Associations between Hormonal and Mechanical Factors of Knee Osteoarthritis in Women

One of the leading causes of disability in the elderly is the pain associated with knee osteoarthritis (OA). Chronic pain from knee OA can decrease physical activity, increasing the risk for chronic disease, decreased functional independence and diminished quality of life. In spite of the increased prevalence of knee OA in women, there has been limited investigation into the factors underlying the sex disparity of knee OA. And urinary estradiol (E2) metabolites were shown to be associated with the incidence of knee OA in perimenopausal women. In this paper, the authors aimed to determine the associations between urinary estradiol (E₂) metabolite concentration and medial knee loading with radiographic disease severity in middle aged women with initial stage knee osteoarthritis (OA).

Women presenting with knee pain were recruited into a cross-sectional correlation study (KOA, n = 9, age = 52 ± 4 yrs). Self-report menstrual history, the Modified Baecke Questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subjective data were collected. A fasting blood sample (follicle stimulating hormone (FSH) and Tumor Necrosis Factor-α (TNF-α)), and urine catch (16α-hydroxyestrone and 2-hydroxyestrone) were collected. Gait analysis using an 8-camera motion analysis system assessed internal knee varus moment and foot progression angle. Pearson Product moments tested for associations between urinary 16α-hydroxyestrone and 2-hydroxyestrone, TNF-α, medial knee loading, and radiographic disease severity (Kellgren/Lawrence (K/L) radiographic score).

Significant correlations were found within the hormonal biomarkers (r = 0.94, p < 0.001) and within the biomechanical markers (r = 0.76,p < 0.02), but not between hormonal and biomechanical variables (r = 0.39, p = 0.31). No correlations were found for radiographic disease severity or TNF-α.

In summary, the results of this study did not support the hypothesized association between urinary E₂ metabolite concentration and medial knee loading for women with initial stage knee OA in the menopause transition. This finding may be due to the large variability of the E₂ metabolites seen in the menopause transition, as well as, the limited structural changes of initial staged knee OA.

Article by David S. Mandeville, et al, from USA.

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