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Global surge in postmenopausal osteoarthritis and associated disability

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Cases of postmenopausal osteoarthritis, and disabilities associated with the condition, have surged globally by more than 130 per cent over the last three decades, data shows.

During this period, East Asia and high income Asia Pacific countries experienced the fastest growth in the condition while excess weight accounted for 20 per cent of the total years lived with the resulting disability, the analysis indicates.

Osteoarthritis is primarily characterised by the deterioration and damage of joint cartilage, accompanied by bony remodelling, joint dysfunction, and chronic pain.

In 2020 alone, an estimated 595 million people worldwide were living with the condition, comprising nearly eight per cent of the world’s population, with postmenopausal women at heightened risk.

To better understand the global impact of osteoarthritis in this group, researchers drew on The Global Burden of Disease (GBD) 2021 study. This collected and analysed data from 204 countries and territories for the prevalence, severity, and deaths attributable to 371 diseases between 1990 and 2021.

The researchers focused in particular on rates of new and existing cases of knee, hip, hand, and ‘other’ osteoarthritis and years of healthy life lost (DALYs) among postmenopausal women, aged 55 and above.

The menopause signals a decline in oestrogen levels, which not only affects skeletal health, but is also directly linked to the function and stability of the joint system, explain the researchers.

The GBD framework incorporates the SocioDemographic Index (SDI), a composite measure of a nation’s development, based on income per head of the population, average years of education, and fertility rates for those under 25.

And to provide regional estimates of osteoarthritis, these countries and territories were further divided into 21 regions, based on geographic proximity and cultural similarities.

Generally, global age standardised rates of new and existing cases and DALYs for all types of osteoarthritis steadily increased in postmenopausal women across all age groups from 1990 to 2021.

In 2021 there were 14,258,581 new cases; 278,568,950 existing cases; and 99,447,16 DALYs, representing increases of 133 per cent, 140 per cent, and 142 per cent since 1990, respectively.

High SDI areas exhibited significantly greater incidence, prevalence, and DALY rates than other regions, with the exception of other osteoarthritis.

Osteoarthritis of the knee was the most common type and associated with the highest loss of healthy years of life (1264.48/100,000 people), followed by that of the hand and ‘other’.

At the other end of the spectrum, osteoarthritis of the hip was the least common and associated with the lowest rates of DALYs.

Among the 21 GBD regions, high income Asia Pacific countries had the highest age standardised incidence, prevalence, and DALY rates for knee osteoarthritis per 100,000 people, while countries in Central Asia reported the lowest age standardised rates.

The fastest rise in new cases of knee osteoarthritis occurred in Southeast Asia while the most rapid rise in prevalence and DALYs occurred in East Asia.

The highest burden of hand osteoarthritis was in Central Asia while the lowest was in Oceania. The fastest rise in new and existing cases of hand osteoarthritis, as well as DALYs, was observed in East Asia.

All age standardised rates for hip and other osteoarthritis were relatively similar between older men and women of the same age. But women had significantly higher values for hand and knee osteoarthritis than men of the same age.

Specifically, DALYs  for hand osteoarthritis in 55–59 year old women were nearly twice as high as they were in men of the same age.

Hand and other osteoarthritis showed the fastest growth among 55–59 and 60–64 year old women over the past decade.

Excess weight (BMI), a key risk factor for osteoarthritis, was the only risk factor investigated in the GBD 21 data. It was defined as above 20 to 23 kg/m² for those aged at least 20.

Between 1990 and 2021 DALYs attributable to high BMI among postmenopausal women rose significantly across all SDI categories, and in most regions, with the exception of Central Asia.

Globally, DALYs attributed to high BMI among postmenopausal women increased from around 17 per cent in 1990 to around 21 per cent in 2021. Regions at the upper end of SDIs had the highest proportions of DALYs associated with high BMI, exceeding 20 per cent, with East Asia showing the sharpest rise from around 14 per cent to 23 per cent.

Osteoarthritis attributed to high BMI was consistently more of an issue for women in all regions  of the world and across all SDI categories.

The trends observed in East Asia “may be linked to rapid population ageing, increased workforce participation, and a surge in obesity rates due to urbanisation and changing lifestyles,” suggest the researchers.

