Osteoarthritis more common in younger women with PCOS

Young women with polycystic ovarian syndrome (PCOS) are at higher risk of developing osteoarthritis (OA) in both weight and non-weight bearing joints, research has revealed.

A register-based study looked at data from over 75,000 women in Denmark, comparing OA rates in women with either PCOS and/or hirsutism or without over a 20-year period.

It found that the prevalence of hospital-treated knee, hip and hand OA was 5.2% in women with a PCOS diagnosis, a level 73% higher than in age-matched controls.

The knee was the most affected joint (3.7%), followed by the hip (1.1%) and the hand (0.4%).

The association between PCOS and incidence of OA was significant in all age groups, including women below the age of 45.

The research, led by Dr Stefan Kluzek, a Clinical Associate Professor in Sport and Exercise Medicine, Faculty of Medicine & Health Sciences, Nottingham University also showed significantly higher incidence rates of OA in the PCOS group; 2,253 women had a clinical diagnosis of knee, hand or hip OA, of whom 816 (4.3%) were from the PCOS cohort and 1,437 (2.6%) were from the control arm.

Overall, the risk of developing OA was 90% higher for the knee, 80% higher for the hand and 30% higher for the hip in the PCOS cohort compared to the control, the researchers outlined in a paper published in Arthritis Research & Therapy.

Significantly higher risks for developing OA were also seen in the PCOS cohort after excluding women with obesity, but only for that of the knee and hand (both 1.6 times higher), which the authors said highlights that other factors are likely involved in the development of the condition in this group.

“Considering that we observed an increased incidence of OA in both weight-bearing and non-weight-bearing joints, excessive loading associated with higher body weight alone is unlikely to explain the accelerated development of OA in women with PCOS,” they said.

There were a number of possible explanations for their findings, they suggested, with a focus on the components metabolic syndrome such as obesity and dyslipidaemia  that may increase the risk of  early OA.

“The most biologically plausible mechanism for the impact of PCOS on increased OA risk is the higher body mass index (BMI) due to excess adipose tissue. In OA, this has been attributed to excessive loading and to the impact of metabolic dysregulation and systemic inflammation on the regeneration and remodelling of joint tissues,”  they said.

“Metabolic and hormonal changes are likely to influence tissue-remodelling processes accelerated by the direct effect of excessive mechanical loading,” they concluded, adding that further studies will be required “to understand the relative effect of metabolic and hormonal changes linked with PCOS and their role in promoting development of OA”.

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