REVIEW - Limited evidence for a protective effect of unopposed estrogen therapy for OA of the hip

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Rheumatology Advance Access published online on November 10, 2008

Rheumatology, doi:10.1093/rheumatology/ken390

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Review

Limited evidence for a protective effect of unopposed oestrogen

therapy for osteoarthritis of the hip: a systematic review

B. M. de Klerk1, D. Schiphof1, F. P. M. J. Groeneveld1, B. W. Koes1,

G. J. V. M. van Osch2,3, J. B. J. van Meurs4 and S. M. A.

Bierma-Zeinstra1

1Department of General Practice,2Department of

Orthopaedics,3Department of Otorhinolaryngology,4Department of

Internal Medicine, Erasmus MC, University Medical Center Rotterdam,

Rotterdam, The Netherlands

Abstract

Above the age of 50 yrs, the incidence of OA rises steeply in women

but less in men, suggesting an association with changes in female

hormone levels in the menopause. This systematic review summarizes the

evidence on the assumed association between exogenous hormone use and

OA. Medline was searched up to March 2008 for articles assessing

associations between OA of hand, hip or knee and menopause-related

aspects. Methodological quality of the studies was assessed

systematically. The results were summarized in a best-evidence

synthesis. Nineteen studies on exogenous hormone use are included.

Limited evidence was seen for a protective effect of unopposed

oestrogen use for incidence of hip replacement/joint replacement, and

a protective trend for incident radiological OA (ROA) of the knee. In

prevalence studies, conflicting evidence was observed for hormone

replacement therapy (HRT) use with DIP ROA and 'any joint OA', and

oestrogen use with clinical knee OA. We found limited evidence for a

significantly increased risk by using HRT for clinical hip OA and a

significant protective effect of long-term unopposed oestrogen use for

hip ROA. For all other relations studied no associations were found.

Heterogeneity between the hormones used and outcome measurements made

statistical data pooling impossible. The assumed relationship between

the exogenous hormone use and OA was not clearly observed in this

review. The relationship is perhaps too complex, or other aspects, yet

to be determined, play a role in the increased incidence in women aged

over 50 yrs. However, there is some evidence of a protective effect of

unopposed oestrogen use for hip OA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken390v1?papetoc

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