Menopausal status, hormone replacement therapy use and risk of self-reported physician-diagnosed osteoarthritis in women attending menopause clinics in Italy

Objective: In order to offer data on the association between menopausal status, hormone replacement therapy use and risk of self-reported physician-diagnosed osteoarthritis (OA) in women around menopause, we analyzed information collected in the framework of a large epidemiological study conducted in Italy. Methods: Since 1997, a large cross sectional study has been conducting on the characteristics of women around menopause attending a network of first level outpatients menopause clinics in Italy for general counseling about menopause or treatment of menopausal symptoms. Eligible for the study were women consecutively observed at the participating centers. Up to March 2000, a total of 42464 women (mean age 53 years) were observed. Women were asked, using the same questionnaire, about their general characteristics and habits, and if they suffer of OA diagnosed by a physician requiring medical or surgical treatment. Results: A total of 12 521 women reported OA. The risk of OA increased with body mass index (BMI), the odds ratio, OR, being for BMI > or equal to 27 versus < 24, 1.56 (95%CI 1.47-1.64). The risk increased with a history of osteoporosis/osteopenia (OR 1.65, 95% CI 1.57-1.74) and was lower in more educated women (OR high school/ university degree vs. primary school degree 0.79, 95%CI 0.75-0.84). Considering menopausal status, women in spontaneous or surgical menopause were, at increased risk of OA (OR 1.13, 95%CI 1.07-1.21, and 1.18, 95%CI 1.08-1.28, respectively, in women in surgical and spontaneous menopause). No clear relationship, however, emerged with age at menopause. Ever hormonal replacement therapy users were at decreased risk of OA, the OR being for ever users in comparison with never 0.73 (95%CI 0.69-0.78). Conclusion: This analysis gives some epidemiological support to the hypothesis that estrogen deficiency may increased the risk of OA. (C) 2003 Elsevier Ireland Ltd. All rights reserved.