Improving how orthopedic journals report research outcomes based on sex and gender

Sex-based differences in cell biology, tissue function, and anatomy impact disease risk, presentation, and treatment outcomes,¹ including in musculoskeletal care.^2-4 As such, these differences should influence how orthopedic surgeons and other healthcare professionals conduct research and provide care for patients who have musculoskeletal disease and injury. In addition, gender roles influence interactions with people who conduct research and healthcare professionals, as well as the likelihood that patients will seek care and how they will respond to treatment.^{1, 5, 6}

Musculoskeletal research, similar to research in other areas of healthcare, does not always disaggregate results based on a patient's sex or gender.⁷ Although some orthopedic surgery journals have explicit editorial standards on the topic of sex and gender in scientific reporting, and although international entities have published sensible guidelines about it,⁸ we have observed that these standards are inconsistently applied.⁷

Inattention to high-quality standards of scientific reporting can harm patients.^{9, 10} Women have been underrepresented in medical research,¹¹ and this trend continues to varying degrees even today, despite mandates to remedy this disparity, at least in federally funded research.^{12, 13} However, these mandates include no guidance about how data should be analyzed or reported, thereby limiting the impact of including more women in clinical studies. The care of women has been substantially compromised as a result^14-18; not getting this right has sometimes harmed men with certain diagnoses as well.¹⁹ As such, it is no stretch to say that doing better research—and improving how that research is reported in journals—would benefit our patients regardless of their sex or gender.

With this background in mind, leaders of the editorial boards of six orthopedic journals, along with leaders of funding agencies, as well as National Institutes of Health officials, met in November 2023 to discuss these issues. Following that meeting, those editors reached out to the Editors-in-Chief of all indexed orthopedic surgery journals, seeking concurrence on a few key themes pertaining to the reporting of sex and gender in musculoskeletal research.

We hope that by sharing these resolutions with readers, many of whom are also researchers and representatives on institutional review boards, institutional animal care and use committees, and/or funding agencies and organizations, the orthopedic research of the future will be both better designed and better reported.

Funding for this conference was made possible (in part) by (1R13AR082710–01) from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

All ICMJE Disclosure of Potential Conflicts of Interest forms for the Editors-in-Chief of Clinical Orthopaedics and Related Research, Journal of Pediatric Orthopaedics, and Spine; the Assistant Editor-in-Chief of Arthroscopy: The Journal of Arthroscopic & Related Surgery; and the Associate Editor of JBJS Case Connector are on file with the individual publications and can be viewed on request. The Disclosure of Potential Conflicts of Interest form for the Editor-in-Chief of The Journal of Bone and Joint Surgery is provided with the online version of the article (http://links.lww.com/XXXXXXX).

The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services, nor does mention of trade names, commercial practices, or organizations imply endorsement by the US Government.