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. 2001 Apr;60(4):332–336. doi: 10.1136/ard.60.4.332

Users of oestrogen replacement therapy have more knee cartilage than non-users

A Wluka 1, S Davis 1, M Bailey 1, S Stuckey 1, F Cicuttini 1
PMCID: PMC1753592  PMID: 11247861

Abstract

BACKGROUND—Osteoarthritis (OA) is increasingly prevalent in the years after menopause. Epidemiological data suggest that the use of oestrogen replacement therapy (ERT) may protect against knee OA.
AIM—To test the hypothesis that long term ERT (longer than five years) is associated with increased knee cartilage in postmenopausal women.
METHODS—The study involved 81 women (42 current users (⩾ five years) of ERT and 39 who had never used it). Articular cartilage volumes were determined by processing images acquired in the sagittal plane using a T1 weighted fat suppressed magnetic resonance sequence on an independent work station.
RESULTS—After bone size had been accounted for, ERT users had higher tibial cartilage volume than non-users. Total tibial cartilage volume was 7.7% (0.23 ml) greater in the group of ERT users (2.98 (0.47) ml; mean (SD)) than in the untreated group (2.75 (0.50) ml). The difference, after adjustment for the significant explanatory factors (years since menopause, body mass index, age at menopause, and smoking), between the ERT users and non-users increased from 0.23 ml to 0.30 ml (95% confidence interval 0.08 to 0.52, p=0.008). These differences persisted after exclusion of women with OA.
CONCLUSIONS—After adjustment for multiple confounders, women using long term ERT have more knee cartilage than controls. This may indicate that ERT prevents loss of knee articular cartilage.



