Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.
Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.
BMC Public Health. 2018 Oct 22;18(1):1192. doi: 10.1186/s12889-018-6114-1.
Knee osteoarthritis (KOA) is one form of degenerative arthritis that results from the breakdown of cartilage and underlying bone. The prevalence of KOA is considerably higher in women than in men; however, the reason for this difference has not been thoroughly elucidated to date. The aim of the present study was to estimate the effects of reproductive and hormone factors and obesity on KOA prevalence among Chinese women.
The cross-sectional study included 7510 women with a mean age of 62.6 ± 8.6 years. Knee pain was defined as pain or aching stiffness on most days for at least 1 month during the past 12 months or persistent pain or aching stiffness within the past week. Clinical KOA was diagnosed based on both pain complaints and a Kellgren-Lawrence grade ≥ 2 X-ray radiograph of at least one knee.
Oral contraceptives use (OR 1.18, 1.05-1.34), ≥3 pregnancies (1.38, 1.20-1.60), and postmenopausal hormone replacement therapy (HT) (1.59, 1.23-2.06) were positively associated with knee pain, while oral contraceptives use (1.28, 1.04-1.57), and HT (1.79, 1.21-2.65) were positively associated with clinical KOA. Obesity and oral contraceptives use showed additive and multiplicative effects on knee pain. The OR for knee pain among women with a BMI ≥24 kg/m and oral contraceptives use was 2.00 (1.68-2.38) compared with women with a BMI < 24 kg/m and no oral contraceptives use.
A high number of pregnancies, oral contraceptives use, and HT are independent risk factors for KOA, and the effects of reproductive and hormone factors on KOA may be increased by obesity.
膝骨关节炎（KOA）是一种退行性关节炎，其由软骨和骨下骨的破坏引起。KOA 在女性中的患病率明显高于男性；然而，迄今为止，这种差异的原因尚未得到彻底阐明。本研究旨在评估生殖和激素因素以及肥胖对中国女性 KOA 患病率的影响。
这项横断面研究纳入了 7510 名年龄平均为 62.6±8.6 岁的女性。膝关节疼痛定义为过去 12 个月中至少有 1 个月每天有疼痛或酸痛僵硬，或过去 1 周内持续有疼痛或酸痛僵硬。临床 KOA 根据疼痛主诉和至少一个膝关节的 Kellgren-Lawrence 分级≥2 X 射线片来诊断。
口服避孕药的使用（OR 1.18，1.05-1.34）、≥3 次妊娠（1.38，1.20-1.60）和绝经后激素替代治疗（HT）（1.59，1.23-2.06）与膝关节疼痛呈正相关，而口服避孕药的使用（1.28，1.04-1.57）和 HT（1.79，1.21-2.65）与临床 KOA 呈正相关。肥胖和口服避孕药的使用对膝关节疼痛有相加和相乘的影响。BMI≥24 kg/m 且使用口服避孕药的女性发生膝关节疼痛的 OR 为 2.00（1.68-2.38），高于 BMI <24 kg/m 且未使用口服避孕药的女性。
多次妊娠、口服避孕药的使用和 HT 是 KOA 的独立危险因素，而生殖和激素因素对 KOA 的影响可能会因肥胖而增加。
