A systematic review of the sex differences in risk factors for knee osteoarthritis

Ingrid A. Szilagyi*, Jan H. Waarsing, Joyce B.J. van Meurs, Sita M.A. Bierma-Zeinstra, Dieuwke Schiphof

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
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OBJECTIVES: Previous systematic reviews focused on the evidence of common risk factors for knee OA (KOA); however, the effect and strength of association between risk factors and KOA might be different between the two sexes. The aim of the present systematic review was to determine the current evidence on sex differences in the association between risk factors and KOA and their prevalence. METHODS: We searched the following electronic bibliographic databases: MEDLINE (PubMed), EMBASE and Web of Science. A methodological quality assessment was conducted independently by two researchers according to an adapted version of the standardized set of criteria known as the Newcastle-Ottawa Quality Assessment Scale (NOS). The NOS, a star system, was converted to three categories of quality. RESULTS: In total, 27 studies reported sex-specific risk estimates on several risk factors for KOA. Out of the 22 longitudinal cohort studies (except one nested case-control), 12 were of good quality and 10 were of fair quality. The five cross-sectional studies consisted of one of good, three of fair and one of poor quality. There was an indication of sex differences in risk factors leading to higher risk of KOA: high BMI, alcohol consumption, atherosclerosis and high vitamin E levels in women, and high physical activity, soft drink consumption and abdominal obesity in men. Knee injury, high blood pressure and low step rate seem to affect both women and men. CONCLUSION: More good quality studies are needed to assess sex differences in risk factors for KOA, especially for symptomatic/clinical OA.

Original languageEnglish
Pages (from-to)2037-2047
Number of pages11
JournalRheumatology (Oxford, England)
Issue number6
Publication statusPublished - Jun 2023

Bibliographical note

Funding Information:
Disclosure statement: S.M.A.B.-Z. declares doing consultancy for Pfizer (tanezumab) and reports grants from The Netherlands Organisation for Health Research and Development (ZonMw), Dutch Arthritis Association, Foreum. The remaining authors declare no competing financial interests. All authors declare no nonfinancial conflicts of interest. Acknowledgement

Funding Information:
This research was funded by The Netherlands Organisation for Health Research and Development (ZonMw), project number 849200003. The funding source did not have any influence on study design, collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology.


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