46. DOI: 10.1186 / s13075-016-0939-8.

Suh D.H., Han K.D., Hong G.Y., Park J.H., Bae J.H., Moon Y.W., et al. Body composition is more closely related to the development of knee osteoarthritis in women than men: a cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2) // Osteoarthritis and Cartilage. 2016; 24 (4): 605-11. DOI: 10.1016 / j.joca.2015.10.011.

Tonelli S.M., Rakel B.A., Cooper N.A., Angstom W.L., Sluka K.A. Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement // Biology of Sex Differences. 2011; 2: 12. DOI: 10.1186 / 2042-6410-2-12.

Tummala S., Schiphof D., Byrjalsen I., Dam E.B. Gender Differences in Knee Joint Congruity Quantified from MRI: A Validation Study with Data from Center for Clinical and Basic Research and Osteoarthritis Initiative // Cartilage. 2018; 9 (1): 38-45. DOI: 10.1177 / 1947603516684590.

Williamson-Hughes P.S., Flickinger B.D., Messina M.J., Empie M.W. Isoflavone supplements containing predominantly genistein reduce hot flash symptoms: a critical review of published studies // Menopause. 2006; 13 (5): 831-9. https://doi.org/10.1097/01.gme.0000227330.49081.9e

Wise B.L., Niu J., Zhang Y., Liu F., Pang J., Lynch J.A., Lane N.E. Bone shape mediates the relationship between sex and incident knee osteoarthritis // BMC Musculoskeletal Disorders. 2018; 19 (1): 331. DOI: 10.1186 / s12891-018-2251-z.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.