Objectives

Previous studies of the relationships between female reproductive factors and osteoarthritis (OA) have shown conflicting results. In this study, we aimed to explore the relationships between reproductive factors and joint replacement arthroplasty of the knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal Korean women.

Methods

We included 1,134,680 subjects who participated in national health examinations in 2009 in the study. The study outcomes were incident THRA or TKRA due to severe hip or knee OA. The relationships between reproductive factors and THRA or TKRA were evaluated using a multivariable-adjusted proportional hazards model.

Results

During a mean follow-up duration of 8.2 years, 1,610 incident THRA cases and 60,670 incident TKRA cases were observed. Later age at menarche, longer breastfeeding, HRT and OC use were associated with increased risk of TKRA for severe knee OA, while later age at menopause and longer reproductive span were associated with decreased risk. With regard to THRA for severe hip OA, later menarche, longer breastfeeding, HRT more than 5 years, and OC use more than 1 year were associated with higher risk. The associations between reproductive factors and severe OA were more pronounced in underweight and younger subjects.

Conclusion

We found that shorter estrogen exposure was associated with higher risk of TKRA due to severe knee OA, and such associations were more pronounced in underweight and younger subjects. The association between shorter estrogen exposure and THRA was not robust.

中文翻译：

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女性生殖因素和绝经后女性因骨关节炎导致膝关节和髋关节置换术的风险：一项针对 113 万女性的全国性队列研究

目标

先前关于女性生殖因素与骨关节炎 (OA) 之间关系的研究显示出相互矛盾的结果。在这项研究中，我们旨在探讨生殖因素与膝关节置换术 (TKRA) 和髋关节置换术 (THRA) 之间的关系，该研究是在一个以全国人口为基础的大型绝经后韩国女性队列中进行的。

方法

我们将2009年参加国家健康检查的1,134,680名受试者纳入研究。研究结果是由于严重的髋关节或膝关节 OA 导致的 THRA 或 TKRA。使用多变量调整比例风险模型评估生殖因素与 THRA 或 TKRA 之间的关系。

结果

在 8.2 年的平均随访期间，观察到 1,610 例 THRA 病例和 60,670 例 TKRA 病例。初潮年龄较晚、母乳喂养时间较长、HRT 和 OC 使用与严重膝关节 OA 的 TKRA 风险增加有关，而绝经年龄较晚和生育期较长与风险降低有关。对于重度髋关节 OA 的 THRA，初潮较晚、母乳喂养时间较长、HRT 超过 5 年和 OC 使用超过 1 年与较高的风险相关。生殖因素与严重 OA 之间的关联在体重过轻和较年轻的受试者中更为明显。

结论

我们发现，由于严重的膝关节 OA，较短的雌激素暴露与较高的 TKRA 风险相关，并且这种关联在体重过轻和年轻的受试者中更为明显。较短的雌激素暴露与 THRA 之间的关联并不牢固。