AMA report goes beyond reproductive and unique health issues
The term "women's health" has long been thought to refer almost exclusively to reproductive health issues or conditions that are unique to women. Evidence that sex and gender have an impact on almost all health conditions—whether in etiology, prevalence, presentation, or response to treatment—is increasing. Unfortunately, this impact is not always acknowledged, taught in medical schools or residencies, or applied to patient care.
Sex and gender differences have been described in a wide number of disease areas, including cardiovascular disease, autoimmune disease, neurological conditions, mental health, and especially, musculoskeletal health. The impact of sex on musculoskeletal health include the following:
- the increased risk of ACL injuries among female athletes
- the higher rate of osteoarthritis (OA) of the knee among women, especially after ACL injuries
- the greater incidence of OA of the hand among women
- the differing types of femoroacetabular impingement between the sexes
- the higher rate of low-impact fractures among women, but a higher rate of mortality after a fragility fracture of the hip among men
The AAOS, through its Women's Health Issues Advisory Board, and the Ruth Jackson Orthopaedic Society have long championed the need for awareness of the impact of sex and gender on musculoskeletal health conditions. Unfortunately, discussions in other venues about health care or policy do not routinely recognize that "women's health" more accurately refers to all health conditions for which differences have been noted between women and men.
Expanding the definition
During the 2015 annual meeting of the American Medical Association (AMA), the AMA Women Physicians Section submitted a resolution asking that this expanded definition be reflected in future discussions within the AMA of topics listed as "women's health." Several groups within the AMA, led by the orthopaedic section, voted to have the topic of this resolution be referred for study.
As author of the original resolution (while vice-chair of the AMA Women Physicians Section) and as current chair of the orthopaedic section, I have worked with AMA staff during the past year to craft such a report. An Expanded Definition of Women's Health was produced by the AMA's Council on Science and Public Health, and adopted by consensus during the 2016 AMA House of Delegates meeting. The report outlines the scope of the issue, the current state of knowledge, and the impact of sex in various health conditions, including those in the musculoskeletal arena.
The report concludes that the AMA House of Delegates should adopt a new policy with respect to the term "women's health" such that this term is defined as "conditions for which there is evidence that women's risks, presentations, and/or responses to treatments are different from those of men." The report also recommends that "the AMA adopt policy acknowledging the role that sex and gender play in health and supporting application of evidence-based information to practice," with the understanding that "sex differences that impact health and disease will lead to better care for both men and women."
Sex in practice
The report also encourages the inclusion of evidence-based information regarding the impact of sex and gender into medical practice, research, and training. It addresses the issue of research in sex-based differences by amending prior AMA policy. It calls on the AMA to "encourage the inclusion of women, including pregnant women when appropriate, in all research on human subjects, except in those cases for which it would be scientifically irrational, in numbers sufficient to ensure that results of such research will benefit both men and women alike."
The report supports the National Institutes of Health policy requiring investigators to account for the possible role of sex as a biologic variable in vertebrate animal and human studies and emphasizes prior AMA policy that encourages "medical and scientific journal editors to require, where appropriate, a sex-based analysis of data." Finally, it encourages translation of these important research results into practice. The goal of this report is to raise awareness of the impact of sex and gender on all health conditions, beyond only reproductive health. This should ultimately improve the health of both female and male patients in the following ways:
- increasing research into the impact of sex and gender on health and disease
- continuing to encourage study results to be reported based on sex
- translating this information to the bedside, through increased emphasis during training at all levels
The expanded definition of "women's health" should affect the practices of all physicians, especially orthopaedic surgeons, researchers, and educators. Although several musculoskeletal conditions have been identified to demonstrate differences between the sexes, as outlined in the report, there are many conditions for which data are not yet available. These should serve as opportunities for continued research and ultimate translation of results into clinical practice.
Kimberly J. Templeton, MD, is professor of orthopaedic surgery at the University of Kansas, Kansas City; Orthopaedic Surgery Residency program director; past-president of the Ruth Jackson Orthopaedic Society; past-president of the U.S. Bone and Joint Initiative; current president of the American Medical Women's Association; and current chair of the AMA Orthopaedic Section.