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Selected References

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  1. Armstrong C. G., Gardner D. L. Thickness and distribution of human femoral head articular cartilage. Changes with age. Ann Rheum Dis. 1977 Oct;36(5):407–412. doi: 10.1136/ard.36.5.407. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cerhan J. R., Wallace R. B., el-Khoury G. Y., Moore T. E. Risk factors for progression to new sites of radiographically defined osteoarthritis in women. J Rheumatol. 1996 Sep;23(9):1565–1578. [PubMed] [Google Scholar]
  3. Cicuttini F., Forbes A., Asbeutah A., Morris K., Stuckey S. Comparison and reproducibility of fast and conventional spoiled gradient-echo magnetic resonance sequences in the determination of knee cartilage volume. J Orthop Res. 2000 Jul;18(4):580–584. doi: 10.1002/jor.1100180410. [DOI] [PubMed] [Google Scholar]
  4. Cicuttini F., Forbes A., Morris K., Darling S., Bailey M., Stuckey S. Gender differences in knee cartilage volume as measured by magnetic resonance imaging. Osteoarthritis Cartilage. 1999 May;7(3):265–271. doi: 10.1053/joca.1998.0200. [DOI] [PubMed] [Google Scholar]
  5. Cooper C., Cook P. L., Osmond C., Fisher L., Cawley M. I. Osteoarthritis of the hip and osteoporosis of the proximal femur. Ann Rheum Dis. 1991 Aug;50(8):540–542. doi: 10.1136/ard.50.8.540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davis M. A., Ettinger W. H., Neuhaus J. M., Hauck W. W. Sex differences in osteoarthritis of the knee. The role of obesity. Am J Epidemiol. 1988 May;127(5):1019–1030. doi: 10.1093/oxfordjournals.aje.a114878. [DOI] [PubMed] [Google Scholar]
  7. 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]
  8. Fazzalari N. L., Parkinson I. H. Femoral trabecular bone of osteoarthritic and normal subjects in an age and sex matched group. Osteoarthritis Cartilage. 1998 Nov;6(6):377–382. doi: 10.1053/joca.1998.0141. [DOI] [PubMed] [Google Scholar]
  9. Felson D. T., Anderson J. J., Naimark A., Hannan M. T., Kannel W. B., Meenan R. F. Does smoking protect against osteoarthritis? Arthritis Rheum. 1989 Feb;32(2):166–172. doi: 10.1002/anr.1780320209. [DOI] [PubMed] [Google Scholar]
  10. Felson D. T., Anderson J. J., Naimark A., Walker A. M., Meenan R. F. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988 Jul 1;109(1):18–24. doi: 10.7326/0003-4819-109-1-18. [DOI] [PubMed] [Google Scholar]
  11. Felson D. T., Naimark A., Anderson J., Kazis L., Castelli W., Meenan R. F. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987 Aug;30(8):914–918. doi: 10.1002/art.1780300811. [DOI] [PubMed] [Google Scholar]
  12. Felson D. T., Zhang Y., Hannan M. T., Naimark A., Weissman B., Aliabadi P., Levy D. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997 Apr;40(4):728–733. doi: 10.1002/art.1780400420. [DOI] [PubMed] [Google Scholar]
  13. Fernihough J. K., Richmond R. S., Carlson C. S., Cherpes T., Holly J. M., Loeser R. F. Estrogen replacement therapy modulation of the insulin-like growth factor system in monkey knee joints. Arthritis Rheum. 1999 Oct;42(10):2103–2111. doi: 10.1002/1529-0131(199910)42:10<2103::AID-ANR10>3.0.CO;2-S. [DOI] [PubMed] [Google Scholar]
  14. Guerne P. A., Carson D. A., Lotz M. IL-6 production by human articular chondrocytes. Modulation of its synthesis by cytokines, growth factors, and hormones in vitro. J Immunol. 1990 Jan 15;144(2):499–505. [PubMed] [Google Scholar]
  15. 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]
  16. 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]
  17. 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]
  18. Hart D. J., Spector T. D. Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. Ann Rheum Dis. 1993 Feb;52(2):93–96. doi: 10.1136/ard.52.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Hart D. J., Spector T. D. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993 Feb;20(2):331–335. [PubMed] [Google Scholar]
  20. Jones G., White C., Sambrook P., Eisman J. Allelic variation in the vitamin D receptor, lifestyle factors and lumbar spinal degenerative disease. Ann Rheum Dis. 1998 Feb;57(2):94–99. doi: 10.1136/ard.57.2.94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Karvonen R. L., Negendank W. G., Teitge R. A., Reed A. H., Miller P. R., Fernandez-Madrid F. Factors affecting articular cartilage thickness in osteoarthritis and aging. J Rheumatol. 1994 Jul;21(7):1310–1318. [PubMed] [Google Scholar]
  22. Lawrence R. C., Hochberg M. C., Kelsey J. L., McDuffie F. C., Medsger T. A., Jr, Felts W. R., Shulman L. E. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheumatol. 1989 Apr;16(4):427–441. [PubMed] [Google Scholar]
  23. Li B., Aspden R. M. Material properties of bone from the femoral neck and calcar femorale of patients with osteoporosis or osteoarthritis. Osteoporos Int. 1997;7(5):450–456. doi: 10.1007/s001980050032. [DOI] [PubMed] [Google Scholar]
  24. McAlindon T. E., Wilson P. W., Aliabadi P., Weissman B., Felson D. T. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999 Feb;106(2):151–157. doi: 10.1016/s0002-9343(98)00413-6. [DOI] [PubMed] [Google Scholar]
  25. Meachim G., Bentley G., Baker R. Effect of age on thickness of adult patellar articular cartilage. Ann Rheum Dis. 1977 Dec;36(6):563–568. doi: 10.1136/ard.36.6.563. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Meachim G. Effect of age on the thickness of adult articular cartilage at he shoulder joint. Ann Rheum Dis. 1971 Jan;30(1):43–46. doi: 10.1136/ard.30.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. 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]
