Incidence of total knee and hip replacement due to osteoarthritis in relation to circulating sex steroid hormone concentrations in women

Hussain SM, Cicuttini FM, Bell RJ, Robinson PJ, Davis SR, Giles GG, Graves S, Milne RL, Wang Y (2014) Incidence of total knee and hip replacement due to osteoarthritis in relation to circulating sex steroid hormone concentrations in women. Arthritis & rheumatology (Hoboken, N.J.)

Objective: The increased prevalence of osteoarthritis (OA) in postmenopausal women suggests that changes in either circulating sex steroid concentrations or tissue response to sex steroids may have a role in the pathogenesis of OA. The aim of this study was to examine whether circulating sex steroid concentrations were associated with the incidence of total knee and hip replacement for OA. Methods: 2,621 women from the Melbourne Collaborative Cohort Study (MCCS) had circulating sex steroid concentrations measured in blood samples drawn at recruitment (1990-1994). The incidence of total knee and hip replacement for OA during 2001-2011 was determined by linking MCCS records to the Australian Orthopaedic Association National Joint Replacement Registry. Results: 115 women had total knee replacement and 99 had total hip replacement for OA. Greater log estradiol concentration was associated with a lower incidence of knee replacement (hazard ratio (HR) 0.70, 95% CI 0.50-0.96), and greater log androstenedione concentration was associated with a lower incidence of hip replacement (HR 0.70, 95% CI 0.52-0.93). In contrast, greater log sex hormone binding globulin (SHBG) concentration was associated with greater incidence of hip replacement (HR 1.70, 95% CI 1.05-2.77). Conclusion: Lower estradiol concentration is a risk factor for knee OA; lower androstenedione concentration and higher SHBG concentration are risk factors for hip OA in women. The findings suggest a role of circulating sex steroids in the pathogenesis of OA and that modifying these steroid concentrations may provide potential strategies for the prevention and treatment of knee and hip OA. (c) 2014 American College of Rheumatology.