Osteoarthritis Research and Care: The Role of Sex and Gender Differences



The Society for Women’s Health Research (SWHR) published a review in The Journal of Women’s Health assessing research gaps and unmet needs around sex and genders differences in osteoarthritis (OA). The paper summarizes discussions among experts during an SWHR interdisciplinary scientific roundtable and highlights areas of need that warrant further attention in OA research, diagnosis, care, and education.

OA is the leading cause of work disability among adults in the U.S. and affects more than 300 million people globally, but that burden is not distributed equally. Women experience a higher overall prevalence of disease as well as greater severity of symptoms and increased levels of disability. To better understand these disparities and improve health outcomes for all, the influence of sex and gender differences must be considered in OA research and clinical care.

OA develops as cartilage between bones breaks down and wears away, causing joint pain and/or stiffness, tenderness, swelling, and loss of flexibility. The condition may affect any joint in the body, but it is commonly observed in the hands, knees, and hips.

The gender discrepancy in OA prevalence does not appear until about 50 years of age, at which point incidence rises sharply among women. While researchers often suggest sex hormones as a factor that may explain the increase in joint pain in women during the menopausal transition, the role of hormones is not well understood.

Women also often struggle to access appropriate treatment for OA. For example, orthopedic devices have been shown at times to be significantly less effective in women, with women reporting higher frequencies of adverse events. Providers are also less likely to recommend surgical interventions for women compared to men, even if reported symptoms and radiographic severity are consistent across gender and despite the fact that men and women benefit equally from this treatment.

The normalization of women’s pain may contribute to provider bias in treatment recommendations, and this issue may be compounded for women of color, whose pain is also frequently normalized or poorly managed. “Clinical providers and researchers must do a better job at acknowledging that gender, race, and ethnicity may affect symptom reporting, diagnosis, and treatment within the chronic pain space, as well as addressing how their own judgment may be affected by stereotypical beliefs,” the paper states.

SWHR’s review recommends prioritizing the following areas­ in OA­­ research and clinical care:

  • Characterization of normal joint aging vs. OA pathology
  • Effects of biological sex differences on OA pathology and processes
  • Consideration of sex differences in animal models of OA and inclusion of female subjects
  • Sex and gender differences in pain perception
  • The relationship between sex hormones and pain
  • Better methods for measuring OA symptoms, specifically pain and functionality
  • Impact of OA on patient quality of life, disability, functionality, and pain experience
  • Barriers to treatment, including underuse of the effective treatments and availability of treatments
  • Effects of provider biases and education on patient care

Despite the prevalence of OA, there are foundational gaps in research and understanding of the disease’s development and progression. Long-term studies that bolster existing research and explore the areas outlined above are crucial to filling these gaps in knowledge and elucidating sex and gender differences in OA.

Read the Review

The Society for Women’s Health Research (SWHR) published a review in The Journal of Women’s Health assessing research gaps and unmet needs around sex and genders differences in osteoarthritis (OA). The paper summarizes discussions among experts during an SWHR interdisciplinary scientific roundtable and highlights areas of need that warrant further attention in OA research, diagnosis, care, and education.

OA is the leading cause of work disability among adults in the U.S. and affects more than 300 million people globally, but that burden is not distributed equally. Women experience a higher overall prevalence of disease as well as greater severity of symptoms and increased levels of disability. To better understand these disparities and improve health outcomes for all, the influence of sex and gender differences must be considered in OA research and clinical care.

OA develops as cartilage between bones breaks down and wears away, causing joint pain and/or stiffness, tenderness, swelling, and loss of flexibility. The condition may affect any joint in the body, but it is commonly observed in the hands, knees, and hips.

The gender discrepancy in OA prevalence does not appear until about 50 years of age, at which point incidence rises sharply among women. While researchers often suggest sex hormones as a factor that may explain the increase in joint pain in women during the menopausal transition, the role of hormones is not well understood.

Women also often struggle to access appropriate treatment for OA. For example, orthopedic devices have been shown at times to be significantly less effective in women, with women reporting higher frequencies of adverse events. Providers are also less likely to recommend surgical interventions for women compared to men, even if reported symptoms and radiographic severity are consistent across gender and despite the fact that men and women benefit equally from this treatment.

The normalization of women’s pain may contribute to provider bias in treatment recommendations, and this issue may be compounded for women of color, whose pain is also frequently normalized or poorly managed. “Clinical providers and researchers must do a better job at acknowledging that gender, race, and ethnicity may affect symptom reporting, diagnosis, and treatment within the chronic pain space, as well as addressing how their own judgment may be affected by stereotypical beliefs,” the paper states.

SWHR’s review recommends prioritizing the following areas­ in OA­­ research and clinical care:

  • Characterization of normal joint aging vs. OA pathology
  • Effects of biological sex differences on OA pathology and processes
  • Consideration of sex differences in animal models of OA and inclusion of female subjects
  • Sex and gender differences in pain perception
  • The relationship between sex hormones and pain
  • Better methods for measuring OA symptoms, specifically pain and functionality
  • Impact of OA on patient quality of life, disability, functionality, and pain experience
  • Barriers to treatment, including underuse of the effective treatments and availability of treatments
  • Effects of provider biases and education on patient care

Despite the prevalence of OA, there are foundational gaps in research and understanding of the disease’s development and progression. Long-term studies that bolster existing research and explore the areas outlined above are crucial to filling these gaps in knowledge and elucidating sex and gender differences in OA.

Read the Review