Is osteoarthritis (OA) more prevalent in women than in men?

Prevalence of Osteoarthritis Between Men and Women

Women have a significantly higher prevalence of osteoarthritis than men, with a 23% higher prevalence risk of hand osteoarthritis (relative risk 1.23,95% CI 1.11-1.34) and an even more dramatic difference after age 40. 1, 2

Gender Differences in Prevalence

Overall Prevalence

• Women account for approximately 60% of people with osteoarthritis globally 3
• The prevalence gap between genders widens significantly after age 40 1, 2
• After age 65, osteoarthritis affects approximately 60% of men and 70% of women 4
• The gender difference is age-dependent, with women having lower incidence before age 40 but higher incidence after this age 1

Joint-Specific Differences

• Hand osteoarthritis: Women have a 23% higher prevalence risk than men (RR 1.23,95% CI 1.11-1.34) 1, 2
• Forearm fractures: Approximately four times higher in women than men (0.4% vs 0.1% of the population at risk) 1
• Knee and hip osteoarthritis: While specific prevalence data varies, women generally show higher rates, particularly after menopause 2, 3

Factors Contributing to Gender Differences

Biological Factors

• Sex hormones play a significant role, particularly estrogen reduction during menopause 1, 2
• Men and women experience different patterns of bone and cartilage loss:
  • Women lose trabecular connectivity in bone structure
  • Men primarily experience loss of trabecular thickness but maintain connectivity 1
• Women have smaller joint cartilage volumes than men, even after adjusting for age, body, and bone size 2

Risk Factors More Prevalent in Women

• Menopausal status and hormonal changes 1, 2, 5
• Higher rates of obesity, particularly during/after menopause 2
• Different joint anatomy and alignment 3
• Lower muscle strength 3

Clinical Presentation Differences

• At the same radiographic severity, women report greater pain severity than men 3
• Women experience greater limitations in physical function and performance independent of BMI, OA severity, and exercise levels 3
• Women have greater use of analgesic medications but less utilization of arthroplasty 3

Age as a Critical Factor

• Osteoarthritis is rare before age 40 in both genders 1
• After age 40, incidence increases dramatically, especially in women 1, 2
• When using age 40 as a cut-off, it has a likelihood ratio of 3.73 (95% CI 2.69-5.18) for developing hand osteoarthritis 1

Occupational and Environmental Factors

• Certain occupations increase risk for both genders but may affect joint distribution differently 1
• Cotton picking and similar repetitive tasks show dose-dependent risk, particularly targeting specific joints 1
• Strong evidence exists for hip OA risk with lifting activities in men 2
• Strong evidence exists for knee OA with kneeling, squatting, and bending activities in both genders 2

The gender disparity in osteoarthritis prevalence is well-established in the medical literature, with women bearing a significantly higher burden of disease, particularly after age 40. This difference appears to be driven by a complex interplay of hormonal factors, anatomical differences, and potentially different responses to environmental risk factors.