Gender differences in musculoskeletal health are not solely due to hormones

Osteoarthritis, osteoporosis, fractures, and spinal disorders are among the most common reasons for doctor visits. These conditions have more than one thing in common: they are all musculoskeletal problems and are more prevalent in women.

"Most clinicians are unaware that the sex differences associated with these problems are the result of inherent differences in biology at the cellular and molecular level," said Laura L. Tosi, MD, orthopedic surgeon and director of the Bone Health Program at Children's National Medical Center in Washington, DC.

In her research article on gender differences in musculoskeletal health, published in The Journal of Bone and Joint Surgery, these differences are not solely due to hormones. Dr. Tosi said, "There is a biologic basis for the differences in injury mechanism, pain sensation, drug handling, and healing response that cannot be explained simply by hormone levels. Responses to therapy, for example, surgery, anesthesia, pain medication, pharmaceuticals, and rehabilitation also differ with sex."

Despite the fact that numerous studies have confirmed the higher prevalence of chronic musculoskeletal disorders in women, little is known about why this is the case. And according to Dr. Tosi and her colleagues, more research is needed to explore these important issues.

The musculoskeletal system is made up of bones, muscles, joints, tendons, cartilage, ligaments, bursae (fluid-filled areas), and connective tissue which work in tandem and enable the body to have full-range of motion. The primary role of bones is to support the body and protect vital organs. Muscles, which are attached to the bones by tendons, allow for movement. The connective tissue binds everything together.

Problems arise when a specific body part gets overused or used to a greater extent than it was intended to. Muscle tissue can be injured by:
•Wear and tear of everyday activities
•Trauma (i.e., accidents, falls, bone breaks or fractures, sprains, etc.)
•Prolonged immobilization
•Muscle misuse
•Poor body mechanics (i.e., spinal misalignment, or postural problems)

Injury can be acute, but if it occurs repetitively over a long stretch of time, the trauma can cause chronic damage.

Symptoms of musculoskeletal injury vary tremendously from person to person. They can include: inflammation, swelling, pain, weakness, joint incompetence, stiffness, and a limited range of motion. A significant portion of people with musculoskeletal problems complain of fatigue, sleep disturbances, and pain.

Treatment for musculoskeletal disorders depends on the individual's condition and symptoms. According to information from the Mayo Foundation for Education and Research, treatment can include:

•Injections with anesthetic or anti-inflammatory medications in or around the pain site
•Exercise that includes muscle strengthening and stretching
•Physical or occupational therapy
Acupuncture or acupressure
•Relaxation/biofeedback techniques
•Osteopathic manipulation (a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body)
•Chiropractic care
•Therapeutic massage

Due to the disproportionate number of women suffering from musculoskeletal problems, more research is needed to properly determine etiology, risk factors, and effective treatments. According to Dr. Tosi, "In the orthopaedic practice of the future, sex differences in the physiology and pathogenesis of disease will determine how each patient is treated."

Source: The Journal of Bone and Joint Surgery

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