J Menopausal Med.  2024 Aug;30(2):78-87. 10.6118/jmm.24014.

Menopausal Hormone Therapy and Osteoarthritis Risk: Retrospective Population-Based Study in South Korea

• Lee JL
• Seo J
• Shin Y
• Han GH
• Yoon SH
• Noh JH
• Kim MH
• Yuk JS

• KMID: 2559370
• DOI: http://doi.org/10.6118/jmm.24014

Abstract

Objectives
This study aimed to investigate the risk of osteoarthritis associated with menopausal hormone therapy (MHT).
Methods
This population-based retrospective cohort study used a database of Korean health insurance claims (2007–2020). Females aged ≥ 40 who initiated menopause-related healthcare visits between 2011 and 2014 were identified. The MHT group comprised females aged ≥ 40 who initiated MHT for ≥ 6 months during this period. The non-MHT group comprised females aged ≥ 40 who attended menopause-related healthcare visits but did not receive MHT. To account for potential confounding factors, the two groups were matched at a 1:1 ratio using propensity score matching.
Results
A cohort of 453,040 postmenopausal females aged ≥ 40 years was identified, with 26,354 assigned to either the MHT or nonMHT group after propensity matching. The median age was 49 years, and the median follow-up was 8.2 years. The Cox proportional hazards model demonstrated an elevated risk of osteoarthritis with MHT (hazard ratio [HR], 1.154; 95% confidence interval [CI], 1.117–1.193) for knee (HR, 1.148; 95% CI, 1.102–1.195) and other arthritis (HR, 1.205; 95% CI, 1.151–1.261), although not statistically significant for hip arthritis. Tibolone (HR, 1.211; 95% CI, 1.161–1.263), estrogen–progestogen therapy (EPT) (HR, 1.092; 95% CI, 1.048– 1.137), and estrogen therapy (ET) (HR, 1.235; 95% CI, 1.148–1.329) were associated with a higher risk of osteoarthritis compared to nonMHT users.
Conclusions
MHT was associated with an increased risk of osteoarthritis, consistently observed across tibolone, EPT, and ET, particularly affecting joints other than the hip, with a trend toward an elevated risk of hip osteoarthritis.

Keyword

Estrogens; Hormone replacement therapy; Osteoarthritis; Progesterone; Tibolone