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Lower sex hormone levels are associated with more chronic musculoskeletal pain in community-dwelling elderly women

de Kruijf, Marjolein; Stolk, Lisette; Zillikens, M. Carola; de Rijke, Yolanda B.; Bierma-Zeinstra, Sita M.A.; Hofman, Albert; Huygen, Frank J.P.M.; Uitterlinden, Andre G.; van Meurs, Joyce B.J.

doi: 10.1097/j.pain.0000000000000535
Research Paper
Global Year 2016

Chronic pain is more prevalent in women than in men, with increasing differences between sexes in advanced age. This could be caused by differences in sex hormone levels. We therefore studied the relationship between sex hormones and the prevalence and incidence of chronic pain. The association between sex hormone levels and chronic pain was examined in 9717 participants aged 45 years and older from the Rotterdam Study, a population-based study. Chronic pain was defined as pain in the lower back, hands, knees and/or hips for at least 3 months. Sex hormone levels included estrogen, testosterone, androstenedione, and 17-hydroxyprogesterone. Relationships between hormones and prevalent and new onset chronic pain were analyzed using linear and logistic regression, stratified by gender. Women with androstenedione or estradiol levels in the lowest tertile had more chronic pain (odds ratio, 1.20; 95% CI, 1.03-1.39 and odds ratio, 1.27; 95% CI, 1.10-1.48, respectively). Mean estradiol levels were lower among men with chronic pain (mean difference −3.88 pmol/L; P = 0.005). Lowest tertile 17-hydroxyprogesterone in women was associated with 38% more new onset pain. All these associations were independent from age, body mass index, health and lifestyle factors, and osteoarthritis. Lower sex hormone levels are associated with chronic musculoskeletal pain, independent from lifestyle and health-related factors, in community-dwelling elderly women. These results suggest that sex hormones play a role in chronic pain and should be taken into account when a patient presents with chronic pain. Therefore, sex hormones may be a potential treatment target for these patients.

Supplemental Digital Content is Available in the Text.Lower sex hormone levels are associated with chronic musculoskeletal pain, independent from lifestyle and health-related factors, in community-dwelling elderly women.

Departments of aInternal Medicine


cClinical Chemistry

dGeneral Practice, Erasmus MC

eOrthopedic Surgery, University Medical Center Rotterdam, the Netherlands

fEpidemiology, Erasmus MC, Rotterdam, the Netherlands

Corresponding author. Address: Genetic Laboratory Department of Internal Medicine, Erasmus MC, Room Ee579b, MC PO Box 1738, 3000 DR Rotterdam, the Netherlands, Tel.: +31107038425. E-mail address: (J. B.J. van Meurs).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received September 24, 2015

Received in revised form February 08, 2016

Accepted February 10, 2016

© 2016 International Association for the Study of Pain
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