  28. Nevitt M. C., Felson D. T. Sex hormones and the risk of osteoarthritis in women: epidemiological evidence. Ann Rheum Dis. 1996 Sep;55(9):673–676. doi: 10.1136/ard.55.9.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. 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]
  30. 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]
  31. Peterfy C. G., van Dijke C. F., Janzen D. L., Glüer C. C., Namba R., Majumdar S., Lang P., Genant H. K. Quantification of articular cartilage in the knee with pulsed saturation transfer subtraction and fat-suppressed MR imaging: optimization and validation. Radiology. 1994 Aug;192(2):485–491. doi: 10.1148/radiology.192.2.8029420. [DOI] [PubMed] [Google Scholar]
  32. Pilch L., Stewart C., Gordon D., Inman R., Parsons K., Pataki I., Stevens J. Assessment of cartilage volume in the femorotibial joint with magnetic resonance imaging and 3D computer reconstruction. J Rheumatol. 1994 Dec;21(12):2307–2321. [PubMed] [Google Scholar]
  33. Rosner I. A., Goldberg V. M., Getzy L., Moskowitz R. W. Effects of estrogen on cartilage and experimentally induced osteoarthritis. Arthritis Rheum. 1979 Jan;22(1):52–58. doi: 10.1002/art.1780220108. [DOI] [PubMed] [Google Scholar]
  34. SILBERBERG M., SILBERBERG R. Modifying action of estrogen on the evolution of osteoarthrosis in mice of different ages. Endocrinology. 1963 Mar;72:449–451. doi: 10.1210/endo-72-3-449. [DOI] [PubMed] [Google Scholar]
  35. Sahyoun N. R., Brett K. M., Hochberg M. C., Pamuk E. R. Estrogen replacement therapy and incidence of self-reported physician-diagnosed arthritis. Prev Med. 1999 May;28(5):458–464. doi: 10.1006/pmed.1998.0440. [DOI] [PubMed] [Google Scholar]
  36. 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]
  37. Sandmark H., Hogstedt C., Lewold S., Vingård E. Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy. Ann Rheum Dis. 1999 Mar;58(3):151–155. doi: 10.1136/ard.58.3.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Sittek H., Eckstein F., Gavazzeni A., Milz S., Kiefer B., Schulte E., Reiser M. Assessment of normal patellar cartilage volume and thickness using MRI: an analysis of currently available pulse sequences. Skeletal Radiol. 1996 Jan;25(1):55–62. doi: 10.1007/s002560050032. [DOI] [PubMed] [Google Scholar]
  39. Spector T. D., Brown G. C., Silman A. J. Increased rates of previous hysterectomy and gynaecological operations in women with osteoarthritis. BMJ. 1988 Oct 8;297(6653):899–900. doi: 10.1136/bmj.297.6653.899. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Spector T. D., Cicuttini F., Baker J., Loughlin J., Hart D. Genetic influences on osteoarthritis in women: a twin study. BMJ. 1996 Apr 13;312(7036):940–943. doi: 10.1136/bmj.312.7036.940. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Spector T. D., Harris P. A., Hart D. J., Cicuttini F. M., Nandra D., Etherington J., Wolman R. L., Doyle D. V. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. doi: 10.1002/art.1780390616. [DOI] [PubMed] [Google Scholar]
  42. 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]
  43. Stewart A., Black A., Robins S. P., Reid D. M. Bone density and bone turnover in patients with osteoarthritis and osteoporosis. J Rheumatol. 1999 Mar;26(3):622–626. [PubMed] [Google Scholar]
  44. Tsai C. L., Liu T. K. Osteoarthritis in women: its relationship to estrogen and current trends. Life Sci. 1992;50(23):1737–1744. doi: 10.1016/0024-3205(92)90056-u. [DOI] [PubMed] [Google Scholar]
  45. Turner A. S., Athanasiou K. A., Zhu C. F., Alvis M. R., Bryant H. U. Biochemical effects of estrogen on articular cartilage in ovariectomized sheep. Osteoarthritis Cartilage. 1997 Jan;5(1):63–69. doi: 10.1016/s1063-4584(97)80032-5. [DOI] [PubMed] [Google Scholar]
  46. Uitterlinden A. G., Burger H., Huang Q., Odding E., Duijn C. M., Hofman A., Birkenhäger J. C., van Leeuwen J. P., Pols H. A. Vitamin D receptor genotype is associated with radiographic osteoarthritis at the knee. J Clin Invest. 1997 Jul 15;100(2):259–263. doi: 10.1172/JCI119530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Verstraeten A., Van Ermen H., Haghebaert G., Nijs J., Geusens P., Dequeker J. Osteoarthrosis retards the development of osteoporosis. Observation of the coexistence of osteoarthrosis and osteoporosis. Clin Orthop Relat Res. 1991 Mar;(264):169–177. [PubMed] [Google Scholar]
  48. Vingård E., Alfredsson L., Malchau H. Lifestyle factors and hip arthrosis. A case referent study of body mass index, smoking and hormone therapy in 503 Swedish women. Acta Orthop Scand. 1997 Jun;68(3):216–220. doi: 10.3109/17453679708996687. [DOI] [PubMed] [Google Scholar]
  49. Waterton J. C., Solloway S., Foster J. E., Keen M. C., Gandy S., Middleton B. J., Maciewicz R. A., Watt I., Dieppe P. A., Taylor C. J. Diurnal variation in the femoral articular cartilage of the knee in young adult humans. Magn Reson Med. 2000 Jan;43(1):126–132. doi: 10.1002/(sici)1522-2594(200001)43:1<126::aid-mrm15>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  50. 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]
  51. van Saase J. L., van Romunde L. K., Cats A., Vandenbroucke J. P., Valkenburg H. A. Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations. Ann Rheum Dis. 1989 Apr;48(4):271–280. doi: 10.1136/ard.48.4.271. [DOI] [PMC free article] [PubMed] [Google Scholar]

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