title: Sex hormones and structural changes in osteoarthritis: a systematic review.
abstract: OBJECTIVE
  To systematically review the evidence for a relationship between sex hormones and structural changes in osteoarthritis (OA).
  
  
  METHODS
  Electronic searches of MEDLINE were performed in November-December 2010 and in February 2011 for studies of sex hormones and OA that met a predefined set of criteria. Both controlled trials and observational studies were eligible for inclusion. Two independent reviewers extracted the data and assessed the methodological quality of the included studies. Due to the heterogeneity of the studies, we were unable to perform a best evidence synthesis. However we have provided summaries for each section.
  
  
  RESULTS
  Twenty-seven studies were included in this review, of which 11 were considered high quality. The evidence suggests an association between endogenous oestrogen and cartilage turnover and radiographic OA, and between testosterone and cartilage volume. There is also evidence for an association between exogenous oestrogen and cartilage and bone turnover, although its effects on radiographic and MRI structure as well as joint replacement are unclear. The evidence also supports an association between oestrogen receptor α and β gene polymorphisms and OA.
  
  
  CONCLUSIONS
  Although the heterogeneity of the studies means that there is insufficient evidence to form strong conclusions, the available evidence supports an effect of endogenous and exogenous oestrogen as well as oestrogen receptor polymorphisms on joint health.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University-Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Tanamas
authors.forename: Pushpika
authors.initials: P
authors.lastname: Wijethilake
authors.forename: Anita E
authors.initials: AE
authors.lastname: Wluka
authors.forename: Miranda L
authors.initials: ML
authors.lastname: Davies-Tuck
authors.forename: Donna M
authors.initials: DM
authors.lastname: Urquhart
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Wang
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Cicuttini
mesh_terms: D002356:Cartilage / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D004967:Estrogens / Q000378:metabolism*; D012739:Gonadal Steroid Hormones / Q000378:metabolism*; D006801:Humans; D007596:Joints / Q000378:metabolism*; D010003:Osteoarthritis / Q000235:genetics / Q000378:metabolism* / Q000473:pathology; D011110:Polymorphism, Genetic; D011859:Radiography; D011960:Receptors, Estrogen / Q000235:genetics / Q000378:metabolism*; D013739:Testosterone / Q000378:metabolism
chemical_list: D004967:Estrogens; D012739:Gonadal Steroid Hormones; D011960:Receptors, Estrogen; D013739:Testosterone