Bridging the gender data-gap in studies of musculoskeletal research

Abstract

Gender and sex disparities encompass many aspects in our daily lives. This has a relevant impact on scientific research, medical diagnostics, and treatment. Sex is commonly referred to as the biological features characterising women and men, while gender represents the social roles like identity and behaviour of women, men, and gender-diverse people [5]. Regardless of whether the focus is on physiological or social aspects, data about women often remain invisible, leading to a critical data discrepancy and bias [3].

The awareness of the need for gender equality is growing, including research in the field of orthopaedics and sports medicine. Still, the importance of reporting gender-specific data in scientific studies is underestimated and this leads to the fact that there is a paucity of data available. The gender data-gap derives from heterogeneous study cohort composition and from a selection bias and the tendency to consider men (usually men of Caucasian ethnicity) as the standard and women as the deviant [12]. In the last decades, several efforts have been made to counteract this tendency by several major institutions. For example, the National Institutes of Health encouraged increased women inclusion in clinical research, requiring justification in cases of exclusion [21], and the European Association of Science Editors created a Gender Policy Committee to develop a set of guidelines for reporting Sex and Gender Equity in Research [5].

In the field of orthopaedics and sports medicine research, many aspects of injury prevention and/or treatment can be affected by sex and, therefore, deserve meticulous analyses, being one of the candidates for scrutiny in patient profiling towards more personalised management [10, 13]. This may appear obvious, but it is not always the case when considering all aspects. Up to the '70s, the suitability of sports participation for women was still being questioned by major parts of society, as exemplified by publications, which included strong opinions like ‘Women in Sports: Some Misconceptions’ and ‘Inferiority of Female Athletes: Myth or Reality?’. Such opinions have, however, been challenged over time, and in some areas of orthopaedics and sports medicine, this has led to thorough scientific investigations [9]. However, lingering memories of misconceptions about women's sports participation still affect researchers of the musculoskeletal field, often preventing them from more critically examining gender differences in relation to sports medicine [14].

Women have a longer life expectancy than men, but they are more frequently affected by chronic diseases including musculoskeletal disorders. Musculoskeletal tissues differ in men and women in terms of several physiological features, ranging from biological to hormonal, anatomical and biomechanical aspects. This may lead to women often experiencing different symptoms, with a greater prevalence of chronic musculoskeletal pain, as well as even a different response to treatment [12, 13]. Unfortunately, gender-specific data in orthopaedic and sports medicine studies are still limited. For example, sex bias can be found in preclinical and even in clinical literature on common pathologies, the overall scientific evidence offers astonishingly limited data on different treatments in men and women [9, 10, 19].

Despite a call for action by leading regulatory bodies, there is still a great gender data-gap, and this is not well recognised in science and medicine. Accordingly, KSSTA, the Knee Surgery, Sports Traumatology, Arthroscopy journal, has decided to publish a special issue to stimulate the discussion and to increase the awareness and knowledge on the importance of gender- and sex-specific data. With more studies reporting sex-disaggregated data, researchers have the possibility to perform more extensive meta-analyses comparing women's and men's treatment responses, separated by treatment category, thus generating the specific knowledge needed to advance the field in this direction. This should be the focus of the future research related to the available and new emerging treatment options, with more gender- and sex-disaggregated data including women, men, and gender-diverse people, with the final aim to pursue personalised approaches.

It is increasingly obvious that the era of ‘one fits all’ is no longer applicable in any context, least of all in health care. In the field of orthopaedic surgery, for example, we are moving away from the standard approaches to instead embrace more personalised approaches in order to respect anatomy and personal needs that often correlate with gender identity [6]. This path towards personalisation in medicine will still take some time and will obviously have to come to terms with economic sustainability. But for certain, where even the highest standard of personalisation is not achieved, at least being guided by such substantial differences as those induced by gender and sex is a must.

In this KSSTA special issue, experts critically analyse the available literature and address gender-focused analyses of several important datasets. Large studies with significant data reported through gender-based stratification, analysis and discussion have been specifically developed and collected for this special issue [1, 2, 4, 7, 8, 11, 15-18, 20]. The articles collected in this special issue are perfect examples of the large number of aspects in which sex and gender have an impact on the musculoskeletal field. Therefore, the purpose of this special issue is to stimulate further research in this direction and to become a reference for even stronger research in the musculoskeletal field, including a more thoughtful approach to bridging the gender data-gap through gender equality in scientific studies, thus offering better research and better therapeutic alternatives to everyone based on their sex and gender.

The authors declare no conflict of interest.

The authors have nothing to report.