Abstract
OBJECTIVES—It has been suggested that hormone replacement therapy (HRT) may protect against osteoarthritis (OA). The aim of this paper was to assess the association between HRT and radiographically defined patterns of OA. METHODS—475 consecutive women aged 50 years or older (mean age 66.1) who underwent hip or knee joint replacement because of advanced OA in four hospitals in south west Germany were enrolled in a cross sectional study. Participants underwent a standardised interview including detailed history of medication use and a physical examination. Furthermore, radiographs of the joint being replaced and of the contralateral joint as well as of both hands were obtained. Patients were categorised as having bilateral or unilateral OA according to the presence or absence of radiographic OA in the contralateral joint. If radiographic OA of different hand and finger joint groups was present, participants were categorised as having generalised OA (GOA). Logistic regression was used to estimate odds ratios and their 95% confidence intervals for the association between HRT and bilateral or GOA while adjusting for potential confounders. RESULTS—Fifty five women (11.6%) were using HRT. The median duration of use was 5.4 years. The prevalence of bilateral and GOA was similar among users of ORT (86.3% and 27.5%, respectively) and among non-users of HRT (88.7% and 35.7%, respectively). After adjustment for potential confounding factors, the odds ratios (95% confidence intervals) of bilateral OA and GOA among HRT users compared with non-users was 1.21 (0.48, 3.03) and 1.21 (0.53, 2.74), respectively. CONCLUSION—Despite limited generalisability because of the selective study sample, these data do not support the hypothesis that HRT acts as a systemic protective factor against OA.
Full Text
The Full Text of this article is available as a PDF (131.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Croft P., Cooper C., Wickham C., Coggon D. Defining osteoarthritis of the hip for epidemiologic studies. Am J Epidemiol. 1990 Sep;132(3):514–522. doi: 10.1093/oxfordjournals.aje.a115687. [DOI] [PubMed] [Google Scholar]
- Dennison E. M., Arden N. K., Kellingray S., Croft P., Coggon D., Cooper C. Hormone replacement therapy, other reproductive variables and symptomatic hip osteoarthritis in elderly white women: a case-control study. Br J Rheumatol. 1998 Nov;37(11):1198–1202. doi: 10.1093/rheumatology/37.11.1198. [DOI] [PubMed] [Google Scholar]
- Greendale G. A., James M. K., Espeland M. A., Barrett-Connor E. Can we measure prior postmenopausal estrogen/progestin use? The Postmenopausal Estrogen/Progestin Interventions Trial. The PEPI Investigators. Am J Epidemiol. 1997 Nov 1;146(9):763–770. doi: 10.1093/oxfordjournals.aje.a009352. [DOI] [PubMed] [Google Scholar]
- Günther K. P., Scharf H. P., Puhl W., Willauschus W., Kalke Y., Glückert K., Sun Y. Reproduzierbarkeit der radiologischen Diagnostik bei Gonarthrose. Z Orthop Ihre Grenzgeb. 1997 May-Jun;135(3):197–202. doi: 10.1055/s-2008-1039580. [DOI] [PubMed] [Google Scholar]
- Günther K. P., Scharf H. P., Puhl W., Willauschus W., Sauerland S., Glückert K., Sun Y. Reproduzierbarkeit der röntgenologischen Beurteilung von Coxarthrosen. Z Orthop Ihre Grenzgeb. 1997 Jan-Feb;135(1):3–8. doi: 10.1055/s-2008-1039547. [DOI] [PubMed] [Google Scholar]
- Günther K. P., Stürmer T., Sauerland S., Zeissig I., Sun Y., Kessler S., Scharf H. P., Brenner H., Puhl W. Prevalence of generalised osteoarthritis in patients with advanced hip and knee osteoarthritis: the Ulm Osteoarthritis Study. Ann Rheum Dis. 1998 Dec;57(12):717–723. doi: 10.1136/ard.57.12.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hannan M. T., Anderson J. J., Zhang Y., Levy D., Felson D. T. Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum. 1993 Dec;36(12):1671–1680. doi: 10.1002/art.1780361205. [DOI] [PubMed] [Google Scholar]