“Conversely, the high burden observed in high-income Asia Pacific could be attributed to advanced healthcare systems with better diagnostic capabilities, facilitating comprehensive identification and reporting of [osteoarthritis] cases,” they add.

The researchers acknowledge various limitations to their findings including regional variations in data quality, while data from low income countries were often scarce. The age cut-off of 55 may also have excluded women who were postmenopausal at younger ages.

But they conclude: “The burden of [osteoarthritis] among postmenopausal women continues to escalate, highlighting its significant impact on [their] global health.”

They add: “There is an urgent need for proactive measures to rigorously monitor and manage risk factors, with a particular emphasis on promoting lifestyle adjustments aimed at controlling BMI. Additionally, policies should be implemented that take into account socio-demographic disparities, to effectively alleviate the burden of [osteoarthritis] in postmenopausal women.”

Ageing

Higher BMI in early adulthood linked to lower breast cancer risk after menopause

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Higher BMI at 20 was linked to a lower risk of post-menopausal breast cancer in an analysis of more than 33,000 women.

Lower breast density later in life may partly explain the link between higher body mass index, or BMI, in early adulthood and lower breast cancer risk after menopause.

The findings could help explain why higher body weight in childhood, adolescence and early adulthood appears linked to lower long-term risk, while being overweight in middle age is associated with increased breast cancer risk.

First author Dr Benoit Jauniaux, a surgical trainee in the North-West Deanery, said: “Researchers in previous studies have observed that women with a higher BMI in childhood or their early adulthood appear to have a lower risk of breast cancer after the menopause, but we have not fully understood why.

“This study suggests that downstream changes to breast density may explain a large part of this effect.”

The study was published in the British Journal of Cancer on 17 September 2026 and was supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC): Manchester.

Researchers at The University of Manchester and Manchester University NHS Foundation Trust followed 33,816 women taking part in the UK Predicting Risk of Cancer at Screening (PROCAS) programme for more than a decade.

They recorded 1,261 cases of post-menopausal breast cancer and compared women’s self-reported BMI at age 20 with breast density measurements from routine mammograms.

Breast density refers to the amount of fibrous and glandular tissue compared with fatty tissue in the breast. Women with denser breasts are known to have a higher risk of breast cancer.

Women with a higher BMI at age 20 generally had lower percentage breast density later in life and were less likely to develop post-menopausal breast cancer.

For every five-point increase in BMI at age 20, the risk of developing post-menopausal breast cancer fell by around 15 per cent. Further analysis suggested lower breast density may account for almost 60 per cent of this effect.

Researchers believe the timing of body weight gains may be crucial because women’s breasts are still developing during adolescence and early adulthood, potentially leading to long-term changes in tissue structure.

The study also found that different measures of breast density may reflect different biological pathways linked to breast cancer risk.

One measure, estimating the percentage of dense tissue within the breast, appeared to capture some of the lasting effects associated with higher body weight in early adulthood. Another measure, based on the total volume of glandular tissue, appeared to be more strongly influenced by body weight later in life.

Senior author Professor Andrew Renehan is professor of cancer studies and surgery at The University of Manchester and programme co-lead in the Cancer Prevention and Early Detection Theme at the NIHR BRC: Manchester/

The researcher said: “These findings do not suggest that gaining weight is protective.

“What they offer is further insight into how breast tissue and consequent breast cancer risk may be shaped across a woman’s lifetime, and we want to understand these mechanisms further.

“Maintaining a healthy weight remains important, because excess weight in later adulthood is linked to a higher risk of breast cancer and many other serious diseases.

“But this study adds to growing evidence that exposures during early life can have lasting effects on health decades later.”

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Mental health

Neuroscience-backed journaling for women’s mental health

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AI-powered journaling app Véa is supporting mental health by helping women to understand their thoughts, triggers and behavioural patterns. 

Winner of the Brain and Mental Health Innovation Award at this year’s Femtech World Awards, Véa is designed to address the emotional gap in women’s health technology.

The journal – which has been built by a female team and trained on women’s health papers – tracks inner states, provides personalised insights and somatic practices, and utilises AI to explain complex neuroscience in relatable terms.

Described by its founders as a “protector, seeker, and sculptor”, Véa provides a longitudinal map of women’s emotional journeys, integrating journaling with therapy and both in-person and online community support.

