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Global surge in postmenopausal osteoarthritis and associated disability
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.”
Ovarian cancer cases are rising among younger adults in England, with bowel cancer showing a similar pattern, a new study suggests.
Researchers said excess weight is a key contributor, but is unlikely on its own to explain the pattern.
The authors wrote: “These patterns suggest that while similar risk factors across ages are likely, some cancers may have age-specific exposures, susceptibilities, or differences in screening and detection practices.”
They added: “Although overweight and obesity are linked to 10 of the 11 cancers evaluated and account for a substantial proportion of cancer cases, both BMI-attributable and BMI-non-attributable incidence rates have increased, though the latter more slowly, suggesting other contributors.”
The study analysed cancer incidence, meaning new diagnoses, in England between 2001 and 2019 across more than 20 cancer types, comparing adults aged 20 to 49 with those aged 50 and over.
Among younger women, cases of 16 out of 22 cancers increased significantly over the period, while among younger men, 11 out of 21 cancers increased significantly.
In particular, there was a significant rise in 11 cancers with known behavioural risk factors among adults under 50. These were thyroid, multiple myeloma, liver, kidney, gallbladder, bowel, pancreatic, endometrial, mouth, breast and ovarian cancers.
Rates of all 11 also rose significantly among adults aged 50 and over, with the notable exceptions of bowel and ovarian cancer.
Five cancers, endometrial, kidney, pancreatic, multiple myeloma and thyroid cancer, increased significantly faster in younger than in older women, while multiple myeloma increased faster in younger than in older men.
The researchers looked at established risk factors including smoking, alcohol intake, diet, physical inactivity and body mass index, a measure used to assess whether someone is underweight, a healthy weight, overweight or obese.
With the exception of mouth cancer, all 11 cancers were associated with obesity. Six, liver, bowel, mouth, pancreatic, kidney and ovarian, were also linked to smoking.
Four, liver, bowel, mouth and breast, were associated with alcohol intake. Three, bowel, breast and endometrial, were linked to physical inactivity, and one, bowel, was associated with dietary factors.
But apart from excess weight, trends in those risk factors over the past one to two decades were stable or improving among younger adults.
That suggests other factors may also play a part, including reproductive history, early-life or prenatal exposures, and changes in diagnosis and detection.
The study noted that red meat consumption fell among younger adults, while fibre intake remained stable or slightly improved in both sexes between 2009 and 2019, although more than 90 per cent of younger adults were still not eating enough fibre in 2018.
Established behavioural risk factors accounted for a substantial share of cancer cases.
Excess weight was the risk factor associated with most cancers in 2019, ranging from 5 per cent for ovarian cancer to 37 per cent for endometrial cancer.
The researchers said the findings were based on observational data, meaning the study could identify patterns but could not prove cause and effect.
They also noted there were no consistent long-term national data for several risk factors, that the analysis was limited to England rather than the UK, and that cancer remains far more common overall in older adults despite the rise in cases among younger people.
Early miscarriage care after a first loss could prevent about 10,000 pregnancy losses a year in the UK, according to a new study.
The study by Tommy’s National Centre for Miscarriage Research and Birmingham women’s hospital involving 406 women found a 4 per cent reduction in the risk of future miscarriage for women on the graded model of care compared with usual care.
Women in England, Wales and Northern Ireland currently become eligible for specialised NHS care for early baby loss only after they have had at least three miscarriages.
Tommy’s has called for women to become eligible after one miscarriage, saying this could reduce the risk of future miscarriages and improve health outcomes for mothers.
Researchers said that would translate to 10,075 fewer miscarriages a year across the UK.
Kath Abrahams, chief executive of Tommy’s, said women were being “left without early access to services that could help prevent future losses and reduce the debilitating feelings of isolation and hopelessness that we know affect so many who experience pregnancy loss”.
She said: “Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care.
“Put simply, it is the right thing to do. We will do all we can to drive that change across the UK so that more women and families are supported after every miscarriage.”
