Gender-specific Issues in Orthopaedic Surgery: Editorial Comment
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In 2004, the American Academy of Orthopaedic Surgeons and National Institutes of Health organized a workshop to explore advances in gender-based characteristics of musculoskeletal health. At the time, six priorities were identified for future musculoskeletal research : (1) Monitor gender differences and similarities for all musculoskeletal diseases and conditions; (2) Conduct and design longitudinal and cross-sectional studies of musculoskeletal conditions allowing results to be analyzed by gender; (3) Make gender-specific data in musculoskeletal diseases and conditions more readily available; (4) Mine cross-species information and develop relevant in vivo and in vitro models that incorporate the biologic clock. Stratify human and animal studies of musculoskeletal diseases and conditions based on gender; (5) Expand research on gender differences in neural organization and function, pain and analgesia with respect to musculoskeletal diseases and conditions; (6) Promote research on gender differences at the molecular, cellular and tissue level with specific emphasis in musculoskeletal diseases and conditions.
Although we are still far from reaching many of these goals, researchers are increasingly focusing on gender differences in the practice of orthopaedic surgery. While some of these findings have been widely discussed in the popular media, others remain underappreciated by the orthopaedic community. This symposium provides a sample of cutting-edge, original research analyzing the effects of sex and gender on the treatment and outcomes of musculoskeletal conditions. Given that these topics are not limited to a single discipline, the task is a challenging one. We present a variety of themes in hopes of touching upon the many subspecialties that have contributed to this growing field of study.
Gender differences in osteoarthritis have perhaps received the greatest degree of attention. The prevalence of the disease is higher in women . Genetic , anatomical  and physiological  factors have been suggested to contribute to the disease burden . Although men and women with advanced osteoarthritis typically present with similar symptoms, disparities in the rate of treatment have been reported, with most studies pointing towards underuse of total joint arthroplasty among women . More detailed assessments of outcomes following total joint arthroplasty will be helpful in allowing physicians to tailor and optimize treatment methods.
Responsible for 1.5 million annual fractures in the United States, osteoporosis has also been the focus of intense research. Approximately 80% of those affected by osteoporosis are women and 50% of women over the age of 50 will have a fragility fracture in their lifetime . Studies persistently demonstrate ineffective physician practices in adequately evaluating and treating patients for osteoporosis, particularly after fragility fractures [4, 14]. Continuing resources should be dedicated to identifying populations at risk and initiating appropriate preventive strategies.
In addition to osteoarthritis and osteoporosis, investigators have identified several other conditions that disproportionately affect the sexes [8, 13]. Furthermore, many authors are focusing on analyzing differences in outcomes and health-care utilization rates between men and women [7, 12]. These efforts should be encouraged and developed.
Graduate medical education is another subject that deserves special mention. Orthopaedic surgery continues to lag behind other surgical specialties in attracting female residents, and successful recruitment begins early in medical school . Orthopaedic surgeons should thus actively engage students through mentoring programs and ensure that residency training meet the needs of female and male trainees alike.
This symposium presents some of the more recent data examining differences between men and women in orthopaedic surgery. Observational studies as well as comparative series and basic science research are included among the highlighted papers. I am indebted to the talented group of individuals who contributed articles towards its publication, and hope that the work presented will encourage others to follow in their footsteps.
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