The Association of Hormone Replacement Therapy With Rotator Cuff Tendinopathy and Rotator Cuff Repair Among Menopausal Women

Background: Rotator cuff (RC) tendinopathy is a common condition that causes shoulder pain and weakness. The decline of estrogen during menopause may increase RC tendinopathy risk. While hormone replacement therapy (HRT) may counteract these effects, its role in tendon health remains unclear. Purpose: To examine the prevalence of RC tendinopathy and subsequent rotator cuff repair (RCR) surgery among menopausal women taking HRT compared with those not taking HRT. Study Design: Cohort study; Level of study, 3. Methods: The authors utilized the TriNetX database to evaluate RC tendinopathy and subsequent RCR in menopausal women aged 45 to 60 years. Two cohorts were created: (1) menopausal women taking estradiol and (2) menopausal women not taking estradiol. Cohorts were 1 to 1 propensity score matched for hyperlipidemia, osteoarthritis, nicotine dependence, type 2 diabetes, thyrotoxicosis, alcohol-related disorders, rheumatoid arthritis, lupus, injections, body mass index, and demographic factors. Outcomes evaluated were RC tendinopathy diagnosis (International Classification of Diseases, 10th Revision [ICD-10] codes: M67.81, M75.10, M75.11, M75.12, S43.42, M75.4, M75.5) and RCR (Current Procedural Terminology [CPT]: 29827, 23410, 23412, 23420) at 1, 5, and 10 years after HRT. Results: Each cohort included 177,198 menopausal women. Women on HRT had significantly higher rates of RC tendinopathy at 1 year compared with women not taking HRT (odds ratio [OR], 1.095 [95% CI, 1.016-1.179]; P = .018). Significantly more women taking HRT also underwent RCR after 1 year (OR = 1.309 [95% CI, 1.045-1.641]; P = .019). After 5 years on HRT, menopausal women were significantly more likely to be both diagnosed with RC tendinopathy (OR = 1.139 [95% CI, 1.088-1.192]; P < .0001) and undergo RCR (OR = 1.278 [95% CI, 1.122-1.456]; P < .0001). After 10 years on HRT, menopausal women demonstrated a similar trend with increased instances of RC tendinopathy (OR = 1.152 [95% CI, 1.105-1.202]; P < .0001) and RCR (OR = 1.279 [95% CI, 1.137-1.439]; P < .0001). Conclusion: Menopausal women taking HRT had significantly higher instances of RC tendinopathy and RCR at all time points. These findings suggest a potential association between HRT and tendon pathology, warranting further research into the interplay between menopause, HRT, and musculoskeletal health to better inform clinical practice.