Difference In Osteoarthritis Research Articles

Gender-specific Issues in Orthopaedic Surgery: Editorial Comment

While we have long been aware that diseases affect men and women differently, progress towards understanding the root causes of these differences has been slow. The last decade, however, has seen a dramatic increase in research examining gender disparities in the prevalence, diagnosis, and treatment of many diseases. In particular, gender has an important effect on many musculoskeletal conditions ranging from osteoarthritis to osteoporosis and fracture care.Fig. 1: Tamara D. Rozental, MD is shown.In 2004, the American Academy of Orthopaedic Surgeons and National Institutes of Health organized a workshop to explore advances in gender-based characteristics of musculoskeletal health. At the time, six priorities were identified for future musculoskeletal research [15]: (1) Monitor gender differences and similarities for all musculoskeletal diseases and conditions; (2) Conduct and design longitudinal and cross-sectional studies of musculoskeletal conditions allowing results to be analyzed by gender; (3) Make gender-specific data in musculoskeletal diseases and conditions more readily available; (4) Mine cross-species information and develop relevant in vivo and in vitro models that incorporate the biologic clock. Stratify human and animal studies of musculoskeletal diseases and conditions based on gender; (5) Expand research on gender differences in neural organization and function, pain and analgesia with respect to musculoskeletal diseases and conditions; (6) Promote research on gender differences at the molecular, cellular and tissue level with specific emphasis in musculoskeletal diseases and conditions. Although we are still far from reaching many of these goals, researchers are increasingly focusing on gender differences in the practice of orthopaedic surgery. While some of these findings have been widely discussed in the popular media, others remain underappreciated by the orthopaedic community. This symposium provides a sample of cutting-edge, original research analyzing the effects of sex and gender on the treatment and outcomes of musculoskeletal conditions. Given that these topics are not limited to a single discipline, the task is a challenging one. We present a variety of themes in hopes of touching upon the many subspecialties that have contributed to this growing field of study. Gender differences in osteoarthritis have perhaps received the greatest degree of attention. The prevalence of the disease is higher in women [11]. Genetic [1], anatomical [6] and physiological [3] factors have been suggested to contribute to the disease burden [10]. Although men and women with advanced osteoarthritis typically present with similar symptoms, disparities in the rate of treatment have been reported, with most studies pointing towards underuse of total joint arthroplasty among women [5]. More detailed assessments of outcomes following total joint arthroplasty will be helpful in allowing physicians to tailor and optimize treatment methods. Responsible for 1.5 million annual fractures in the United States, osteoporosis has also been the focus of intense research. Approximately 80% of those affected by osteoporosis are women and 50% of women over the age of 50 will have a fragility fracture in their lifetime [9]. Studies persistently demonstrate ineffective physician practices in adequately evaluating and treating patients for osteoporosis, particularly after fragility fractures [4, 14]. Continuing resources should be dedicated to identifying populations at risk and initiating appropriate preventive strategies. In addition to osteoarthritis and osteoporosis, investigators have identified several other conditions that disproportionately affect the sexes [8, 13]. Furthermore, many authors are focusing on analyzing differences in outcomes and health-care utilization rates between men and women [7, 12]. These efforts should be encouraged and developed. Graduate medical education is another subject that deserves special mention. Orthopaedic surgery continues to lag behind other surgical specialties in attracting female residents, and successful recruitment begins early in medical school [2]. Orthopaedic surgeons should thus actively engage students through mentoring programs and ensure that residency training meet the needs of female and male trainees alike. This symposium presents some of the more recent data examining differences between men and women in orthopaedic surgery. Observational studies as well as comparative series and basic science research are included among the highlighted papers. I am indebted to the talented group of individuals who contributed articles towards its publication, and hope that the work presented will encourage others to follow in their footsteps.

