The effect of estrogen plus progestin on knee symptoms and related disability in postmenopausal women - The Heart and Estrogen/Progestin Replacement Study, a randomized, double-blind, placebo-controlled trial

Objective. Most observational studies suggest that postmenopausal women taking hormone replacement therapy have a reduced risk of radiographic knee and hip osteoarthritis (OA). There are no randomized trial data on the association of hormone treatment with knee or hip OA, and no studies have been published regarding the relationship of hormone treatment to knee or hip symptoms. This study examined the association of hormone treatment with prevalent knee symptoms and disability related to knee pain as assessed at the final visit of the Heart and Estrogen/Progestin Replacement Study (HERS). Methods. The HERS was a 4-year randomized, double-blind, placebo-controlled trial of estrogen plus medroxy progesterone acetate for prevention of coronary heart disease in postmenopausal women with documented coronary disease. Participants in this sub-study on knee pain were 969 postmenopausal women, with a mean age of 66 years and mean body mass index of 28.6 kg/m(2), attending the final visit at 9 clinical centers. Frequent knee symptoms were assessed by interview and the severity of knee pain and disability related to knee pain were determined using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Knee symptoms and disability were compared between women assigned to receive hormones and those assigned to receive placebo. Results. Frequent knee pain was reported in 24.1% of women assigned to receive hormone therapy versus 26.1% of those assigned to the placebo group, a difference of -2.0% (95% confidence interval [95% CI] -7.4% to 3.5%). Among women with knee pain, there were no differences in the severity of pain (score difference -0.2, 95% CI -1.2 to 0.8) or disability (score difference -0.7, 95% CI -3.8 to 2.4) as assessed on the WOMAC. All results were similar for women whose body mass index was either above or below the median. Conclusion. In a group of older, postmenopausal women with cardiac disease, we found no significant effect of 4 years of estrogen plus progestin therapy compared with placebo on knee pain and related disability. Our findings may not apply to other groups of women or to the effect of hormone therapy on the structural changes of knee OA.