title: No clear association between female hormonal aspects and osteoarthritis of the hand, hip and knee: a systematic review.
abstract: OBJECTIVE
  Incidence of OA rises steeply in women of age >50 years; the climacteric period for women. The simultaneous occurrence of these events suggests an association between OA and changes in female hormonal aspects. This systematic review studies the assumed association between OA and aspects concerning the fertile period (duration, endogenous hormones, age at menarche/menopause) and the menopause [menopausal status, years since menopause (YSM) and surgical menopause].
  
  
  METHODS
  Medline and EMBASE were searched for articles assessing associations between hand/hip/knee OA and female hormonal aspects. Methodological quality was assessed systematically, and results were summarized in a best-evidence synthesis.
  
  
  RESULTS
  Sixteen studies were included in the present study. For most hormonal aspects no association was found. Conflicting evidence was found for an association of age at menarche with Herberden's nodes (HNs) and hand ROA, YSM with knee ROA and ovariectomy with hip OA. An increased risk was seen for low estradiol serum levels in the early follicular phase with incident knee ROA, age at menarche being < or =11 years old with total hip replacement, being post-menopausal and YSM with the presence of HN. A protective effect was seen for age at menopause being > or =52 years with total knee replacement. Evidence level was limited for all.
  
  
  CONCLUSIONS
  The assumed relationship between the female hormonal aspects 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 >50 years.
authors.affiliation: Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. b.deklerk@erasmusmc.nl
authors.forename: Bianca M
authors.initials: BM
authors.lastname: de Klerk
authors.forename: Dieuwke
authors.initials: D
authors.lastname: Schiphof
authors.forename: Frans P M J
authors.initials: FP
authors.lastname: Groeneveld
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Gerjo J V M
authors.initials: GJ
authors.lastname: van Osch
authors.forename: Joyce B J
authors.initials: JB
authors.lastname: van Meurs
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004958:Estradiol / Q000097:blood*; D005260:Female; D050823:Hand Joints; D006801:Humans; D008572:Menarche / Q000502:physiology; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D010003:Osteoarthritis / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D015207:Osteoarthritis, Hip / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D010052:Ovariectomy; D055815:Young Adult
chemical_list: D004958:Estradiol