Gender differences in osteoarthritis

Gender differences in osteoarthritis

Expressing pain and fatigue: A new method of analysis to explore differences in osteoarthritis experience

To apply a new method of analysis to 2 large qualitative datasets in order to examine differences in osteoarthritis (OA) experience according to the affected joint (knee or hip) and sex. A secondary analysis of qualitative data from 2 studies was conducted. Study 1 comprised 28 focus groups with 50 men and 80 women (ages 47-92 years). Study 2 comprised 14 focus groups with 32 men and 56 women (ages 56-91 years). All participants had symptomatic OA. In Study 1, secondary analysis using comparative keyword analysis (CKA) compared relative frequencies of words uttered by participants experiencing knee pain with words used by participants experiencing hip pain. In Study 2, CKA compared words used by men with words used by women. Subsequent analysis explored the contexts in which participants used key words. All participants in Study 1 described concerns with their bodies, activity limitations, and pain management, but details of their concerns differed. People with knee pain focused on stairs, weight, and stiffness, while those with hip pain were concerned with sidedness and groin pain. In Study 2, both men and women discussed activity and interaction with spouses. However, men used more factual words, especially relating to enumeration, while women offered more explanation without prompting from others. CKA provides productive inroads into qualitative datasets. Understanding the different ways that affected joints are discussed, and sex differences in descriptions of OA, may lead to improvements in clinical assessment tools, better targeting of interventions, and enhanced communication between health care professionals and patients.

Sex Differences in Osteoarthritis of the Hip and Knee

The prevalence, incidence, and severity of osteoarthritis are different in women than in men. Women are more likely than men to suffer from osteoarthritis,and women experience more severe arthritis in the knee. Genetics, anatomy,and prior knee injury are risk factors for developing osteoarthritis. Although the presentation of osteoarthritis does not differ between men and women,symptom severity does. Additionally, women are three times less likely than men to undergo hip or knee arthroplasty. Patient education, particularly for women, must be improved so that women with osteoarthritis who are candidates for hip and knee arthroplasty not only receive treatment but also receive it in a timely manner.

Prevalence of Osteoarthritis, Osteoporotic Vertebral Fractures, and Spondylolisthesis among the Elderly in a Japanese Village

To study the prevalence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis among elderly residents of a Japanese village and to examine the correlation between radiographic evidence of abnormality and lower back pain. 205 men (mean age, 70.7 years) and 323 women (mean age, 70.5 years) in a Japanese village participated in this cross-sectional study. Plain lateral radiographs were taken from the lower thoracic spine to the sacral spine. They were evaluated by 3 independent orthopaedic surgeons for degree of osteoarthritis (using Weiner grading system) and the presence of osteoporotic vertebral fractures and spondylolisthesis. The prevalence of osteoarthritis in elderly Japanese villagers was 38.3%, whereas that of osteoporotic vertebral fractures and spondylolisthesis was 17.8% and 8.9%, respectively. There was no significant difference in osteoarthritis between men and women, but osteoporotic vertebral fractures and spondylolisthesis were significantly more common in females (p<0.01). No significant correlation was observed between lower back pain and radiographic evidence of degenerative spinal disease. The prevalence of spondylolisthesis in elderly Japanese was much lower than that in whites or African Americans. The prevalence of osteoarthritis or osteoporotic vertebral fractures was comparable with other English or US studies. Radiographic evidence of osteoarthritis, osteoporotic vertebral fractures, and spondylolisthesis is not necessarily associated with lower back pain.

A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis

To resolve uncertainty regarding sex differences in osteoarthritis (OA) by performing a meta-analysis of sex differences in OA prevalence, incidence and severity. Standard search strategies for population-based studies of OA providing sex-specific data. Random effects meta-analysis to provide pooled male vs female risk and rate ratios for prevalent and incident OA, and standardized mean differences (SMD) for OA severity. Meta-regression was used to investigate sources of heterogeneity. Males had a significantly reduced risk for prevalent OA in the knee [Risk Ratio (RR) 0.63, 95% CI 0.53-0.75] and hand [RR 0.81, 95% CI 0.73-0.90] but not for other sites. Males aged <55 years had a greater risk of prevalent cervical spine OA [RR 1.29, 95% CI 1.18-1.41]. Males also had significantly reduced rates of incident OA in the knee [Incidence Rate Ratio (IRR) 0.55, 95% CI 0.32-0.94] and hip [IRR 0.64, 95% CI 0.48-0.86], with a trend for hand [IRR 0.65, 95% confidence interval (CI) 0.35-1.20]. Females, particularly those > or = 55 years, tended to have more severe OA in the knee but not other sites. Heterogeneity in the estimates of sex differences in prevalence was substantially explained by age and other study design factors including method of OA definition. The results demonstrate the presence of sex differences in OA prevalence and incidence, with females generally at a higher risk. Females also tend to have more severe knee OA, particularly after menopausal age. The site differences indicate the need for further studies to explore mechanisms underlying OA.

