Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Ist Orthopedic Department, IRCCS - Istituto Ortopedico Rizzoli, Via G. Cesare Pupilli, 1, Bologna, Italy.
Eur J Orthop Surg Traumatol. 2024 May;34(4):1901-1910. doi: 10.1007/s00590-024-03871-4. Epub 2024 Mar 8.
The aim of the present review is to systematically analyse the current literature about gender differences in hip or knee cartilage composition and degeneration, to help explaining how and why osteoarthritis affects women more often and more severely than men. A systematic review of the literature in English was performed. Eleven studies on 1962 patients (905 females and 787 males) that reported differences on cartilage composition between males and females were included. Nine evaluated the knee, one the hip, and one both. They were heterogeneous in their methods: one conducted histological analyses, and all the others evaluated cartilage characteristics (volume, width, and composition) through magnetic resonance imaging. All authors reported gender differences in both volume and morphology of the cartilage, from infancy to menopause. In fact, a study on 92 healthy children statistically showed significant gender differences in cartilage thickness at all sites, even after adjustment for age, body, and bone size. Gender differences become more evident after menopause, when women have a lower cartilage volume and a higher cartilage loss. Men show significantly higher knee and hip cartilage volumes than women, and women carry a significantly greater risk to develop osteoarthritis. This is in part due to body and bone size, but also depends on qualitative and quantitative differences in the composition of cartilage and its degeneration rate after menopause. Structural changes in cartilage that occur between genders during ageing have significance in the development of osteoarthritis.
本综述旨在系统分析目前关于髋关节或膝关节软骨成分和退变的性别差异的文献，以帮助解释为什么骨关节炎会更频繁、更严重地影响女性。我们对英文文献进行了系统性回顾。纳入了 11 项研究，共涉及 1962 名患者（905 名女性和 787 名男性），这些研究报告了男性和女性之间的软骨成分差异。其中 9 项研究评估了膝关节，1 项研究评估了髋关节，1 项研究同时评估了这两个关节。这些研究在方法上存在差异：一项研究进行了组织学分析，而其余所有研究都通过磁共振成像评估了软骨特征（体积、宽度和成分）。所有作者都报告了从婴儿期到绝经期，男性和女性的软骨体积和形态都存在性别差异。事实上，一项对 92 名健康儿童的研究统计显示，即使在调整了年龄、身体和骨骼大小后，所有部位的软骨厚度都存在显著的性别差异。绝经后，女性的软骨体积更低，软骨丢失更多，性别差异变得更加明显。男性的膝关节和髋关节软骨体积明显高于女性，女性患骨关节炎的风险也明显更高。这部分是由于身体和骨骼大小的原因，但也取决于软骨成分的定性和定量差异及其绝经后退变的速度。两性在衰老过程中软骨发生的结构变化对骨关节炎的发展具有重要意义。
