No Bones About it: Men and Women Aren’t Equals in Orthopedics (USAToday)
Whether they’re young athletes, middle-aged adults or seniors playing competitive sports, females and males are vulnerable to problems with their bones and joints. Even with similar conditions, treatment and recovery can vary by gender. A new study looks at the Venus-Mars divide in orthopedic conditions, as experts work to raise awareness among men and women, parents and physicians.
Different Risks
If you’re a man, watch your fingers and hands – fractures are more common in males. If you’re a woman, you’re more vulnerable to tearing a key ligament in your knee or spraining an ankle. And you’re more likely to have knee osteoarthritis – the ‘wear’-and-tear’ arthritis that can become more disabling with age.
Women are also at higher risk for osteoporosis and have more hip fractures related to the bone-thinning condition. However, men with the same fracture are more likely to suffer major complications, according to a review article in the June issue of the Journal of the American Academy of Orthopaedic Surgeons. The review looked at findings from previous studies, which show men are more likely to develop conditions such as pneumonia and systemic infections after a hip fracture, and to die within the first few months of being injured.
“Osteoporosis in men is often under-diagnosed because nobody thinks of it as a man’s problem. They think of it only as a problem for small, Caucasian women. Not true,” says Dr. Jennifer Moriatis Wolf, an orthopedic surgeon and the lead study author. “And the mortality rate for men after osteoporotic fractures is higher than for women.”
Men: Muscles and Tendons
Soft-tissue injuries are more common in men, says Dr. Timothy Miller, an assistant professor of clinical orthopaedics at The Ohio State University. These include tears to the Achilles tendon, distal biceps, quadriceps and pectoral tendons. Women are more likely to have bone injuries, says Miller, who is also a team physician with OSU Sports Medicine.
A distal biceps tendon rupture, an arm-muscle injury, is a man’s problem. “It’s almost unheard of in women,” Miller says. The tear typically happens to men between ages 30 and 60 during manual labor such as lifting and carrying large, heavy loads, which they suddenly drop, ramping up demand on the muscle.
The Achilles tendon, located to the back and center of the ankle, above the heel, is injured about three times as often in men, Miller says, although Achilles tears are growing more common in women. The area takes a beating from different forces during speed training and uphill running, jumping and contact sports – or non-inline sports. “Inline sports are simple running, swimming or cycling when no lateral or side-to-side motion takes place,” he explains. Basketball, football and soccer, with their sudden changes in motion, are cutting sports.
Women Athletes and Knees
For young athletes who play cutting sports, the anterior cruciate ligaments, vital to knee stability and movement, are vulnerable to injury. Women and girls face higher risk for ACL tears than men and boys in similar activities. However, the gap has narrowed since the early 2000s, Miller says.
Why women are more vulnerable to ACL tears is uncertain. It might be partly due to reproductive hormones that affect joint laxity, or looseness. Anatomical differences in pelvis width, leg alignment and knee articulation may be factors, Miller says.
Women who undergo surgery to reconstruct a torn ACL are more likely to tear the opposite ACL afterwards, according to the study. And in general, women are less likely than men to return to sports after an ACL tear. That could be due to a variety of reasons, Moriatis Wolf says, including slow recovery, stiffness and possibly feeling less confident after the injury.
“Prehab” programs work on quadriceps strength, flexibility, and teach athletes how to turn, cut, jump and land more safely. “But the outcomes are mixed as to whether they prevent ACL tears later,” Moriatis Wolf says.
Athletes into sprinting or hurdling are at higher risk of hamstring tears. “Stretching, a good solid warmup program, a strengthening program specifically for the hamstrings and just knowing the proper techniques for going over the hurdles can decrease the risk,” Miller says.
Sensible Shoes Make Sense
Even simple sprains affect the sexes differently, with women more likely to sprain their ankles. While you can’t control anatomy, Moriatis Wolf advises avoiding flip-flops and non-supportive shoes, especially when walking on uneven surfaces.
High heel injuries are on the rise, according to the latest Journal of Foot and Ankle Surgery. Compared to a decade ago, women wearing high heels, especially young women in their 20s, are nearly twice as likely to visit the emergency room for strains and sprains of their feet and ankles.
Bone Health in Older Women … and Men
As women reach menopause, they’re at higher risk for hip fractures from osteoporosis. In men, osteoporosis is only one of several possible causes. Rheumatoid arthritis, low levels of physical activity, thyroid and other conditions can all be factors for men, according to Moriatis Wolf’s study. With men, there’s a danger that osteoporosis can be missed, until later stages when more bone has been lost.
“Osteoporosis causes a risk of hip fractures and wrist fractures, vertebral spine fractures – and being aware of that risk, whether you’re male or you’re female, is extremely important,” Moriatis Wolf says. Preventive measures include vitamin D and calcium supplementation and regular weight-bearing exercise.
If you have concerns, she suggests talking to your doctor about having your bone density evaluated. According to current U.S. guidelines, all women should have a bone density scan at 65 or younger if they have additional risk factors. For men, recommendations vary – the National Osteoporosis Foundation advises testing for men 70 and older.
Treatment and Doctor Differences
Some research has shown orthopedic surgeons are less likely to recommend total knee replacement for women than men with moderate knee arthritis. Women, for their part, may delay surgery until their condition is more advanced – and they don’t do as well with function or gait afterward.
Women physicians who specialize in orthopedic surgery are far outnumbered by men, says Moriatis Wolf, a past president of the Ruth Jackson Orthopaedic Society, a group for female orthopedic surgeons. Currently, women represent only 4 percent of the profession. “These numbers should be increasing, as 13 percent of orthopedic residents are women,” she says. “But we are still harder to find, for sure.”
The important thing is not to make assumptions based on a patient’s gender alone, but to keep variations in mind. For instance, she says, practitioners have only recently become more aware of how heart attacks show up in women versus men. Similarly, Moriatis Wolf hopes her study raises awareness of gender differences in musculoskeletal disease and boosts awareness of risk and prevention among men and women alike, along with the health care providers who treat them.