- Hannan M. T., Felson D. T., Anderson J. J., Naimark A., Kannel W. B. Estrogen use and radiographic osteoarthritis of the knee in women. The Framingham Osteoarthritis Study. Arthritis Rheum. 1990 Apr;33(4):525–532. doi: 10.1002/art.1780330410. [DOI] [PubMed] [Google Scholar]
- Hart D. J., Doyle D. V., Spector T. D. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum. 1999 Jan;42(1):17–24. doi: 10.1002/1529-0131(199901)42:1<17::AID-ANR2>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
- Hart D. J., Mootoosamy I., Doyle D. V., Spector T. D. The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis. 1994 Mar;53(3):158–162. doi: 10.1136/ard.53.3.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hart D., Spector T., Egger P., Coggon D., Cooper C. Defining osteoarthritis of the hand for epidemiological studies: the Chingford Study. Ann Rheum Dis. 1994 Apr;53(4):220–223. doi: 10.1136/ard.53.4.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kallman D. A., Wigley F. M., Scott W. W., Jr, Hochberg M. C., Tobin J. D. New radiographic grading scales for osteoarthritis of the hand. Reliability for determining prevalence and progression. Arthritis Rheum. 1989 Dec;32(12):1584–1591. doi: 10.1002/anr.1780321213. [DOI] [PubMed] [Google Scholar]
- Nevitt M. C., Cummings S. R., Lane N. E., Hochberg M. C., Scott J. C., Pressman A. R., Genant H. K., Cauley J. A. Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1996 Oct 14;156(18):2073–2080. [PubMed] [Google Scholar]
- Oliveria S. A., Felson D. T., Klein R. A., Reed J. I., Walker A. M. Estrogen replacement therapy and the development of osteoarthritis. Epidemiology. 1996 Jul;7(4):415–419. doi: 10.1097/00001648-199607000-00013. [DOI] [PubMed] [Google Scholar]
- Oliveria S. A., Felson D. T., Reed J. I., Cirillo P. A., Walker A. M. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 1995 Aug;38(8):1134–1141. doi: 10.1002/art.1780380817. [DOI] [PubMed] [Google Scholar]
- Samanta A., Jones A., Regan M., Wilson S., Doherty M. Is osteoarthritis in women affected by hormonal changes or smoking? Br J Rheumatol. 1993 May;32(5):366–370. doi: 10.1093/rheumatology/32.5.366. [DOI] [PubMed] [Google Scholar]
- Sowers M. F., Hochberg M., Crabbe J. P., Muhich A., Crutchfield M., Updike S. Association of bone mineral density and sex hormone levels with osteoarthritis of the hand and knee in premenopausal women. Am J Epidemiol. 1996 Jan 1;143(1):38–47. doi: 10.1093/oxfordjournals.aje.a008655. [DOI] [PubMed] [Google Scholar]
- Spector T. D., Nandra D., Hart D. J., Doyle D. V. Is hormone replacement therapy protective for hand and knee osteoarthritis in women?: The Chingford Study. Ann Rheum Dis. 1997 Jul;56(7):432–434. doi: 10.1136/ard.56.7.432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stürmer T., Sun Y., Sauerland S., Zeissig I., Günther K. P., Puhl W., Brenner H. Serum cholesterol and osteoarthritis. The baseline examination of the Ulm Osteoarthritis Study. J Rheumatol. 1998 Sep;25(9):1827–1832. [PubMed] [Google Scholar]
- Sun Y., Stürmer T., Günther K. P., Brenner H. Inzidenz und Prävalenz der Cox- und Gonarthrose in der Allgemeinbevölkerung. Z Orthop Ihre Grenzgeb. 1997 May-Jun;135(3):184–192. doi: 10.1055/s-2008-1039578. [DOI] [PubMed] [Google Scholar]
- Weyermann M., Brenner H. Factors affecting bone demineralization and blood lead levels of postmenopausal women--a population-based study from Germany. Environ Res. 1998 Jan;76(1):19–25. doi: 10.1006/enrs.1997.3780. [DOI] [PubMed] [Google Scholar]
- Zhang Y., McAlindon T. E., Hannan M. T., Chaisson C. E., Klein R., Wilson P. W., Felson D. T. Estrogen replacement therapy and worsening of radiographic knee osteoarthritis: the Framingham Study. Arthritis Rheum. 1998 Oct;41(10):1867–1873. doi: 10.1002/1529-0131(199810)41:10<1867::AID-ART20>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
