Knee osteoarthritis in midlife women: unique considerations and comprehensive management

Knee osteoarthritis (KOA) is a common musculoskeletal condition that particularly afflicts women in menopause. The purpose of this review is to describe the pathophysiology and treatment considerations for this subset of the population.

Medline/PubMed indexed articles related to the pathophysiology, diagnosis, and management of osteoarthritis were included in this narrative review.

Menopause has a multitude of effects that affect KOA, including hormonal shifts; loss of bone mineral density, muscle mass, and tendon strength; and changes to pain perception. Here, we discuss how a practitioner can assess the factors that are known to worsen KOA symptoms, including postural (spine, pelvic, and knee) alignment and functional muscle strength. The development of an effective exercise program is at the forefront of management. Optimizing other lifestyle factors including nutrition and sleep are particularly important in this patient population. Sleep disturbance from vasomotor symptoms can also increase perception of knee pain, for which pharmacologic options such as gabapentin or duloxetine may be pursued. In total, these interventions have large ramifications in decreasing pain and increasing function through improved range of motion, body composition, and walking speed in women with KOA.