Osteoarthritis and Menopause

Osteoarthritis (OA) is the most common form of arthritis, characterised by the breakdown of cartilage in the joints, leading to pain, stiffness, and reduced mobility. It commonly affects the knees, hips, toes and hands, making everyday activities challenging for those who suffer from it.

The Connection Between Menopause and Osteoarthritis

Role of Oestrogen

Oestrogen, a hormone that decreases significantly during menopause, is vital in maintaining joint health. Research indicates that oestrogen has anti-inflammatory properties and helps maintain the cartilage that cushions the joints. A study published in the National Center for Biotechnology Information (NCBI) highlights how oestrogen deficiency can contribute to the development and progression of OA​.

Oestrogen's Role in Cartilage Health

1. Cartilage Maintenance and Repair

   • Oestrogen receptors are present in cartilage cells (chondrocytes), indicating that oestrogen directly influences these cells.

   • Oestrogen promotes the synthesis of proteoglycans and collagen, essential components of the cartilage matrix, thus contributing to the maintenance and repair of cartilage.

2. Anti-inflammatory Effects

   • Oestrogen has anti-inflammatory properties, which are crucial for protecting cartilage from degradation.

   • It reduces the production of pro-inflammatory cytokines and increases the production of anti-inflammatory cytokines, thus reducing inflammation in the joints.

3. Inhibition of Cartilage Degradation

   • Oestrogen decreases the activity of enzymes that break down cartilage.

   • It also stops the expression of another enzyme involved in cartilage breakdown.

4. Bone and Cartilage Interaction

   • Oestrogen helps maintain bone density, which indirectly supports cartilage health.

   • Strong and healthy bones provide better support for the cartilage, reducing the risk of joint degeneration.

Osteoarthritis (OA) is a common joint disorder characterised by cartilage degradation. Studies have shown that the prevalence of knee osteoarthritis is higher in postmenopausal women compared to premenopausal women. A study reported that just under half of women aged 45-65 experience some form of knee osteoarthritis. It also suggests that oestrogen plays a protective role against OA:

1. Women are more likely to develop OA after menopause, a period marked by a significant drop in oestrogen levels.

2. Hormone replacement therapy (HRT) has been associated with a reduced risk of developing OA, indicating the protective role of oestrogen. Women on HRT have been reported to have a 3 in 10 chance of lower risk of developing knee and hip osteoarthritis compared to those not on HRT.

3. Studies have shown that postmenopausal women on HRT experience less cartilage degradation compared to those not on HRT. These studies suggest that maintaining oestrogen levels may help preserve joint health and prevent the progression of OA.

Mechanisms of Oestrogen Action

1. Receptor Interaction

   • Oestrogen acts through oestrogen receptors present. Binding to these receptors promotes cartilage repair and reduces inflammation.

2. Gene Regulation

   • Oestrogen influences the expression of genes involved in cartilage production and degradation. It upregulates the expression of cartilage-positive genes and downregulates cartilage-negative genes, balancing cartilage synthesis and breakdown.

Additional Risk Factors for Osteoarthritis

While hormonal changes play a significant role, other non-oestrogen-related factors also contribute to the risk of developing osteoarthritis. These include:

• Age - The risk of osteoarthritis increases due to the cumulative wear and tear on the joints.

• Genetics - Family history can influence the likelihood of developing OA.

• Weight - Excess body weight stresses weight-bearing joints, particularly the knees and hips.

• Injury - Joint injuries from sports or accidents can increase the risk of OA.

• Occupation - Jobs that require repetitive movements or heavy lifting can lead to joint stress and OA.

Symptoms of Osteoarthritis

1. Joint Pain and Tenderness

   • Joint pain is often the first symptom of osteoarthritis, ranging from mild to severe.

   • Pain typically worsens with activity and improves with rest.

   • Joints may feel tender when applying light pressure.

2. Stiffness

   • Stiffness is especially noticeable in the morning or after periods of inactivity, such as sitting for a long time.

   • It usually improves after moving around.

3. Loss of Flexibility

   • Affected joints may lose their full range of motion.

   • This can make it difficult to perform everyday tasks.

4. Grating Sensation

   • A grating or grinding sensation, known as crepitus, can occur when moving the joint.

   • This sensation is due to the rough surfaces of cartilage rubbing against each other.

