Bias in bones: integrating sex into skeletal health and research policy to improve public health outcomes

Abstract

Osteoporotic fractures are a major public health concern. Fragility fractures result in serious disability, impacting quality of life, and mortality risk. Understanding fractures is important for creating successful interventions to reduce fracture risk and improve the delivery of skeletal health care. Further, as the population ages the increasing prevalence of fragility fractures is a growing economic issue.

It is well understood that women and men have anatomically and physiologically different bone structures. With age, women have a higher incidence of fragility fractures than men but men are twice as likely to die following an osteoporotic-fracture. Gender influence is also evident in other skeletal conditions including osteopenia, Paget’s disease of bone, osteoarthritis and osteosarcoma. In the UK, there have been several attempts to shift from population to individual based therapeutic approaches. The aim would be to have more personalised treatments that would provide more effective treatment options for women and men.

However, the translation of personalised medicines from laboratories to the clinic is challenged at pre-clinical stage by historic sex bias, whereby laboratories favour one sex for their experiments. This bias translates to clinics where drugs studied and optimised for women with osteoporosis for example are given to men.

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ORCID for Valentina Cardo: orcid.org/0000-0002-1993-6058

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