Osteoarthritis (OA) prevalence and incidence varies between women and men, but it is unknown whether this follows sex-specific differences in systemic factors (e.g. hormones) and/or differences in pre-morbid joint anatomy. We recognize that classifications of sex within humans cannot be reduced to female/male, but given the lack of literature on non-binary individuals, this review is limited to the sexual dimorphism of articular morphotypes. Based on a Pubmed search using relevant terms, and input from experts, we selected articles based on the authors’ judgment of their relevance, interest, originality, and scientific quality; no “hard” bibliometric measures were used to evaluate their quality or importance. Focus was on clinical rather than pre-clinical studies, with most (imaging) data being available for the knee joint. After introducing “sexual dimorphism”, the specific literature on articular morphotypes is reviewed, structured by: radiographic joint space width (JSW), meniscus, ligaments, articular cartilage morphology, articular cartilage composition and deformation, and articular tissue response to treatment. Sex-specific differences were clearly observed for JSW, meniscus damage, ligament size, and cartilage morphometry (volume, thickness, and surface areas) but not for cartilage composition. Ligament and cartilage measures were smaller in women even after matching for confounders. Taken together, the findings indicate that female (knee) joints may be structurally more vulnerable and at greater risk of OA. The “one size/sex fits all” approach must be abandoned in OA research, and all observational and interventional studies should report their results for sex-specific strata, at least in pre-specified secondary or post-hoc analyses.

中文翻译：

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关节组织解剖学中的性别二态性——理解骨关节炎性别差异的关键？


骨关节炎（OA）的患病率和发病率在女性和男性之间存在差异，但尚不清楚这是否遵循全身因素（例如激素）的性别差异和/或病前关节解剖结构的差异。我们认识到人类性别的分类不能简化为女性/男性，但鉴于缺乏关于非二元个体的文献，本综述仅限于关节形态类型的性别二态性。基于使用相关术语的 Pubmed 搜索以及专家的输入，我们根据作者对其相关性、兴趣、原创性和科学质量的判断来选择文章；没有使用“硬”文献计量方法来评估其质量或重要性。重点是临床而不是临床前研究，大多数（影像）数据可用于膝关节。在介绍“性别二态性”之后，回顾了有关关节形态类型的具体文献，结构如下：放射学关节间隙宽度（JSW）、半月板、韧带、关节软骨形态、关节软骨组成和变形以及关节组织对治疗的反应。在 JSW、半月板损伤、韧带大小和软骨形态测量（体积、厚度和表面积）方面可以清楚地观察到性别特异性差异，但在软骨成分方面则没有。即使在匹配混杂因素后，女性的韧带和软骨测量值仍然较小。综上所述，研究结果表明，女性（膝）关节在结构上可能更脆弱，患骨关节炎的风险更大。 OA 研究中必须放弃“一刀切/性别通用”的方法，所有观察性和干预性研究都应报告其针对特定性别阶层的结果，至少在预先指定的二级或事后分析中如此。