Why Are Women More Prone to Osteoarthritis?

Research suggests that women are more likely to experience joint pain, aching, and stiffness caused by osteoarthritis. For example, evidence suggests that:

• Women aged 50 to 60 years may be 3.5 times (350%) more likely to develop hand osteoarthritis than men in the same age group.¹Prieto-Alhambra D, Judge A, Javaid MK, Cooper C, Diez-Perez A, Arden NK. Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis. 2014;73(9):1659‐1664. doi:10.1136/annrheumdis-2013-203355
• Women are 40% more likely to develop knee osteoarthritis than men.²Losina E, Weinstein AM, Reichmann WM, et al. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res (Hoboken). 2013;65(5):703–711. doi:10.1002/acr.21898
• Women are 10% more likely to develop hip osteoarthritis than men.³Murphy et. al, "One in four people may develop symptomatic hip osteoarthritis in his or her lifetime," Osteoarthritis and Cartilage 18 (2010): 1372-1379.

In addition, limited research suggests women tend to report more severe osteoarthritis pain than men.⁴Glass N, Segal NA, Sluka KA, Torner JC, Nevitt MC, Felson DT, Bradley LA, Neogi T, Lewis CE, Frey-Law LA. Examining sex differences in knee pain: the multicenter osteoarthritis study. Osteoarthritis Cartilage. 2014 Aug;22(8):1100-6. doi: 10.1016/j.joca.2014.06.030. Epub 2014 Jul 4. PMID: 24999111; PMCID: PMC4180745.

Why is there such a difference between men and women when it comes to osteoarthritis? Three possible reasons are described below.

1. Changes in hormone levels

Evidence suggests that women’s susceptibility to osteoarthritis may be related to hormone levels.⁵Jin X, Wang BH, Wang X, Antony B, Zhu Z, Han W, Cicuttini F, Wluka AE, Winzenberg T, Blizzard L, Jones G, Ding C. Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis. Osteoarthritis Cartilage. 2017 Jul;25(7):1100-1106. doi: 10.1016/j.joca.2017.01.015. Epub 2017 Feb 2. PMID: 28163248. Hormone levels fluctuate with menstruation cycles and change during menopause.

Menstruation and joint laxity

Increased hormone levels during certain stages of the menstrual cycle may increase joint laxity, which is associated with joint instability and injury.⁶Shultz SJ, Sander TC, Kirk SE, Perrin DH. Sex differences in knee joint laxity change across the female menstrual cycle. J Sports Med Phys Fitness. 2005;45(4):594-603.^,7Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019;9:1834. Published 2019 Jan 15. doi:10.3389/fphys.2018.01834 Both joint instability and injury can contribute to the development of osteoarthritis.

The relationship between menstruation, joint laxity, and osteoarthritis is perhaps most clear in the case of knee osteoarthritis. Many researchers believe fluctuations in joint laxity help explain why female athletes are 2 to 8 times more likely than men to tear the anterior cruciate ligament (ACL) in the knee.⁷Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019;9:1834. Published 2019 Jan 15. doi:10.3389/fphys.2018.01834 People who have had a past ACL injury are as much as 4 to 6 times more likely to develop knee osteoarthritis in the affected knee.⁸Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014 Sep;42(9):2242-52. doi: 10.1177/0363546513508376. Epub 2013 Nov 8. PMID: 24214929.^,9Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury - a systematic review and meta-analysis. Br J Sports Med. 2019 Dec;53(23):1454-1463. doi: 10.1136/bjsports-2018-100022. Epub 2019 May 9. PMID: 31072840.

See Knee Osteoarthritis Symptoms

Menopause

Women’s risk of developing osteoarthritis increases significantly after menopause, and women may notice joint pain appears or worsens during this time.³Murphy et. al, "One in four people may develop symptomatic hip osteoarthritis in his or her lifetime," Osteoarthritis and Cartilage 18 (2010): 1372-1379. Estrogen levels drop during menopause. This drop may contribute to changes in the body that accelerate the osteoarthritis process.

2. Differences in the musculoskeletal system and biomechanics

While women’s bodies have the same joints as men’s, certain musculoskeletal differences exist. These differences alter the way women tend to stand, walk, and run,¹⁰Bruening DA, Frimenko RE, Goodyear CD, Bowden DR, Fullenkamp AM. Sex differences in whole body gait kinematics at preferred speeds. Gait Posture. 2015 Feb;41(2):540-5. DOI: 10.1016/j.gaitpost.2014.12.011^,11Bruening DA, Baird AR, Weaver KJ, Rasmussen AT. Whole body kinematic sex differences persist across non-dimensional gait speeds. PLoS One. 2020 Aug 20;15(8):e0237449. doi: 10.1371/journal.pone.0237449^,12Phinyomark A, Osis ST, Hettinga BA, Kobsar D, Ferber R. Gender differences in gait kinematics for patients with knee osteoarthritis. BMC Musculoskelet Disord. 2016;17:157. Published 2016 Apr 12. doi: 10.1186/s12891-016-1013-z and how their joint surfaces move in relation to one another (joint articulation).

