Abstract
Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and Web of Knowledge in the last 10 years. Inclusion criteria were limited to clinical studies of patients affected by OA in any joints, analyzing as primary aim gender/sex differences. Exclusion criteria were review articles, in vitro, in vivo and ex vivo studies, case series studies and papers in which gender/sex differences were adjusted as confounding variable. Of the 120 records screened, 42 studies were included. Different clinical outcomes were analyzed: morphometric differences, followed by kinematics, pain, functional outcomes after arthroplasty and health care needs of patients. Women appear to use more health care, have higher OA prevalence, clinical pain and inflammation, decreased cartilage volume, physical difficulty, and smaller joint parameters and dimensions, as compared to men. No in-depth studies or mechanistic studies analyzing biomarker differential expressions, molecular pathways and omic profiles were found that might drive preclinical and clinical research towards sex-/gender-oriented protocols.
Highlights
Osteoarthritis (OA) is a widespread musculoskeletal disease, affecting an estimated300 million people worldwide and >40 million people across Europe
We included papers following inclusion criteria: clinical reports about sex/gender differences in osteoarthritis conditions, full text, written in English language, published in the last 10 years; the primary stated item should be the investigation of sex or gender differences in OA population
↑ fJSW in men vs. women, at baseline. ↓ risk of radiographic K-L grade and of worsening lateral joint space narrowing (JSN) in men vs. women. ↑ risk of medial JSN worsening based on OARSI grade progression in men vs. women. ↑ medial fJSW in men, at 4 years vs. men and women
Summary
Osteoarthritis (OA) is a widespread musculoskeletal disease, affecting an estimated300 million people worldwide and >40 million people across Europe. Clinical trials have demonstrated that the presence of OA is significantly associated with a higher risk of being frail [9,10,11,12,13,14]; on the other hand, the role of frailty in the development of degenerative joint diseases has been hypothesized due to the increase in pro-inflammatory mediators and the presence of sarcopenia associated with a higher fall risk [15] While risk factors such as age, obesity, injury and genetic profiles have been identified, the role of gender in OA has been understated [16,17], even if for many years, sex/gender differences have been noted in the prevalence, incidence and severity of OA [18]. Sex and gender are two different concepts, in medicine they are often linked and in the present study they were used as synonyms
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