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Date:
27 September 2016, At: 20:27
Climacteric
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ISSN: 1369-7137 (Print) 1473-0804 (Online) Journal homepage: /loi/icmt20
Estrogen, menopau and joints
Anna Fenton & Nick Panay
To cite this article: Anna Fenton & Nick Panay (2016) Estrogen, menopau and joints,Climacteric, 19:2, 107-108, DOI: 10.3109/13697137.2016.1151151To link to this article:
/10.3109/13697137.2016.1151151
Published online: 25 Feb 2016.
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EDITORIAL
Estrogen,menopau and joints
午夜巴塞罗那原声Anna Fenton and Nick Panay
EDITORS-IN-CHIEF
A spectrum of musculoskeletal symptoms occurs at meno-pau,ranging from arthralgia to osteoarthritis 1.In fact,joint aches are some of the most commonly reported symptoms at menopau.The typically affect the small joints of the hand and can give ri to pain and impaired function.There are clear x-specific differences in the biology of osteoarthritis (OA),with increasing prevalence in women after menopau leading to twice as many women affected as men.Typically the OA will affect the distal interphalangeal joints of the hands,with or without involvement of the proximal interpha-langeal and carpometacarpal joints.Involvement of the joints can occur without evidence of OA at other sites.The International Menopau Society has previously highlighted the significant impact of OA in women 2.However,OA is a particularly ’unxy’area of medicine so,along with the gen-eral lack of understanding of its pathogenesis and the appar-ent abnce of any dia-modifying treatment,we often e the symptoms being disregarded.
Any real understanding of the pathogenesis of OA is still in its infancy.Family history,body mass index,trauma and over-u all have a role to play.However,gender differences in its incidence would also suggest a role for x steroids.Data collected from a multidisciplinary hand clinic in London showed that 80%of the patients were women and the major-ity had developed their symptoms within
4years of reaching menopau or stopping their menopau hormone therapy (MHT)3.This association has also been en in young women with an early menopau and in tho taking aromata inhibitors after breast cancer 4.
If estrogen does indeed slow OA progression and reduce pain and stiffness,how is this mediated?OA is a dia that affects the entire joint and we know that estrogen receptors (ERs)are prent in cartilage,sub-chondral bone,synovium,muscles and tendons.Deletion of ERs in animal models caus cartilage damage and changes in the sub-chondral bone,but studies of ER a polymorphisms and OA have pro-duced conflicting results 5,6.There are also conflicting data on the link between endogenous x steroid levels and the risk of OA.Estrogen appears to have pro-or anti-inflammatory effects depending on the situation 7,8.Loss of estrogen increas reactive oxygen species and pro-inflammatory cyto-kines.In animal models,estrogen and androgens,but not progesterone,appear to attenuate the effects of ovariectomy.Animal studies examining the effect of tibolone after induced joint damage have also demonstrated its ability to reduce
cartilage degeneration and synovitis.Replacing estrogen appears to have x-specific benefits limited only to females.In contrast to the positive findings,a number of groups have demonstrated pro-inflammatory effects on cartilage and sub-chondral bone with high-do estrogen.So,perhaps do
is important.
Aside from basic science models,the critical question for clinicians is whether MHT provides any benefit in postmeno-pausal women.Here,once again,there are mixed data.Some studies have shown no effect,while others have shown a pro-tection from estrogen therapy.The Ulm Osteoarthritis Study reported no significant association between MHT u and radiographic hip,knee,or hand OA in 475women 9.However,women from the Study of Osteoporotic Fractures who were currently using oral estrogen had a significantly reduced risk of OA of the hip or moderate-to-vere radiographic manifes-tations of OA.Current urs who had taken estrogen for at least 10years had a greater reduction in the risk of any OA of the hip compared with that of urs for less than 10years 10.The Women’s Health Initiative demonstrated lower rates of hip joint replacement in Caucasian women taking unoppod estrogen and lower rates of joint pain and stiff-ness in the combined hormone therapy arm 11.The latter was confirmed in the WISDOM trial 12.The reduction in pain has been hypothesized to occur via estrogen’s effect on the opi-oid system as well as direct effects on bone and cartilage.The General Practice Rearch Databa retrospective cohort study demonstrated a 40%reduction in revision rates after knee and hip joint replacement surgery if estrogen was started following the arthroplasty 13.Pre-operative u had no benefit,possibly becau of suppression of bone resorption and issues with integration of the prosthesis.
Although in vivo ,in vitro ,genetic and clinical studies are assisting our understanding,without an intervention trial specially addressing hormones and joint health,the role of x steroids remains open to debate.Advocating MHT as first-line treatment in postmenopausal women with OA is not where the data take us at the moment,particularly if long-term therapy is required.Questions that need to be answered include:
Is estrogen a major contributor to joint health?
Is any reduction in OA due to a protective effect of estro-gen alone or do androgens or progestogens/progesterone play a role?
ß2016International Menopau Society
CLIMACTERIC,2016
VOL.19,NO.2,107–108
/10.3109/13697137.2016.1151151
What impact does the timing of MHT u have on OA pro-gression or symptom verity?
中国奥运代表团正式亮相
What impact does MHT have on outcomes from arthro-plasty procedures?
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