{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T22:02:16Z","timestamp":1780005736886,"version":"3.53.1"},"reference-count":40,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Tendinopathies are common in middle-aged women. While estrogen regulates tendon remodeling, the influence of systemic hormone replacement therapy (HRT) on the risk of tendon degeneration remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis\/Purpose:<\/jats:title>\n                    <jats:p>The purpose of this study was to investigate the association between systemic HRT use and tendon injuries\/repair in perimenopausal women. It was hypothesized that systemic HRT would be associated with an increased incidence of tendon injuries and repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Using the TriNetX Research Network, we identified female patients aged \u226545 years diagnosed with major tendon abnormalities, including rotator cuff tears, bicipital tendinitis, lateral or medial epicondylitis, Achilles tendinopathy, patellar tendinitis, or quadriceps strain, from January 2004 to July 2025. HRT exposure was defined as systemic estrogen and\/or progestin use within 1 year before a diagnosis. Patients with contraindications to HRT were excluded. After 1:1 propensity score matching, 2 groups of 63,836 patients each were generated. Primary outcomes included diagnosis rates of specific tendon conditions; secondary outcomes were lifetime rates of corresponding tendon repair procedures. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The independent\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      test and chi-square test were used for analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      HRT users had significantly higher rates of several tendon abnormalities compared to matched controls, including rotator cuff tears (39.2% vs 37.9%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), bicipital tendinitis (13.3% vs 11.0%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), lateral epicondylitis (27.8% vs 22.7%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), and medial epicondylitis (6.8% vs 5.3%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Achilles tendinopathy had similar rates between the 2 groups (14.6% vs 14.5%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .387). Surgical repair was more common in the HRT group, including biceps tendon repair\/tenodesis (3.9% vs 3.3%, respectively; OR, 1.16 [95% CI, 1.10-1.23];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), rotator cuff repair (6.6% vs 6.2%, respectively; OR, 1.06 [95% CI, 1.01-1.11];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .013), and Achilles tendon repair (0.7% vs 0.6%, respectively; OR, 1.23 [95% CI, 1.06-1.41];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .005).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our study showed that systemic HRT use in women aged \u226545 years was associated with an increased risk of tendon injuries and a greater likelihood of surgical repair, although the absolute risk differences were modest. These findings underscore the need for awareness of the possible musculoskeletal effects of hormone therapy and highlight an underexplored area in women's orthopaedic health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671261428457","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T21:31:41Z","timestamp":1779831101000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Hormone Replacement Therapy and Incidence of Tendon Injuries and Surgical Repair in Perimenopausal Women: A Propensity Score\u2013Matched National Cohort Study"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9296-2824","authenticated-orcid":false,"given":"George","family":"Bcharah","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Cancio-Bello","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Iturregui-Pastrana","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5501-9282","authenticated-orcid":false,"given":"Zaid","family":"Elsabbagh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ysa","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil J.","family":"Karsen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karan A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anikar S.","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.04.2016.04"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2009.07.010"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21249739"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2018.01834"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-01603"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1474-9726.2007.00307.x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011419838294"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.91439.2008"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.03.2014.11"},{"issue":"2","key":"e_1_3_3_11_2","first-page":"92","article-title":"The effect of female sex hormone supplementation on tendon in pre and postmenopausal women: a systematic review","volume":"16","author":"Ganderton C","year":"2016","unstructured":"Ganderton C, Semciw A, Cook J, Pizzari T. 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