The graded model of miscarriage care proposed by Tommy’s is already available in Scotland, and the charity is calling for it to be introduced across the whole of the UK.
The graded model includes nurse-led support after one miscarriage, with advice on reducing risk factors such as low vitamin D, folic acid intake, alcohol consumption and caffeine use.
Women who received the specialised care were 47 per cent more likely to have a risk factor identified and receive relevant advice to help prevent future miscarriages than women receiving usual care, the study found.
Among women who had experienced two miscarriages and received the specialised care, one in five were found to have thyroid dysfunction or anaemia, both conditions that can affect pregnancy outcomes.
About one in four pregnancies ends in miscarriage, most often within the first 12 weeks of pregnancy.
The report comes ahead of the long-awaited final findings of the government’s investigation into maternity care in England. Interim findings uncovered a range of failures, including claims that NHS hospitals that caused harm to women and babies during childbirth often resorted to a “cover-up” of their mistakes, falsified medical records and denied bereaved parents answers.
Women’s health minister Gillian Merron said: “Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need.
“I welcome the findings of this important report, and this will be carefully considered as part of our ongoing work to make sure women get the high-quality, compassionate NHS care they deserve.”
Indian pharmaceutical giant Sun Pharma has agreed to buy Organon for US$11.75bn in a deal aimed at expanding its women’s health and biosimilars business.
Organon, which was spun out of Merck in 2021, has built a portfolio of more than 70 women’s health and general medicines products, including biosimilars, sold in the US and about 140 other countries.
The acquisition would give Sun Pharma a broader presence in biosimilars, which are medicines designed to be highly similar to existing biological drugs, and strengthen its position in women’s health.
Dilip Shanghvi, executive chairman of Sun Pharma, said: “Organon’s portfolio, capabilities, and global reach are highly complementary to our own, and we believe that bringing the two organizations together can create a stronger and more diversified platform.”
The companies said the combined business would generate annual revenue of US$12.4bn, operate across 150 countries and rank among the top three companies globally in women’s health.
They also said it would become the seventh largest biosimilar player.
Sun Pharma said the deal would help grow its innovative medicines business and expand its biosimilars offering.
It added that the combined company would have 18 large markets each generating more than US$100m in revenue.
Organon’s largest markets include the US, Brazil, Canada, China and countries in the European Union. The company also has six manufacturing facilities across the EU and emerging markets.
The deal follows market speculation that began on 10 April, when Indian media reported that Sun Pharma had submitted an all-cash offer for Organon.
A later report said the offer had been revised to US$13bn. Sun Pharma shares rose about 7 per cent on India’s National Stock Exchange after the announcement.
Sun Pharma said it would acquire all of Organon’s issued and outstanding shares in cash, using a combination of available cash and committed bank financing. It also estimated synergies of about US$350m within two to four years of completion.
The company said the acquisition would strengthen its cash generation, with EBITDA and cash flow set to nearly double, supporting efforts to reduce the net debt to EBITDA ratio of 2.3 times resulting from the deal. EBITDA is a measure of operating performance before certain costs are deducted.
Organon reported revenue of US$6.2bn last year and adjusted EBITDA of US$1.9bn. It also reported debt of US$8.64bn, down from US$9.5bn when it separated from Merck, and a cash balance of US$574m.
In November, Organon announced plans to sell its JADA System, designed to control and treat abnormal postpartum uterine bleeding or haemorrhage, to Laborie Medical Technologies for up to US$465m. Net proceeds from the sale will contribute to Organon’s cash balance as of 31 March 2026.
Organon will merge with a subsidiary of Sun Pharma, with Organon surviving the merger. The boards of both companies have approved the transaction.
Carrie Cox, executive chair of Organon, said: “Following a comprehensive review of strategic alternatives, our Board determined that this all-cash transaction offers compelling and immediate value to Organon stockholders.”
The transaction is expected to close in early 2027, subject to regulatory approvals and Organon stockholder approval.
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