The journal’s goal is to improve women’s mental health without replacing professional care. 

Zahra Bhatti, co-founder and CEO and Katrina Zalcmane , co-founder and growth lead speak to Femtech World about the technology, winning a Femtech World Award and their plans for the future.

Women’s health and wellbeing technology has grown so rapidly over the last few years, but is largely focused around physical health. What was the emotional gap that you saw that inspired you to create the journal? 

“Women’s health has been focused on reproductive health and physical health, but it is all one ecosystem – it always starts with the mind,” says Zahra.

“Whatever you feel down here, you feel up there too, and the hormones reflect that. 

“With Véa, it was actually built from our own personal experience of burnout. 

“We wanted to make a space where women could feel safe and were able to reflect what’s on their mind, but also understand their mind the same way that women understand their hormones. 

“Women need to understand what happens in our minds. Véa helps women to understand cognitive distortions, why they feel the way they feel, black and white thinking – we wanted to really surface that for them. 

“For example, when you’re in your luteal phase, your serotonin levels drop, so that means you’re going to be a bit more nervous. 

“You’re going to be more reactive. You’re going to be taking things more deeply, and that’s something that your rational mind wouldn’t normally do if you’re in your ovulation phase. 

“So that’s what Véa does – she reflects that back to you, so you understand your body and thought processes.”

Véa describes itself as a journal that’s designed for the female mind. What does that mean in practice, and how does the experience differ from using traditional journaling?

“The majority of our team is female, so Véa has been built from all of our lived experiences, and the AI itself is trained on women’s health papers,” says Katrina. 

“It takes into account what having a certain condition means for individuals. For example, if you have endometriosis or PCOS, We’ve trained our AI on womens health data and research, which gets reflected back to the woman in a simple and effective way

“We have a clinical board, who are all also women, who look through the AI and the language. They ensure that all outputs are evidence based, ethical and take into account the various therapies which are proven to work for women.

“We also have somatic practices which are focused on women which we call “rituals”. We have a self-inquiry ritual, a confidence mirror ritual, or we have one of our psychotherapists on the board who does therapy through novels, for example. 

“These aim to make you the protagonist of your story. 

“Generic journaling apps are one size fits all, but women are not one size fits all, and that’s what we’ve made sure to put in the forefront of Véa.”

Instead of conventional mood tracking, you are focused on the inner states of women. How do you develop that approach, and what kind of insights has it revealed about how women reflect on their emotions? 

Katrina says: “Mood plays a part in our inner state and Véa checks in on that. 

“It allows you to have a journey across time. For example, on a good day, maybe their “protector” aspect is good at setting boundaries, but on a bad day, it could be really closed off. 

“It’s a richer approach, and these inner states are tied to specific prompts which are then linked in the journaling.”

“As women, we are fluid,” adds Zahra. 

“We are not one entity. 

“For example, you might be in a state where you’re really overthinking, but actually, you’re seeking new perspectives, and that’s why within Véa, the inner state is called a “seeker”. 

“When you converse with Véa in your seeker mode, she will challenge you in a Socratic way.

“However, the next day, you might be a “protector”, and then Véa will adjust her voice for a reflective and exploratory tone compared to when you were a seeker.

“Another state which I love is the “sculptor” which is when you’re feeling confident. 

“When you’re a sculptor, Véa will talk about how you can be creative, asking questions such as ‘what did you create today?’ ‘How did that make you feel?’ and ‘How would you describe that if you could put a shape to this color, this feeling?’, for example. 

“Véa goes into all of these different modes, and it builds a longitudinal map of the woman as well. So, throughout weeks, months and years, you can see how you’ve changed across time.”

How did you approach designing an AI companion that feels supportive without replacing human connection or professional care? 

“For the past six years, I’ve been a product manager. So I’ve seen how all of these web apps and applications have been built, and I’ve worked quite deeply with AI so I knew what was missing and like what women truly needed,” says Zahra.

“The key thing for us is that we want to bring “URL to IRL” [in real life]. 

“We have a community that goes alongside Véa. This includes a WhatsApp community and events. 

“We turn the rituals inside Véa into in-person workshops at our events with our clinical board and with professionals in the space. 

“We are not neuroscientists, but there are neuroscientists who have helped us build the app, and we make sure that AI is there to support you, but AI will never replace that human touch.

