Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Sex Differences in Musculoskeletal Disease and Science 16 articles


Are Changes in Composition in Response to Treatment of a Mouse Model of Osteogenesis Imperfecta Sex-dependent?

Adele L. Boskey PhD, Josephine Marino MPh, Lyudmila Spevak MS, Nancy Pleshko PhD, Stephen Doty PhD, Erin M. Carter MS, Cathleen L. Raggio MD

Osteogenesis imperfecta (OI) is a genetic disease characterized by skeletal fragility and deformity. There is extensive debate regarding treatment options in adults with OI. Antiresorptive treatment reduces the number of fractures in growingmice, an animal model that reproducibly mimics the moderate-to-severe form of OI in humans. Effects of long-term treatments with antiresorptive agents, considered for treatment of older patients with OI with similar presentation (moderate-to-severe OI) are, to date, unknown.

Do Sex Differences Exist in Rates of Falls and Fractures in Hutterite, Rural, and Nonrural Populations, Aged 20 to 66 Years?

Lee Weidauer PhD, Teresa Binkley PhD, Tianna Beare BS, Maggie Minett MS, Lacey McCormack PhD, Andrew Wey PhD, Bonny Specker PhD

Falls and fractures are a major public health concern with an economic impact of more than USD 19 billion per year. Extensive research into the risk of falls and fractures in elderly populations has been performed; however, little is known about fall or fracture risk in younger populations. Additionally, sex- and population-specific (rural versus nonrural) fall and fracture risk may be important in identifying groups most at risk in an effort to develop preventive measures.

β-Ecdysone Augments Peak Bone Mass in Mice of Both Sexes

Weiwei Dai PhD, HongLiang Zhang MD, PhD, Zhendong A. Zhong PhD, Li Jiang MD, Haiyan Chen MS, Yu-An Evan Lay MS, Alexander Kot BS, Robert O. Ritchie PhD, Nancy E. Lane MD, Wei Yao MD

One of the strongest predictors for osteoporosis is peak bone mass. Interventions to augment peak bone mass have yet to be developed. β-Ecdysone (βEcd), a natural steroid-like compound produced by arthropods to initiate metamorphosis, is believed to have androgenic effects and so may be used to augment bone mass.

How Does Bone Strength Compare Across Sex, Site, and Ethnicity?

Stephen H. Schlecht PhD, Erin M. R. Bigelow MS, Karl J. Jepsen PhD

The risk of fragility fractures in the United States is approximately 2.5 times greater among black and white women compared with their male counterparts. On average, men of both ethnicities have wider bones of greater cortical mass compared with the narrower bones of lower cortical mass among women. However, it remains uncertain whether the low cortical area observed in the long bones of women is consistent with their narrower bone diameter or if their cortical area is reduced beyond that which is expected for the sex differences in body size and external bone size.

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review

Bryan D. Haughom MD, Brandon J. Erickson MD, Michael D. Hellman MD, Joshua J. Jacobs MD

Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender.

Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model

Ata M. Kiapour PhD, Braden C. Fleming PhD, Martha M. Murray MD

Despite the well-established role of sex on the anterior cruciate ligament (ACL) injury risk, its effects on ACL surgical outcomes remain controversial. This is particularly critical when developing novel surgical techniques to treat the injury because there are limited data existing on how these procedures will respond in each sex. One such approach is bridge-enhanced ACL repair, in which primary suture repair of the ACL is augmented with a bioactive scaffold saturated with autologous blood. It has shown comparable biomechanical outcomes to ACL reconstruction in preclinical models.

Femoroacetabular Impingement: Prevalent and Often Asymptomatic in Older Men: The Osteoporotic Fractures in Men Study

Lorenzo Nardo MD, Neeta Parimi MS, Felix Liu MS, Sonia Lee MD, Pia M. Jungmann MD, Michael C. Nevitt PhD, Thomas M. Link MD, PhD, Nancy E. Lane MD

The epidemiology of femoroacetabular impingement (FAI) is important but incompletely understood, because most reports arise from symptomatic populations. Investigating the prevalence of FAI in a community-based cohort could help us better understand its epidemiology and in particular the degree to which it might or might not be associated with hip pain.

Do Secular Trends in Skeletal Maturity Occur Equally in Both Sexes?

