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Estrogen and testosterone deficiency linked to higher rates of rotator cuff repair

News — April 13, 2022Patients with lower levels of sex hormones – testosterone in men and estrogen in women – are more likely to undergo surgery for rotator cuff tears, suggests a study in the Journal of Bone and Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

Sex hormone deficiencies “were associated with a significantly increased incidence of CPR within [two] independent databases,” according to new research by Peter N. Chalmers, MD, and colleagues at the University of Utah, Salt Lake City. These findings add to previous evidence that hormone levels may be a systemic factor contributing to the development of rotator cuff tears. , a common condition that is a major cause of shoulder pain.

In both men and women, sex hormone deficiency associated with rotator cuff repair

The study included nearly 230,000 adults under the age of 65 who had surgery to repair a torn rotator cuff from 2008 to 2017, with data taken from a national health insurance database. Patients were matched by age, gender, and insurance type to an equal number of patients who had not undergone rotator cuff surgery.

Patients undergoing rotator cuff repair had an average age of 54 years and 58% were male. Most patient characteristics were similar between those who underwent rotator cuff repair and those who did not, with the exception of smoking, which was more common in the surgical cohort.

When analyzing insurance records, 27% of women and 7% of men undergoing rotator cuff surgery were diagnosed with sex hormone deficiency, compared with 20% and 4% in the control group, respectively. After adjusting for other factors, the odds of rotator cuff repair were 48% higher in women with estrogen deficiency and 89% higher in men with testosterone deficiency.

To confirm their findings, the researchers assessed the Veterans Administration Genealogy Database, which includes data on millions of individuals linked to Veterans Administration health data. In this independent database, rotator cuff repair was about 2.5 times more likely in women with estrogen deficiency and three times more likely in men with testosterone deficiency.

This study builds on an earlier study by the same research group, which demonstrated that women with mutations in an estrogen receptor gene were more likely to develop rotator cuff disease, with higher rates of rotator cuff disease. failed rotator cuff surgery.

This new study is the first to directly analyze the effects of estrogen or testosterone deficiency on the incidence of rotator cuff repair in men. The authors note some limitations of their study, which does not include Medicaid patients and cannot account for the effects of hormone replacement therapy.

However, the observed association between sex hormone deficiency and rotator cuff repair strongly supports the theory that low levels of estrogen and testosterone may contribute to the development of rotator cuff tears. Dr. Chalmers and colleagues conclude, “Future prospective studies are needed to understand the relationship between sex hormones and the pathophysiology of rotator cuff disease.”

Click here to read “The Relationship Between Sex Hormone Deficiency and the Incidence of Rotator Cuff Repair; Analysis of a Large Insurance Database”

DOI: 10.2106/JBJS.21.00103

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On The Journal of Bone and Joint Surgery

The Journal of Bone and Joint Surgery (JBJS) has been the most valuable source of information for orthopedic surgeons and researchers for over 125 years and is the gold standard for peer-reviewed scientific information in the field. A staple journal and essential reading for general and specialty orthopedic surgeons worldwide, The Journal publishes evidence-based research to improve the quality of orthopedic patient care. Standards of excellence and high quality are maintained in everything we do, from the science of published content to the customer service we provide. JBJS is an independent non-profit journal.

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