Do women tend to develop osteoarthritis (OA) at an earlier stage than men?

Women Present with Osteoarthritis at Earlier Stages Than Men

Women tend to develop osteoarthritis at earlier stages than men, with a dramatic increase in incidence after age 40 that creates a significant gender gap in prevalence. 1, 2

Epidemiological Evidence

• Women have a 23% higher prevalence risk of hand osteoarthritis compared to men (relative risk 1.23,95% CI 1.11-1.34) 1
• Osteoarthritis is rare before age 40 in both genders, but after this age, the incidence increases dramatically, especially in women 1, 2
• Globally, women account for approximately 60% of people with osteoarthritis, with this difference becoming more pronounced after age 40 3
• The prevalence of osteoarthritis after age 65 is about 60% in men and 70% in women 4

Biological Factors Contributing to Earlier Presentation in Women

Hormonal Influences

• Sex hormones play a significant role in the development of osteoarthritis in women 1, 2
• The reduction in estrogen due to menopause is suggested as a contributing factor to the higher incidence of osteoarthritis in women after age 40 1
• However, evidence from hormone replacement therapy (HRT) studies has not conclusively shown that HRT reduces the risk of osteoarthritis 1

Structural and Physiological Differences

• 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 2
• Women may have different joint anatomy, alignment, and muscle strength compared to men 3

Clinical Manifestations and Severity

• At the same radiographic severity, women report greater pain severity than men 2, 3
• Women experience greater limitations in physical function and performance independent of BMI, osteoarthritis severity, and exercise levels 2, 3
• Women have greater use of analgesic medications but are three times less likely than men to undergo hip or knee arthroplasty 3, 5

Risk Factors

• Risk factors for hand osteoarthritis include:

  • Female sex
  • Increasing age over 40
  • Menopausal status
  • Family history
  • Obesity
  • Higher bone density
  • Greater forearm muscle strength
  • Joint laxity
  • Prior hand injury
  • Occupation-related usage 1

• Occupational factors affect both genders but may have different impacts:

  • Certain repetitive tasks show dose-dependent risk, particularly targeting specific joints 1, 2
  • 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

Clinical Implications

• The American College of Rheumatology recommends early intervention for women due to faster progression and higher symptom severity 2
• Weight management is particularly critical for women due to hormonal changes affecting body composition during menopause 2
• Exercise programs should be tailored differently for women, especially during/after menopause, focusing on postural alignment, functional muscle strength, and range of motion exercises 2
• Pain management should consider medications that address both pain and sleep disruption 2

Understanding the earlier presentation and different disease patterns in women compared to men is crucial for timely diagnosis and appropriate management of osteoarthritis, potentially improving long-term outcomes and quality of life.