Associations between low sex steroid concentrations and incidence of knee and hip replacement for osteoarthritis in community-dwelling older women

Mengjie Zeng; Susan R Davis; Flavia M Cicuttini; Angus Franks; John J McNeil; Yuanyuan Wang

doi:10.1016/j.maturitas.2024.108174

Associations between low sex steroid concentrations and incidence of knee and hip replacement for osteoarthritis in community-dwelling older women

Maturitas. 2024 Dec 14:193:108174. doi: 10.1016/j.maturitas.2024.108174. Online ahead of print.

Authors

Mengjie Zeng¹, Susan R Davis², Flavia M Cicuttini³, Angus Franks⁴, John J McNeil⁵, Yuanyuan Wang⁶

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].
³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].
⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: [email protected].

PMID: 39693720
DOI: 10.1016/j.maturitas.2024.108174

Abstract

Objective: To examine whether low circulating sex steroid concentrations are associated with the incidence of knee and hip replacement for osteoarthritis in community-dwelling older women.

Study design: This prospective cohort study examined 5535 Australian women recruited into the Aspirin in Reducing Events in the Elderly (ASPREE) trial, aged ≥70 years, not taking medications affecting sex steroid concentrations, and with sex steroid concentrations measured by liquid chromatography-tandem mass spectrometry.

Main outcome measures: The incidence of knee and hip replacement for osteoarthritis was determined by hospitalisations for knee and hip surgical procedures where osteoarthritis was recorded as the indication.

Results: With a mean follow-up of 3.9 (SD 1.4) years, 311 women underwent knee replacement and 242 underwent hip replacement. A greater incidence of knee replacement was observed in women with the lowest quartile concentrations of oestrone (HR 1.35, 95 % CI 1.04-1.75, p = 0.03) and testosterone (HR 1.35, 95 % CI 1.05-1.72, p = 0.02) compared with quartiles 2 to 4, after adjusting for age, body mass index, socioeconomic status, smoking, alcohol consumption, and comorbidities. A greater likelihood of hip replacement was seen for women with the lowest quartile concentrations of dehydroepiandrosterone compared with quartiles 2 to 4 (HR 1.37, 95 % CI 1.03-1.82, p = 0.03).

Conclusions: Low concentrations of endogenous sex steroids were associated with a greater likelihood of lower-limb joint replacement for osteoarthritis in community-based women aged 70 years or older. These findings suggest sex steroids contribute to musculoskeletal health in later life, although the mechanisms by which sex steroids might influence joint replacement remain unclear.

Clinicaltrials: gov NCT01038583. International Standard Randomized Controlled Trial Number Register ISRCTN83772183.

Keywords: Hip replacement; Knee replacement; Older women; Osteoarthritis; Sex steroids.