Menopausal hormone therapy may protect against adhesive capsulitis
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Women who did not receive menopausal hormone therapy had greater odds of developing adhesive capsulitis compared with those on HT, according to preliminary study results presented at the North American Menopause Society annual meeting.
“We know that estrogen plays an important role in the musculoskeletal system; stimulating new bone formation, promoting muscle growth and repair, maintaining connective tissue integrity and reducing inflammation,” Anne C. Ford, MD, NCMP, associate professor of obstetrics and gynecology at Duke University Medical Center, Durham, North Carolina, told Healio. “Our study draws attention to estrogen’s potential benefit apart from the FDA-approved indications — vasomotor symptoms, bone protection and vulvovaginal atrophy.”
Adhesive capsulitis is associated with thyroid dysfunction, diabetes and treatment for breast cancer and disproportionately affects women aged 40 to 60 years, according to study background.
Ford and colleagues analyzed data collected in November 2018 from a single institution electronic medical record system on 1,952 women with menopause aged 45 to 60 years. ICD-10 codes of interest included those for perimenopausal or menopausal symptoms, menopause, estrogen replacement therapy, shoulder pain, shoulder stiffness and adhesive capsulitis.
Cases of adhesive capsulitis were confirmed by a sports medicine fellowship-trained orthopedic surgeon and a shoulder-specialized physical therapist. Those with adhesive capsulitis were further reviewed for related outcomes, such as rotator cuff tears, corticosteroid injection use and if surgery was required.
Overall, 152 women received HT, and among those 11.2% had a thyroid disorder and 9.2% had diabetes compared with 12.4% with a thyroid disorder and 14.3% with diabetes among women who did not receive HT.
A total of 4% of women who received HT and 7.7% who did not receive HT had adhesive capsulitis. Women who did not receive HT had almost double the odds of adhesive capsulitis as those on HT. However, this association was not statistically significant (OR = 1.99; 95% CI, 0.86-4.58; P = .11).
According to Ford, further research is required, but these findings suggest a nuanced approach in treating women with menopause with systemic HT with attention to possible benefits separate from current FDA indications.
“Our data is preliminary, and due to the small sample size, this association did not reach statistical significance,” Ford said. “Larger prospective studies are needed to evaluate and confirm our findings.”
For more information:
Anne C. Ford, MD, NCMP, can be reached at anne.ford@duke.edu.
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Ford AC, et al. Is hormone replacement therapy associated with reduced risk of adhesive capsulitis in menopausal women? Presented at: North American Menopause Society Annual Meeting; Oct. 12-15, 2022; Atlanta.
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