Menopausal Hormone Therapy and Osteoarthritis Risk: Retrospective Population-Based Study in South Korea
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Objectives: This study aimed to investigate the risk of osteoarthritis associated with menopausal hormone therapy (MHT). Methods: This population-based retrospective cohort study used a database of Korean health insurance claims (2007–2020). Females aged ≥ 40 who initiated menopause-related healthcare visits between 2011 and 2014 were identified. The MHT group comprised females aged ≥ 40 who initiated MHT for ≥ 6 months during this period. The non-MHT group comprised females aged ≥ 40 who attended menopause-related healthcare visits but did not receive MHT. To account for potential confounding factors, the two groups were matched at a 1:1 ratio using propensity score matching. Results: A cohort of 453,040 postmenopausal females aged ≥ 40 years was identified, with 26,354 assigned to either the MHT or non- MHT group after propensity matching. The median age was 49 years, and the median follow-up was 8.2 years. The Cox proportional hazards model demonstrated an elevated risk of osteoarthritis with MHT (hazard ratio [HR], 1.154; 95% confidence interval [CI], 1.117–1.193) for knee (HR, 1.148; 95% CI, 1.102–1.195) and other arthritis (HR, 1.205; 95% CI, 1.151–1.261), although not statistically significant for hip arthritis. Tibolone (HR, 1.211; 95% CI, 1.161–1.263), estrogen–progestogen therapy (EPT) (HR, 1.092; 95% CI, 1.048– 1.137), and estrogen therapy (ET) (HR, 1.235; 95% CI, 1.148–1.329) were associated with a higher risk of osteoarthritis compared to non- MHT users. Conclusions: MHT was associated with an increased risk of osteoarthritis, consistently observed across tibolone, EPT, and ET, particularly affecting joints other than the hip, with a trend toward an elevated risk of hip osteoarthritis.
Abstract
Objectives: This study aimed to investigate the risk of osteoarthritis associated with menopausal hormone therapy (MHT). Methods: This population-based retrospective cohort study used a database of Korean health insurance claims (2007–2020). Females aged ≥ 40 who initiated menopause-related healthcare visits between 2011 and 2014 were identified. The MHT group comprised females aged ≥ 40 who initiated MHT for ≥ 6 months during this period. The non-MHT group comprised females aged ≥ 40 who attended menopause-related healthcare visits but did not receive MHT. To account for potential confounding factors, the two groups were matched at a 1:1 ratio using propensity score matching. Results: A cohort of 453,040 postmenopausal females aged ≥ 40 years was identified, with 26,354 assigned to either the MHT or non- MHT group after propensity matching. The median age was 49 years, and the median follow-up was 8.2 years. The Cox proportional hazards model demonstrated an elevated risk of osteoarthritis with MHT (hazard ratio [HR], 1.154; 95% confidence interval [CI], 1.117–1.193) for knee (HR, 1.148; 95% CI, 1.102–1.195) and other arthritis (HR, 1.205; 95% CI, 1.151–1.261), although not statistically significant for hip arthritis. Tibolone (HR, 1.211; 95% CI, 1.161–1.263), estrogen–progestogen therapy (EPT) (HR, 1.092; 95% CI, 1.048– 1.137), and estrogen therapy (ET) (HR, 1.235; 95% CI, 1.148–1.329) were associated with a higher risk of osteoarthritis compared to non- MHT users. Conclusions: MHT was associated with an increased risk of osteoarthritis, consistently observed across tibolone, EPT, and ET, particularly affecting joints other than the hip, with a trend toward an elevated risk of hip osteoarthritis.
