Background-Osteoarthritis (OA) is increasingly prevalent in the years after menopause. Epidemiological data suggest that the use of oestrogen replacement therapy (ERT) may protect against knee OA. Aim-To test the hypothesis that long term ERT (longer than five years) is associated with increased knee cartilage in postmenopausal women. Methods-The study involved 81 women (42 current users (> five years) of ERT and 39 who had never used it). Articular cartilage volumes were determined by processing images acquired in the sagittal plane using a T1 weighted fat suppressed magnetic resonance sequence on an independent work station. Results-After bone size had been accounted for, ERT users had higher tibial cartilage volume than non-users. Total tibial cartilage volume was 7.7% (0.23 ml) greater in the group of ERT users (2.98 (0.47) ml; mean (SD)) than in the untreated group (2.75 (0.50) ml). The diVerence, after adjustment for the significant explanatory factors (years since menopause, body mass index, age at menopause, and smoking), between the ERT users and non-users increased from 0.23 ml to 0.30 ml (95% confidence interval 0.08 to 0.52, p=0.008). These diVerences persisted after exclusion of women with OA. Conclusions-After adjustment for multiple confounders, women using long term ERT have more knee cartilage than controls. This may indicate that ERT prevents loss of knee articular cartilage. (Ann Rheum Dis 2001;60:332-336) Osteoarthritis (OA) is the major cause of disability in people over 65.
1No known treatment aVects its progression. It is more common in women than men, suggesting that diVerences in sex hormones modulate the disease. However, the eVect of oestrogen replacement therapy (ERT) on the incidence and prevalence of OA in postmenopausal women is controversial. Few epidemiological studies on the eVect of ERT on the prevalence of OA have produced statistically significant results. [2][3][4]