Dana L. Duren PhD, Ramzi W. Nahhas PhD, Richard J. Sherwood PhD

Skeletal maturity assessment provides information on a child’s physical development and expectations based on chronological age. Given recently recognized trends for earlier maturity in a variety of systems, most notably puberty, examination of sex-specific secular trends in skeletal maturation is important. For the orthopaedist, recent trends and changes in developmental timing can affect clinical management (eg, treatment timing) if they are currently based on outdated sources.

Are There Sex Differences in Knee Cartilage Composition and Walking Mechanics in Healthy and Osteoarthritis Populations?

Deepak Kumar PT, PhD, Richard B. Souza PT, PhD, Karupppasamy Subburaj PhD, Toran D. MacLeod PT, PhD, Justin Singh BS, Nathaniel E. Calixto BS, Lorenzo Nardo MD, Thomas M. Link MD, Xiaojuan Li PhD, Nancy E. Lane MD, Sharmila Majumdar PhD

Women are at a greater risk for knee osteoarthritis (OA), but reasons for this greater risk in women are not well understood. It may be possible that differences in cartilage composition and walking mechanics are related to greater OA risk in women.

Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study

Barton L. Wise MD, MSc, Jingbo Niu DSc, David T. Felson MD, MPH, Jean Hietpas LCSW, Alesia Sadosky PhD, MPH, MBA, James Torner PhD, MS, Cora E. Lewis MD, MSPH, Michael Nevitt PhD, MPH

Debilitating pain associated with knee osteoarthritis (OA) often leads patients to seek and complete total knee arthroplasty (TKA). To date, few studies have evaluated the relation of functional impairment to the risk of TKA, despite the fact that OA is associated with functional impairment.

Sex Differences in Arm Muscle Fatigability With Cognitive Demand in Older Adults

Hugo M. Pereira MSc, Vincent C. Spears BSc, Bonnie Schlinder-Delap MA, Tejin Yoon PhD, April Harkins PhD, Kristy A. Nielson PhD, Marie Hoeger Bement PhD, Sandra K. Hunter PhD

Muscle fatigability can increase when a stressful, cognitively demanding task is imposed during a low-force fatiguing contraction with the arm muscles, especially in women. Whether this occurs among older adults (> 60 years) is currently unknown.

Women Build Long Bones With Less Cortical Mass Relative to Body Size and Bone Size Compared With Men

Karl J. Jepsen PhD, Erin M. R. Bigelow MS, Stephen H. Schlecht PhD

The twofold greater lifetime risk of fracturing a bone for white women compared with white men and black women has been attributed in part to differences in how the skeletal system accumulates bone mass during growth. On average, women build more slender long bones with less cortical area compared with men. Although slender bones are known to have a naturally lower cortical area compared with wider bones, it remains unclear whether the relatively lower cortical area of women is consistent with their increased slenderness or is reduced beyond that expected for the sex-specific differences in bone size and body size. Whether this sexual dimorphism is consistent with ethnic background and is recapitulated in the widely used mouse model also remains unclear.

Disability After Deployment Injury: Are Women and Men Service Members Different?

Jessica C. Rivera MD, Christina M. Hylden MD, Anthony E. Johnson MD

Civilian trauma literature suggests sexual dimorphism in outcomes after trauma. Because women represent an increasing demographic among veterans, the question remains if war trauma outcomes, like civilian trauma outcomes, differ between genders.

Sex Differences in Cartilage Topography and Orientation of the Developing Acetabulum: Implications for Hip Preservation Surgery

Jonathan B. Peterson MD, Josh Doan MEng, James D. Bomar MPH, Dennis R. Wenger MD, Andrew T. Pennock MD, Vidyadhar V. Upasani MD

Increased attention is being placed on hip preservation surgery in the early adolescent. An understanding of three-dimensional (3-D) acetabular development as children approach maturity is essential. Changes in acetabular orientation and cartilage topography have not previously been quantified as the adolescent acetabulum completes development.

Does Patient Sex Affect the Rate of Mortality and Complications After Spine Surgery? A Systematic Review

Andrew J. Schoenfeld MD, MSc, Elyse N. Reamer BS, Emily I. Wynkoop BS, Hwajung Choi PhD, Christopher M. Bono MD

Available studies disagree regarding the influence of patient sex on mortality and complications after spine surgery. We sought to conduct a systematic review and pool the results of existing research to better understand this issue.