Sex Hormones May Benefit Osteoarthritis

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Could taking sex hormones have a positive effect on osteoarthritis? A team of German researchers have found that two sex hormones, testosterone and estrogen, may help regenerate cartilage in people who have this most common type of arthritis.

Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of the joint’s cartilage. As the breakdown progresses, the process of the bones rubbing against each other leads to stiffness, loss of movement in the joint, and pain. Approximately 27 million Americans have osteoarthritis, according to the Arthritis Foundation. The symptoms typically first appear after age 40, and after age 50 women are more likely to have the disease than are men.

Osteoarthritis impacts the hips, knees, lower back, neck, and hands most often, and loss of joint function is a major cause of work disability and poorer quality of life. It is estimated that arthritis and osteoarthritis cost the US economy about $128 billion per year in medical care and lost work-related costs. All of these factors make an effective treatment for the disease highly desirable.

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To that end, investigators from the August University in Goettingen, Germany, evaluated the activity of chondrogenic progenitor cells (CPCs) in tissue samples they collected from 372 patients who had undergone total knee replacement associated with osteoarthritis. CPCs have been found in the tissue of individuals who have late stage osteoarthritis.

Previous research has shown that estrogens have a positive impact on bone metabolism. In this study, researchers noted that 17B-estradiol, which is known to increase calcium accumulation in both men and women, was found in the joint fluid, along with CPCs positive for estrogen receptors and androgen (male hormone) receptors.

The tissue samples revealed elongated cells not observed in healthy connective tissue. Evaluation of the elongated cells revealed a unique population of CPCs in nearly all of the samples, which the investigators believe are good targets for therapy with hormones. “Hormone replacement therapy in joint fluid may help mitigate the effects of OA and further investigation is needed,” noted Nicolai Miosge, MD, PhD, a co-author of the study.

The World Health Organization (WHO) estimates that osteoarthritis will be the fourth leading cause of disability among older adults by 2020. New forms of treatment for this most common type of arthritis are needed, and the use of sex hormones in late stages of the disease may be an addition to the treatment options in the near future.

SOURCES:
Arthritis Foundation
Helmick C et al. Arthritis & Rheumatism 2008; 58(1): 15-25
Koelling S and Miosge N. Arthritis & Rheumatism 2010 March 30; DOI: 10.1002/art.27311
MMWR 2007; 56(01): 4-7

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