5. Swelling

   • The area around the affected joints may become swollen.

   • This swelling can be due to the inflammation of the soft tissues surrounding the joint or the production of excess joint fluid.

Other Possible Symptoms

• Bone Spurs - Extra bits of bone, called osteophytes or bone spurs, may form around the affected joint, contributing to pain and reduced movement.

• Decreased Function - Over time, the ability to use the affected joint may decrease, impacting daily activities such as walking, gripping objects, or climbing stairs.

• Hot to touch - The affected joint may feel warm to the touch, indicating inflammation.

Treatments for Osteoarthritis

Medications

• Pain relievers - Over-the-counter medications like paracetamol can help manage pain.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - These reduce inflammation and alleviate pain but should be used under medical supervision, such as ibuprofen.

• Corticosteroids - These steroids can be injected into the joint to reduce inflammation and pain.

Physical Therapy

Physical therapy can help improve joint function and reduce pain. Exercises focusing on strengthening the muscles around the joints and improving flexibility are beneficial.

Lifestyle Changes

• Weight management: Losing weight reduces the strain on joints.

• Exercise: Low-impact exercises like swimming, walking, and cycling can help maintain joint health without causing excessive stress.

• Healthy diet: A diet rich in omega-3 fatty acids, antioxidants, and vitamins can support overall joint health.

Surgical Options

In severe cases of osteoarthritis, surgical interventions like joint replacement may be considered. Hip and knee replacements are standard procedures that can significantly improve the quality of life for patients with advanced OA.

Medications

Pain Relievers: Over-the-counter options like paracetamol can help manage mild pain. For more severe pain, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be prescribed.

Topical Treatments: Creams or gels containing NSAIDs or capsaicin can be applied directly to the affected joints.

Corticosteroid Injections: For severe inflammation, corticosteroid injections directly into the joint can provide temporary relief.

Hormone Replacement Therapy (HRT)

HRT Benefits: Hormone replacement therapy can help alleviate menopausal symptoms and may reduce the risk of osteoarthritis by maintaining oestrogen levels, which support joint health.

Considerations: HRT is not suitable for everyone and can have side effects. It’s essential to discuss the risks and benefits with a healthcare provider.

Physical Therapy

Exercise Programs: Tailored exercise programs designed by a physical therapist can strengthen the muscles around the joints, improve flexibility, and reduce pain.

Low-Impact Activities: Swimming, cycling, and walking are recommended to maintain joint mobility without causing excessive strain.

Assistive Devices

Braces and Supports: Braces can help stabilise the joints and reduce pain during activities.

Orthotic Devices: Shoe inserts or custom orthotics can improve joint alignment and reduce stress on the affected joints.

Prevention of Osteoarthritis Related to Menopause

Maintain a Healthy Weight

Weight Management Programme: Excess weight stresses weight-bearing joints such as the knees and hips. Maintaining a healthy weight can reduce the risk of developing OA and alleviate symptoms if OA is already present.

Balanced Diet

Nutrient-Rich Foods: A diet rich in vitamins and minerals, particularly calcium and vitamin D, supports bone health. Omega-3 fatty acids in fish, flaxseeds, and walnuts can help reduce inflammation.

Anti-Inflammatory Foods: Incorporating anti-inflammatory foods like berries, leafy greens, and olive oil can help manage joint inflammation.

Regular Physical Activity

Exercise: Regular exercise helps maintain joint function and reduces stiffness. Focus on activities that enhance strength, flexibility, and cardiovascular health.

Strength Training: Building muscle strength around the joints provides better support and reduces the risk of injury.

Avoid Joint Overuse

Protecting Joints: Avoid repetitive movements that can strain the joints. Use proper techniques when weight training or performing tasks that require joint movement.

Preventive Health Measures

Regular Check-Ups: Regular medical check-ups can help monitor bone health and manage menopause-related symptoms. Early intervention can prevent the progression of OA.

Bone Density Tests: Postmenopausal women should consider getting bone density tests to check for osteoporosis, which can exacerbate OA.

While the decline in oestrogen levels during menopause can contribute to the development of osteoarthritis, it's essential to consider other risk factors and adopt a holistic approach to management. By staying informed and proactive, women can effectively manage the symptoms of osteoarthritis and maintain a good quality of life during and after menopause.