Lower sex hormone levels are associated with more chronic musculoskeletal pain in community-dwelling elderly women

Abstract

Chronic pain is more prevalent in women than in men, with increasing differences between sexes in advanced age. This could be caused by differences in sex hormone levels. We therefore studied the relationship between sex hormones and the prevalence and incidence of chronic pain. The association between sex hormone levels and chronic pain was examined in 9717 participants aged 45 years and older from the Rotterdam Study, a population-based study. Chronic pain was defined as pain in the lower back, hands, knees and/or hips for at least 3 months. Sex hormone levels included estrogen, testosterone, androstenedione, and 17-hydroxyprogesterone. Relationships between hormones and prevalent and new onset chronic pain were analyzed using linear and logistic regression, stratified by gender. Women with androstenedione or estradiol levels in the lowest tertile had more chronic pain (odds ratio, 1.20; 95% CI, 1.03-1.39 and odds ratio, 1.27; 95% CI, 1.10-1.48, respectively). Mean estradiol levels were lower among men with chronic pain (mean difference -3.88 pmol/L; P = 0.005). Lowest tertile 17-hydroxyprogesterone in women was associated with 38% more new onset pain. All these associations were independent from age, body mass index, health and lifestyle factors, and osteoarthritis. Lower sex hormone levels are associated with chronic musculoskeletal pain, independent from lifestyle and health-related factors, in community-dwelling elderly women. These results suggest that sex hormones play a role in chronic pain and should be taken into account when a patient presents with chronic pain. Therefore, sex hormones may be a potential treatment target for these patients.

Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis

“…Circulating testosterone gradually decrease in postmenopausal women and the low testosterone levels have been linked to increased pain sensitivity 41 . Similarly, in a recent study, community-dwelling elderly women with lower sex hormone levels were found to have more chronic musculoskeletal pain 9 . In the present study, we also found an inverse relationship between sex hormone levels and VAS pain score in women, but only the association for testosterone reaches statistical significant.…”

“…No significant relationship was found between testosterone and cartilage morphology or bone structure in an asymptomatic population 8 . Apart from knee structures, low sex hormone levels were also found to be associated with more chronic musculoskeletal pain regardless osteoarthritic status 9 . Research on progesterone and knee structures or pain in osteoarthritis is very limited, thus reflecting the need for further research.…”

Correlation between Sex Hormone Deficiency and Osteoarthritis

“…Conversely, the log-transformed concentration of SHBG was positively associated with the incidence of total hip replacement. Furthermore, a similar study published in 2016 by Kruij et al [21] proposes that lower sex hormone levels are also associated with an increased risk for having and developing chronic musculoskeletal pain, in a manner that is not dependent on lifestyle and health-related factors, in women. In their investigation, De Kruij and colleagues concluded that lower levels of Androstenedione, testosterone, and Estradiol resulted in higher risk for chronic hand pain, in particular.…”

The effects of menstrual phase on orthodontic pain following initial archwire engagement

“…The effects of female sex hormones on pain perceptions have been documented and debated for nearly two decades (Wise et al, 2000;Berger et al, 2015;Frolich et al, 2016). Some studies argued that lower estrogen levels are associated with higher pain levels (Arab et al, 2015;de Kruijf et al, 2016), while others found the reverse association (Ring et al, 2009;Ahmed et al, 2012). This inconsistency may be attributed to different modalities and chronicity of pain that were investigated in different studies (Teepker et al, 2010).…”