IS POSTMENOPAUSAL STATUS ASSOCIATED WITH INCREASED RISK FOR MENISCUS EXTRUSION?
Osteoarthritis Imaging, vol. 2, pp. 100034
Abstract
Postmenopausal status is one of the known OA risk factors. Decreased estrogen levels in postmenopausal women could alter the integrity of the menisci, leading to weakening of the meniscal matrix, followed by meniscal extrusion and subsequent OA development. To evaluate the association between postmenopausal status and meniscus extrusion in an open population of women aged 45-60 years. We used data from a female subcohort of the Rotterdam Study. At baseline, participating women underwent physical, radiographic, and MRI examinations. Postmenopausal status (defined as last menstruation ≥ 3 years), knee symptoms, and a history of knee injury were recorded by questionnaires. To calculate the Body Mass Index (BMI), body height and weight were obtained. The maximum quadriceps muscle strength was tested using a hand-held dynamometer. Medial knee alignment was measured and the presence of Heberden's nodes was documented. Meniscus extrusion was defined as ≥ 3 mm on MRI. Outcome measures were medial meniscal extrusion at baseline and after +/- 5.1 years follow-up (FU). Using generalized estimating equations, the association between postmenopausal status and meniscus extrusion was determined with a stepwise approach, both unadjusted and adjusted for co-variants (age, BMI, K&L ≥ 2, medial meniscal tears at baseline, varus alignment, the maximum strength of the quadriceps muscle, and the presence of Heberden's nodes), both adjusted for the correlation between knees within subjects. At baseline, 1305 knees in 657 women were available for analysis. 65.1% were postmenopausal of which 48.7% had medial meniscus extrusion, compared to 42% in pre-menopausal women. At follow-up, the prevalence of medial meniscal extrusion had increased up to 57% for the postmenopausal women at baseline, compared to 50.9% for premenopausal women. Unadjusted, knees of postmenopausal women showed a significant association with meniscus extrusion at baseline (OR 0.87; 95% CI 0.76, 0.99) and follow-up (1.21; 95% CI 1.06, 1.38). After adjustments for all co-variants, these associations became non-significant, with ORs 1.12 (95% CI 0.8, 1.58) and 1.07 (95% CI 0.66, 1.71), respectively. No evidence was found that postmenopausal women have a directly increased risk for meniscal extrusion. Likely, the higher risk of OA development is explained by mediating factors such as meniscus tears and a higher BMI. No All authors declare no conflict of interest. CORRESPONDENCE ADDRESS: [email protected]
Authors 7
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Erasmus MC · Maasstad Ziekenhuis
Affiliation as printed
Dept. of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Dept. of Radiology, Maasstad Hospital, Rotterdam, The Netherlands
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Affiliation as printed
Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Dept. of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Dept. of Radiology & Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Sita Bierma‐Zeinstra Aachen
Erasmus MC · Alrijne Ziekenhuis
Affiliation as printed
Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Dept. of Orthopedics & Sports Medicine; Alrijne Hospital, Leiderdorp, The Netherlands
Alrijne Hospital, Leiderdorp, The Netherlands
Dept. of Orthopedics & Sports Medicine
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Affiliation as printed
Dept. of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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