“That’s something that’s very close to us, and we want to make sure we connect people together and help people reflect in a safe space. 

“As well as AI, there is the option to talk to the clinical board, to use their rituals, to reflect with the community, and go to our events.” 

Katrina adds: “The key is that whatever the touch point is, whether it’s the app or it is an event or even our online community, we don’t want women to feel alone. We want them to feel together, grow together, and process together.”

People may often start journaling with good intentions, but struggle to stick with the practice. What have you learned about building habits and how those insights have shaped the experience of your product? 

Zahra says: “I think everyone wants to gamify things – what helps us is the community aspect. 

“We’ve created a tribe through the community, and because it’s so hyper personalised, you help shape the app, the app doesn’t shape you. You have full control, which makes people want to come back. 

“Véa remembers what you said yesterday as well as six weeks ago, and she will surface that. 

“We do have “streaks”, but our streaks are very gentle – every time you get a streak, you get a neuroscience fact along with it. 

“Something else we have built in that helps retention is “breakthroughs”. When Véa detects a shift in language, and will highlight, for example, that you have shifted from overthinking to certainty.”

“I think people are sick of data, they’re sick of data that they can’t interpret from. Véa interprets for you. 

“Soon we will evolve even more and add more features such as cycle tracking, wearable tracking and hormone tracking, to build out that ecosystem.”

What does success look like for Véa and how do you see the app and the community evolving as you move forward? 

“We want to launch across so many different markets. Our next target is the US,” explains Katrina.

“We want to bring our events over there as well. We do a lot of corporate events too. We have one with NatWest coming up – we know that work stress is a big thing, especially amongst females. 

“I think there’s a real space for that in the corporate world, so that’s one of our key focuses.”

Zahra adds: “Growing in markets and keeping going with our communities. We have just launched a supper club which sold out in three days in Manchester, which is absolutely amazing. We’re doing some in London and Amsterdam as well in the next few months. We are focused on growth, growing our board as well, and keeping the female mind at the center.”

What does it mean to win the Femtech World Award? 

Katrina says: “When you are so passionate and truly believe in something, you do it for that reason, but that external validation of seeing that it also matters for others in the wider space means so much. 

“Especially, in Femtech – it is a whole category that has been growing, but when it comes to funding and recognising women’s issues, there is still a lot of awareness that needs to be raised. 

“Being recognised gives us that fuel to continue and drive forward, and that it really does matter.”

“We want to be at the forefront of women’s mental wellness as a whole, and have put many sleepless nights into developing the app, so it is a big testament to that,” adds Zahra.

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Features

Gender gap in treatment persists even when men and women have same condition

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Women with the same medical conditions as men were less likely to receive the same treatment across several specialties, a global research review found.

The review found differences in care for conditions including cardiovascular disease, kidney disease and Parkinson’s, with women less likely to receive some active treatments.

Of 38 studies analysed, 33 found women were less likely than men to be offered active treatment.

Researchers at the University of St Andrews found women with myocardial infarction, heart failure or an irregular heartbeat were more likely to receive medication, while men were more likely to undergo coronary bypass surgery, stenting or other surgical treatment.

Women were also less likely to be prescribed statins.

Men with Parkinson’s were more likely to be referred for deep brain stimulation.

Men with liver failure were more likely to receive a transplant, while women with kidney disease requiring dialysis were less likely to receive permanent access and spent longer using a catheter.

Women were also less likely to receive opioids for pain management.

The researchers found no significant difference between women and men in treatment for stroke or diabetes, while women were more likely to receive treatment for dementia.

None of the studies identified clinical guidelines recommending different treatment based on sex.

Researchers said this suggested the differences could not be explained by the need for different clinical approaches to women’s health.

Dr Andrew O’Malley, who co-led the study, said: “For clinicians, the findings are a prompt to check whether treatment is being offered on clinical grounds rather than assumption.”

He said studies showed doctors more often attributed women’s symptoms to anxiety and made more diagnostic errors with female patients, even when test results were positive.

Dr Miriam Veenhuizen, honorary lecturer in the School of Medicine at St Andrews, said: “While the direction of the findings was not a surprise, the consistency was. The same pattern appeared in cardiology, surgery, transplant medicine and emergency care, and it survived statistical adjustment in most studies.”

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