Hormones affect connective tissues

Alterations to cell metabolism in connective tissues of the knee after ovariohysterectomy in a rabbit model: are there implications for the postmenopausal athelete? – PubMed – NCBI Br J Sports Med. 2010 Sep;

Participation in regular exercise and athletic activities across the lifespan is encouraged to maintain the cardiovascular and musculoskeletal systems and general wellbeing.

Before the menopause there is an increased risk of anterior cruciate ligament (ACL) injuries in female athletes, whereas there is an increased risk of joint diseases such as knee osteoarthritis after the menopause.

Although there are few data regarding alterations in individual connective tissues of the knee in humans either before, during or after the menopause, it is possible to assess changes in experimental models following surgical menopause.  


Unique alterations in cell metabolism were detected 2 months after surgical menopause and the pattern of significant changes was tissue specific (number of mRNA species altered, extent of changes, elevation/depression of changes).


Changes in cell metabolism may alter the set point for the tissues of the knee and subsequently the functioning of the knee after the menopause.

Such changes may contribute to an increased risk of injury and/or degenerative conditions.

Further studies in pre and postmenopausal women athletes may also shed light on whether the present findings can be extrapolated to human populations.

Hormonal modulation of connective tissue homeostasis and sex differences in risk for osteoarthritis of the knee – Biol Sex Differ. 2013 – Free full-text PMC article


  1. Young female athletes experience a higher incidence of ligament injuries than their male counterparts,
  2. females experience a higher incidence of joint hypermobility syndrome (a risk factor for osteoarthritis development), and
  3. post-menopausal females experience a higher prevalence of osteoarthritis than age-matched males.

These observations indicate that fluctuating sex hormone levels in young females and loss of ovarian sex hormone production due to menopause likely contribute to observed sex differences in knee joint function and risk for loss of function.

In studies of osteoarthritis, however, there is a general lack of appreciation for the heterogeneity of hormonal control in both women and men. Progress in this field is limited by the relatively few preclinical osteoarthritis models, and that most of the work with established models uses only male animals.

To elucidate sex differences in osteoarthritis, it is important to examine sex hormone mechanisms in cells from knee tissues and the sexual dimorphism in the role of inflammation at the cell, tissue, and organ levels.

There is a need to determine if the risk for loss of knee function and integrity in females is restricted to only the knee or if sex-specific changes in other tissues play a role. This paper discusses these gaps in knowledge and suggests remedies.

Cartilage turnover assessed with a newly developed assay measuring collagen type II degradation products: influence of age, sex, menopause, hormone replacement therapy, and body mass index – Ann Rheum Dis. 2003 Apr; – Free full-text PMC article

Background: Cartilage normally has a slow turnover but in arthritis increased metabolism results in degradation of the tissue.

Objective: To assess cartilage turnover in a sample of the general population by an assay measuring cartilage derived urinary collagen type II (CTX-II) C-telopeptide degradation products.

Conclusions: Cartilage turnover, as assessed by measuring urinary degradation products of CTX-II varies considerably with age, and significant differences between CTX-II levels in men and women as well as in pre- and postmenopausal women are found.

Further studies are required to validate the marker for assessing cartilage degradation in arthritis.


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