Impact of menopause and ageing on joints

Abstract

Musculoskeletal pain, arthralgia and arthritis are all more common in women and their frequency increases with age. Musculoskeletal pain is one of the commonest symptoms reported at the time of the menopause, present in up to 50% of women. The effects of ageing and of estrogen deficiency on joint tissues are discussed, and how this might manifest in the clinic. Changes in muscle (sarcopenia), soft tissues (tendon, ligament), cartilage volume and bone health, as well as changes in pain perception are seen in both conditions. Separating the effects of ageing and other changes due to menopause can therefore be challenging. The evidence for the role of sex hormone deficiency in the aetiology of musculoskeletal pain and arthritis will be reviewed, both in preclinical models and in human studies. There have been few interventional studies specifically within this group of symptomatic patients. Although there may be strong circumstantial evidence, a proven causal link between hormonal changes at the time of menopause and the pathogenesis of conditions such as fibromyalgia, osteoarthritis or rheumatoid arthritis has not been demonstrated. There remains much still to understand about how we might approach preventing or treating musculoskeletal pain and arthritis at the time of the menopause.