Osteoarthritis and the postmenopausal woman: Epidemiological, magnetic resonance imaging, and radiological findings

BACKGROUND There is some observational evidence to suggest an effect of hormones on osteoarthritis (OA), especially in perimenopausal women. OBJECTIVES To review the epidemiological evidence for an effect of estrogen replacement therapy (ERT) on the incidence and prevalence of OA, especially radiological OA, and the effect of ERT on articular cartilage in women. METHODS The literature relating to these questions was reviewed using OVID Medline (1966 to March 2003). RESULTS Some studies which have suggested a protective effect of ERT on the incidence and prevalence of OA. However, many of the confidence intervals include unity. Although a protective effect also was seen on articular knee cartilage in long-term users of ERT compared with never users, no difference in change in cartilage was seen over 2 years. CONCLUSIONS There is weak epidemiological evidence suggesting a role for estrogen therapy in joint health in postmenopausal women. The data are more suggestive of an effect on large joint OA than small joint OA.