How does osteoarthritis (OA) treatment differ in women compared to men?

Gender Differences in Osteoarthritis Treatment

Women require different osteoarthritis treatment approaches than men due to higher prevalence, greater symptom severity, and unique hormonal influences, particularly after menopause.

Epidemiology and Risk Factors

Gender Differences in Prevalence

• Women have a higher prevalence of osteoarthritis (OA) than men, especially after age 40 1
• Women have a 23% higher prevalence risk of hand OA than men (relative risk 1.23,95% CI 1.11-1.34) 1
• OA incidence increases dramatically after age 40, particularly in women 1

Hormonal Factors

• Menopause plays a significant role in OA development in women 1, 2
• Sex hormone changes after menopause contribute to:
  • Loss of bone mineral density
  • Decreased muscle mass
  • Reduced tendon strength
  • Altered pain perception 2
• Women who never used hormone therapy have 2.7 times higher odds of developing OA (CI 1.1-6.9) 3

Anatomical and Structural Differences

• Men have significantly higher knee and hip cartilage volumes than women 4
• Gender differences in cartilage thickness exist from childhood, even after adjusting for age, body, and bone size 4
• Women experience higher cartilage loss rates, especially after menopause 4

Treatment Differences Between Men and Women

Exercise and Physical Activity

• Exercise programs must be tailored differently for women, especially during/after menopause 2
• For women, focus on:
  1. Postural alignment (spine, pelvis, knee)
  2. Functional muscle strength
  3. Range of motion exercises
  4. Walking speed improvement 2

Weight Management

• Weight gain during menopause (average 4kg) increases OA risk in women 3
• Weight management is more critical for women due to the hormonal changes that affect body composition during menopause 2

Pain Management

• Women experience more severe OA symptoms than men 5
• Women with menopause may benefit from:
  • Gabapentin or duloxetine for pain management, especially when sleep is disrupted by vasomotor symptoms 2
  • More aggressive early intervention due to faster progression

Occupational Considerations

• Different occupational risk factors exist for men and women:
  • Men: Strong evidence for hip OA risk with lifting activities 1
  • Men: Moderate evidence for hip OA risk with vibration and cumulative physical loads 1
  • Both genders: Strong evidence for knee OA with kneeling, squatting, and bending activities 1

Treatment Algorithm for OA Based on Gender

For Women:

1. Early intervention - Women should be evaluated earlier due to faster progression and higher symptom severity
2. Hormonal assessment - Consider menopausal status and potential hormone therapy options
3. Weight management - More aggressive approach during menopausal transition
4. Exercise program focusing on:
   • Postural alignment
   • Functional strength
   • Range of motion
5. Pain management - Consider medications that address both pain and sleep disruption (gabapentin/duloxetine)

For Men:

1. Occupational assessment - Focus on lifting activities and vibration exposure
2. Exercise program focusing on:
   • Strength training
   • Joint protection during occupational activities
3. Standard pain management approaches

Common Pitfalls to Avoid

1. Delayed treatment in women - Women are three times less likely than men to undergo hip or knee arthroplasty despite higher disease burden 5
2. Overlooking menopausal status - Failing to consider hormonal changes in treatment planning for women
3. Ignoring occupational differences - Men and women have different occupational risk profiles that should inform prevention and treatment
4. One-size-fits-all exercise programs - Exercise should be tailored to gender-specific needs
5. Underestimating pain severity in women - Women experience more severe symptoms that may require more aggressive management

By recognizing these gender differences in OA presentation and progression, clinicians can provide more effective, targeted treatment approaches that address the unique needs of men and women with osteoarthritis.