Abstract
BACKGROUND: Age and gender are commonly recognized as risk factors for osteoarthritis (OA), implying a potential association between sex hormones and OA pathogenesis. However, the precise role of sex hormones in OA remains elusive. Meanwhile, testosterone to estradiol (TT/E2) ratio is a new biomarker of sex hormone milieu. In this study, we aimed to investigate the relationship between sex hormones, specifically TT/E2 ratio, and the prevalence of OA among adults in the United States. METHODS: This study is a cross-sectional study, and the data sourced from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 cycles. This study primarily focuses on individuals aged 50 and above, employing multivariable logistic regression to examine the association between sex hormones and OA. RESULTS: We included 2,615 participants (972 females). No significant association was observed between testosterone or estradiol levels and OA prevalence when analyzed separately. However, the TT/E2 ratio exhibited a robust inverse association with OA, particularly in females (adjusted OR = 0.61, 95% CI: 0.41-0.91, p = 0.02). A nonlinear relationship was observed in females, with a threshold effect indicating reduced OA risk when the TT/E2 ratio exceeded 0.3. CONCLUSION: The TT/E2 ratio was inversely associated with OA risk, with a stronger and more consistent effect observed in females. These findings suggest the TT/E2 ratio as a potential biomarker for OA risk stratification, particularly in postmenopausal females. Future longitudinal studies are warranted to clarify the causal role of the TT/E2 ratio in OA.