Osteoarthritis Sex Predominance
Yes, osteoarthritis is definitively more common in females, particularly after age 40-50, with women accounting for approximately 60% of all osteoarthritis cases globally and experiencing a dramatic increase in incidence after menopause. 1
Gender-Specific Prevalence Patterns
Women have a significantly higher overall prevalence of osteoarthritis with a relative risk of 1.23 (95% CI 1.11-1.34) compared to men. 2, 3 This female predominance becomes particularly pronounced after age 40, when hormonal changes associated with menopause contribute substantially to disease development. 3
Age-Specific Gender Differences
Before age 40: Women have lower incidence of hand osteoarthritis compared to men, but this pattern reverses dramatically after this threshold. 2
After age 40-50: The incidence in women increases steeply, with menopausal status recognized as an independent risk factor by the American College of Rheumatology. 3 The reduction in estrogen associated with menopause is a key contributing factor. 3
Age 65 and older: Approximately 50% of this population has osteoarthritis, increasing to 85% in those aged 75 and older, affecting both sexes but with higher prevalence in women. 2, 3
Joint-Specific Gender Patterns
The sex predominance varies by joint location, which is a critical clinical distinction:
Knee osteoarthritis: Females have consistently higher prevalence across all disease definitions (radiographic, symptomatic, and clinical). 4 Women also experience more severe knee arthritis than men at the same radiographic severity. 5
Hip osteoarthritis: The pattern is more complex. Radiographically defined hip osteoarthritis is actually more common in males, but symptomatically defined hip osteoarthritis is more common in females. 4 This means women experience more pain and functional limitation from hip osteoarthritis despite having less structural disease on imaging.
Hand osteoarthritis: Women show dramatically higher incidence after age 40, commonly affecting distal interphalangeal joints, proximal interphalangeal joints, and thumb base joints. 3
Clinical Severity and Functional Impact
Women not only have higher prevalence but also worse clinical outcomes across multiple domains:
Pain severity: At the same radiographic severity, women report greater pain than men, likely due to biologically distinct pain pathways, differential activation of central pain processing, and differences in pain sensitivity and perception. 1
Physical function: Women experience greater limitations in physical function and performance independent of BMI, osteoarthritis severity, injury history, and exercise levels. 1
Medication use: Women have greater use of analgesic medications than men. 1
Surgical outcomes: Despite higher disease burden, women are three times less likely to undergo hip or knee arthroplasty than men and have poorer prognosis after surgical interventions. 1, 5
Underlying Mechanisms for Female Predominance
The higher risk in women after age 50 is multifactorial:
- Hormonal influences: Estrogen reduction at menopause is a primary driver. 3
- Joint anatomy and alignment: Structural differences in female joints increase vulnerability. 1
- Muscle strength: Women typically have lower muscle strength protecting joints. 1
- Obesity: Higher rates in postmenopausal women compound risk. 1
- Genetics: Sex-linked genetic factors contribute. 1, 6
Important Clinical Caveats
The American Geriatrics Society explicitly rejects dismissing osteoarthritis symptoms as "normal aging" in women over 50—symptomatic osteoarthritis represents pathology requiring treatment regardless of age. 2
Patient education for women must be improved, as women who are candidates for joint replacement often do not receive timely treatment despite having more severe symptoms than men. 5
A confident clinical diagnosis can be made in women over 40 with typical features (pain on usage, mild morning stiffness) without extensive imaging. 3