참고문헌 (25)
- Flores VA, "Hormone therapy in menopause : concepts, controversies, and approach to treatment", Endocr Rev, 42, pp.720~752 (2021)
- O’Neill TW, "Update on the epidemiology, risk factors and disease outcomes of osteoarthritis", Best Pract Res Clin Rheumatol, 32, pp.312~326 (2018)
- Glyn-Jones S, "Osteoarthritis", Lancet, 386, pp.376~387 (2015)
- Hong JW, "The prevalence of and demographic factors associated with radiographic knee osteoarthritis in Korean adults aged ≥ 50 years : the 2010-2013 Korea National Health and Nutrition Examination Survey", PLoS One, 15, pp.e0230613~ (2020)
- Ham KD, "Effects of longterm estrogen replacement therapy on osteoarthritis severity in cynomolgus monkeys", Arthritis Rheum, 46, pp.1956~1964 (2002)
- Nevitt MC, "Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group", Arch Intern Med, 156, pp.2073~2080 (1996)
- Taylor HS, "Speroff’s clinical gynecologic endocrinology and infertility" (2019), Lippincott, Williams & Wilkins
- Zhang Y, "Estrogen replacement therapy and worsening of radiographic knee osteoarthritis : the Framingham Study", Arthritis Rheum, 41, pp.1867~1873 (1998)
- Cirillo DJ, "Effect of hormone therapy on risk of hip and knee joint replacement in the Women’s Health Initiative", Arthritis Rheum, 54, pp.3194~3204 (2006)
- "The 2022 Hormone Therapy Position Statement of The North American Menopause Society"Advisory Panel, "The 2022 hormone therapy position statement of The North American Menopause Society", Menopause, 29, pp.767~794 (2022)
- Yuk JS, "Relationship between menopausal hormone therapy and breast cancer : a nationwide population-based cohort study", Int J Gynaecol Obstet, 166, pp.735~744 (2024)
- Kim L, "A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples", Epidemiol Health, 36, pp.e2014008~ (2014)
- Quan H, "Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries", Am J Epidemiol, 173, pp.676~682 (2011)
- da Silva JA, "Inflammation-induced cartilage degradation in female rodents. Protective role of sex hormones", Arthritis Rheum, 36, pp.1007~1013 (1993)
- Turner AS, "Biochemical effects of estrogen on articular cartilage in ovariectomized sheep", Osteoarthritis Cartilage, 5, pp.63~69 (1997)
- Wluka AE, "Users of oestrogen replacement therapy have more knee cartilage than non-users", Ann Rheum Dis, 60, pp.332~336 (2001)
- Spector TD, "Is hormone replacement therapy protective for hand and knee osteoarthritis in women? : the Chingford study", Ann Rheum Dis, 56, pp.432~434 (1997)
- Liu B, "Reproductive history, hormonal factors and the incidence of hip and knee replacement for osteoarthritis in middle-aged women", Ann Rheum Dis, 68, pp.1165~1170 (2009)
- Hussain SM, "Female reproductive and hormonal factors and incidence of primary total knee arthroplasty due to osteoarthritis", Arthritis Rheumatol, 70, pp.1022~1029 (2018)
- Eun Y, "Female reproductive factors and risk of joint replacement arthroplasty of the knee and hip due to osteoarthritis in postmenopausal women : a nationwide cohort study of 1. 13 million women", Osteoarthritis Cartilage, 30, pp.69~80 (2022)
- Hou WY, "Association of hormone replacement therapy and the risk of knee osteoarthritis : a meta-analysis", Medicine (Baltimore), 101, pp.e32466~ (2022)
- Smith YR, "Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women", J Neurosci, 26, pp.5777~5785 (2006)
- Dawson-Basoa ME, "Estrogen and progesterone activate spinal kappa-opiate receptor analgesic mechanisms", Pain, 64, pp.608~615 (1996)
- Yoshida A, "Immunohistochemical analysis of the effects of estrogen on intraarticular neurogenic inflammation in a rat anterior cruciate ligament transection model of osteoarthritis", Connect Tissue Res, 53, pp.197~206 (2012)
- Seidel MF, "Nerve growth factor : an update on the science and therapy", Osteoarthritis Cartilage, 21, pp.1223~1228 (2013)