Circulating and synovial levels of IGF-I, cytokines, physical function and anthropometry differ in women awaiting total knee arthroplasty when compared to men

Purpose: Determine if gender differences in osteoarthritis relate to cytokine and growth factor levels. Methods: Cross-sectional comparison of serum and synovial concentrations of cytokines (IL-1αβ, TNF-α, IL-6), growth factors (IGF-I, TGF-β, IRAP), physical performance and perceived function in total knee arthroplasty candidates (TKAC) ( n = 17) and healthy controls ( n = 21) was done. Results: Serum IGF-I values were reduced in female (TKAC 137.6 ± 7.2; Controls 160.2 ± 26.2) but not male TKAC (TKAC 182.6 ± 18.4; Controls 184.0 ± 18.4) ( p < 0.05).). Serum and synovial levels of cytokines and growth factors did not differ significantly by group or gender. Physical performance testing (SPW, TUG) revealed significant group and gender differences ( p = 0.001) with women demonstrating greater functional impairment. Discussion: A systemic, not local component to OA pathophysiology may exist for female TKAC. Male TKAC were less impaired, and their IGF-I levels differ little from Control values.

Racial and ethnic differences in osteoarthritis: prevalence, outcomes, and medical care.

Osteoarthritis (OA) is the most common chronic condition and a leading cause of disability among older adults. Studies indicate there are important racial and ethnic differences in the prevalence of OA, as well as in the associated outcomes and medical care. In general, research suggests some minority groups, especially African-American and Hispanic individuals, may be at risk for poorer outcomes (such as pain and disability), and are less likely to undergo arthroplasty, compared to Caucasian Americans. Racial and ethnic differences in OA and its medical care are poorly understood. Research is needed to examine biological, psychosocial, and lifestyle factors that may contribute to these disparities.

Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work.

The authors used data from the United States first national Health and Nutrition Examination Survey of 1971-1975 (HANES I) to explore the cross-sectional associations between radiographic osteoarthritis of the knee and a variety of putative risk factors. A total of 5,193 black and white study participants aged 35-74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were available for analysis. After controlling for confounders, the authors found significant associations of knee osteoarthritis with overweight, race, and occupation, all of which have been suggested by smaller cross-sectional studies. They then focused specifically on those factors. For overweight, they found a strong association between current obesity and osteoarthritis of the knee, with a dose-response effect not previously assessed. This association was also seen for self-reported minimum adult weight, a proxy for long-term obesity, and was present in persons with asymptomatic osteoarthritis of the knee. These findings strongly suggest that obesity is causative. HANES I was the first study in which racial differences in osteoarthritis of the knee could be assessed within the same country. The black women who were studied had an increased risk of disease (odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.39-3.23) after controlling for age and weight, although the black men did not. Finally, the authors used the US Department of Labor Dictionary of Occupational Titles to obtain characterizations of the physical demands and knee-bending stress associated with occupations and to study the relation between physical demands of jobs and osteoarthritis of the knee. They found for persons aged 55-64 years an association between knee-bending demands and osteoarthritis of the knee (men, OR = 2.45, 95% CI = 1.21-4.97; women, OR = 3.49, 95% CI = 1.22-10.52). Since such occupational physical demands are common, the authors conclude that they may be associated with a substantial proportion of osteoarthritis of the knee.