For example, evidence suggests because of anatomical differences, women’s knees experience more wear and tear. One study found that, when compared to men’s knees, the bony surfaces of women’s knee joints do not fit together or move with each other as well.¹³Tummala S, Schiphof D, Byrjalsen I, Dam EB. Gender Differences in Knee Joint Congruity Quantified from MRI: A Validation Study with Data from Center for Clinical and Basic Research and Osteoarthritis Initiative. Cartilage. 2018;9(1):38-45. doi: 10.1177/1947603516684590 Also, women’s knees contain less cartilage than men’s knees, even when bone size and body mass is taken into account.¹⁴Cicuttini F, Forbes A, Morris K, Darling S, Bailey M, Stuckey S. Gender differences in knee cartilage volume as measured by magnetic resonance imaging. Osteoarthritis Cartilage. 1999 May;7(3):265-71. doi: 10.1053/joca.1998.0200. PMID: 10329301. As cited in Wise BL, Niu J, Zhang Y, et al. Bone shape mediates the relationship between sex and incident knee osteoarthritis. BMC Musculoskelet Disord. 2018;19(1):331. Published 2018 Sep 12. doi:10.1186/s12891-018-2251-z

Over time, these anatomical differences and the associated joint strain may contribute to the development of osteoarthritis.

See Understanding Joint Pain

3. Tendency to carry excess weight

According to the National Institutes of Health, US women are more likely to be obese or extremely obese than men (40.4% compared to 35%).¹⁵National Association of Diabetes and Digestive and Kidney Diseases. Overweight & Obesity Statistics. Last Updated August, 2017. Accessed October 30, 2020. https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity Obesity increases the risk of osteoarthritis because:

• Extra weight puts more stress on load-bearing joints, such as the hips, knees, and ankles. This stress can lead to damaging friction between the bones of joints.¹⁶D’Lima DD, Fregly BJ, Patil S, Steklov N, Colwell CW. Knee joint forces: prediction, measurement, and significance. Proceedings of the Institution of Mechanical Engineers Part H, Journal of Engineering in Medicine. 2012;226(2):95-102.^,17Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005 Jul;52(7):2026-32. PubMed PMID: 15986358.
• Obesity is associated with low-grade, systemic (body-wide) inflammation. This inflammation may contribute to the development of osteoarthritis in any joint, including non-weight bearing joints in the hands.¹⁸Sartori-Cintra AR, Aikawa P, Cintra DE. Obesity versus osteoarthritis: beyond the mechanical overload. Einstein (Sao Paulo). 2014;12(3):374–379. doi:10.1590/S1679-45082014RB2912^,19Rosen, CJ, "Pathogenic mechanisms of obesity-induced osteoarthritis: new clues from old joints." Osteoarthritis and Cartilage (2019), doi:10.1016/j.joca.2019.02.007; Phone interview, June 10, 2019^,20Thijssen E, van Caam A, van der Kraan PM. Obesity and osteoarthritis, more than just wear and tear: pivotal roles for inflamed adipose tissue and dyslipidaemia in obesity-induced osteoarthritis. Rheumatology (Oxford). 2015 Apr;54(4):588-600. doi: 10.1093/rheumatology/keu464. Epub 2014 Dec 11. PMID: 25504962.^,21Carman WJ et al. Obesity as a risk factor for osteoarthritis of the hand and wrist: a prospective study. Am J Epidemiol 1994; 139: 119– 129. As cited in Leung GJ, Rainsford KD, Kean WF. Osteoarthritis of the hand I: aetiology and pathogenesis, risk factors, investigation and diagnosis. J Pharm Pharmacol. 2014 Mar;66(3):339-46. doi: 10.1111/jphp.12196. Epub 2013 Dec 13. Review. PubMed PMID: 24329488.^,22Grotle M et al. Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskelet Disord 2008; 9: 132. As cited in Leung GJ, Rainsford KD, Kean WF. Osteoarthritis of the hand I: aetiology and pathogenesis, risk factors, investigation and diagnosis. J Pharm Pharmacol. 2014 Mar;66(3):339-46. doi: 10.1111/jphp.12196. Epub 2013 Dec 13. Review. PubMed PMID: 24329488.

  See How Effective is Weight Loss for Treating Knee Arthritis Pain?

Experts are still investigating why women are more likely to get osteoarthritis. In the meantime, women—and all adults—can take steps to feel healthier and decrease their joint pain. Walking, physical therapy, and gentle land and pool exercises are generally considered safe because they help maintain and build muscle with minimal joint strain.

See Ways to Get Exercise When You Have Arthritis

If you're struggling with ways to manage your arthritis or general health, talk with your doctor.

Learn more:

5 Alternative Treatments for Osteoarthritis

Tips for Losing Weight to Treat Knee Pain