Abstract
Objective:
In females, estrogen loss has been associated with musculoskeletal dysregulation. During menopause, when estrogen levels decrease, it is known that bone health is harmed and connective tissue integrity decreases. The incidence of soft tissue disorders of the shoulder in females increases significantly with age, specifically during and after the menopausal transition. Thus, the objective of this study was to determine whether postmenopausal females prescribed systemic estrogen or progesterone hormonal replacement therapy (HRT) have decreased odds of developing soft tissue disorders of the shoulder such as adhesive capsulitis (AC), bicep tendinitis (BT), calcific tendinitis (CT), atraumatic rotator cuff tendinopathy or tears (RCTD), shoulder impingement (SIS), and synovitis compared to women without an active HRT prescription.
Methods:
The TriNetX U.S. Collaborative Network, which is a large de-identified patient database of over 300 million patients, was queried. Women aged 40 to 60 years who were in menopausal state as identified by ICD code N95.1 and primary ovarian insufficiency by ICD code E28.3. Patients were grouped according to HRT prescription status by ICD code Z79.890. Patients were one-to-one propensity matched using the nearest neighbor algorithm through the TriNetX platform matching on age, race, and specific risk factors, specifically diabetes mellitus, hypothyroidism, and hyperlipidemia. The odds of developing AC, BT, CT, RCTD, SIS or synovitis identified by ICD codes M75.0, M 75.2, M 75.3, M75.1, M75.4, M65.8, respectively, was studied.
Results:
After propensity-score matching, there were 299,723 females in each cohort. There were no significant differences between cohorts for all variables after propensity score matching (SMD > 0.002). In the HRT cohort, 2,227 (0.75%) developed AC, 1,475 (0.50%) developed BT, 965 (0.32%) developed CT, 2,799 (0.95%) developed RCTD, 2,836 (0.96%) developed SIS, and 186 (0.06%) developed synovitis. In the non-HRT cohort, 2,817 (0.95%) developed AC, 2,090 (0.70%) developed BT, 1,173 (0.39%) developed CT, 4,176 (1.42%) developed RCTD, 3,798 (1.29%) developed SIS, and 314 (0.11%) developed synovitis. Postmenopausal women who are not using HRT had an increased odds of developing AC (OR: 1.266, 95% CI,1.198 - 1.339, p < 0.001), BT (OR: 1.418, 95% CI,1.327 - 1.516, p < 0.001), CT (OR: 1.214, 95% CI,1.115 - 1.322, p < 0.001), RCTD (OR: 1.497, 95% CI,1.426 - 1.570, p < 0.001), SIS (OR: 1.341, 95% CI,1.277 - 1.408, p < 0.001), and synovitis (OR: 1.689, 95% CI,1.409 - 2.024, p < 0.001).
Conclusions:
Menopausal female patients prescribed HRTs containing estrogen and progesterone had a statistically significant decreased odds of developing soft tissue disorders of the shoulder. Future research needs to be conducted to understand if this large database study translates into a retrospective cohort study and potentially, a prospective study impacting the female population.
