Arthralgia in midlife Singaporean women: the Integrated Women’s Health Program (IWHP)

Figures & data

Table 1. Crude (unadjusted) associations between participant characteristics and menopausal arthralgia (moderate or very severe joint muscle discomfort) (n = 1120).

Characteristic	Total (n)	Arthralgia (n = 375, 33.5%)	No arthralgia (n = 745, 66.5%)	p-Value
Demographic and lifestyle factors, n (%)
Age (years)				0.433
45–54	480	170 (35.4)	310 (64.6)
55–64	495	156 (31.5)	339 (68.5)
≥65	145	49 (33.8)	96 (66.2)
Ethnicity				0.031
Chinese	912	287 (31.5)	625 (68.5)
Malay	65	27 (41.5)	38 (58.5)
Indian	110	46 (41.8)	64 (58.2)
Highest education level attained				0.006
No formal or primary	169	42 (24.9)	127 (75.1)
Secondary or pre-university	722	264 (36.6)	458 (63.4)
University	222	66 (29.7)	156 (70.3)
Smoking				0.151
Yes	25	5 (20.0)	20 (80.0)
No	1092	368 (33.7)	724 (66.3)
Alcohol consumption
Yes	77	24 (31.2)	53 (68.8)
No	1040	350 (33.7)	690 (66.3)
Physical activity (MET-min/week)				0.670
<600	281	90 (32.0)	191 (68.0)
≥600	829	277 (33.4)	552 (66.6)
Menopausal and reproductive symptoms, n (%)
Hot flushes				<0.001
Yes	217	113 (52.1)	104 (47.9)
No	902	261 (28.9)	641 (71.1)
Heart discomfort				<0.001
Yes	70	47 (67.1)	23 (32.9)
No	1050	328 (31.2)	722 (68.8)
Physical and mental exhaustion				<0.001
Yes	222	142 (64.0)	80 (36.0)
No	896	232 (25.9)	664 (74.1)
Sexual problems				<0.001
Yes	178	111 (62.4)	67 (37.6)
No	936	262 (28.0)	674 (72.0)
Vaginal dryness				<0.001
Yes	232	138 (59.5)	94 (40.5)
No	885	235 (26.6)	650 (73.4)
Menopausal status				0.199
Premenopausal	142	45 (31.7)	97 (68.3)
Perimenopausal	181	71 (39.2)	110 (60.8)
Postmenopausal	797	259 (32.5)	538 (67.5)
Sleep factors, n (%)
Pittsburgh Sleep Quality Index (PSQI)				<0.001
>5	473	203 (42.9)	270 (57.1)
≤5	638	168 (26.3)	470 (73.7)
Bedtime				0.027
Before 22:00	44	11 (25.0)	33 (75.0)
22:00–23:59	714	224 (31.4)	490 (68.6)
After 23:59	348	135 (38.8)	213 (61.2)
Time taken to fall asleep (min)				<0.001
>15	436	182 (41.7)	254 (58.3)
≤15	677	191 (28.2)	486 (71.8)
Wake time				0.591
Before 06:00	366	129 (35.2)	237 (64.8)
06:00–08:00	648	210 (32.4)	438 (67.6)
After 08:00	98	35 (35.7)	63 (64.3)
Sleep duration (h)				0.017
≤6	666	242 (36.3)	424 (63.7)
7–8	354	98 (27.7)	256 (72.3)
>8	28	11 (39.3)	17 (60.7)
Health conditions, n (%)
Diabetes				0.968
Yes	135	45 (33.3)	90 (66.7)
No	967	324 (33.5)	643 (66.5)
Hypertension				0.883
Yes	492	163 (33.1)	329 (66.9)
No	608	204 (33.6)	404 (66.4)
Depression and/or anxiety				0.114
Yes	198	76 (38.4)	122 (61.6)
No	913	297 (32.5)	616 (67.5)
Urinary incontinence				<0.001
Yes	585	240 (41.0)	345 (59.0)
No	534	134 (25.1)	400 (74.9)
Osteoporosis				0.473
Yes	124	38 (30.6)	86 (69.4)
No	995	337 (33.9	658 (66.1)
Rheumatoid arthritis				<0.001
Yes	120	89 (74.2)	31 (25.8)
No	957	263 (27.5)	694 (72.5)
Osteoarthritis				0.177
Yes	210	79 (37.6)	131 (62.4)
No	859	281 (32.7)	578 (67.3)
Asthma				0.006
Yes	90	42 (46.7)	48 (53.3)
No	1029	333 (32.4)	696 (67.6)
Poor to fair self-rated health				<0.001
Yes	421	187 (44.4)	234 (55.6)
No	688	185 (26.9)	503 (73.1)
Anthropometric and DXA measures, n (%)
Body mass index (BMI) (kg/m^2)				<0.001
Normal or underweight, <23.0	526	147 (27.9)	379 (72.1)
Overweight, 23.0–27.49	380	138 (36.3)	242 (63.7)
Obese, ≥27.5	214	90 (42.1)	124 (57.9)
Visceral adipose tissue (VAT) (cm^2)				0.036
Lowest tertile	380	111 (29.2)	269 (70.8)
Middle tertile	365	122 (33.4)	243 (66.6)
Highest tertile	370	141 (38.1)	229 (61.9)
Physical performance measures, n (%)
Handgrip strength (HGS) (kg)				0.025
<18	260	102 (39.2)	158 (60.8)
≥18	860	273 (31.7)	587 (68.3)
Repeated chair stand test (s)				<0.001
≥12	488	196 (40.2)	292 (59.8)
<12	617	172 (27.9)	445 (72.1)
Muscle strength index (MSI)^a				<0.001
Poor	150	65 (43.3)	85 (56.7)
Intermediate	443	167 (37.7)	276 (62.3)
Normal	522	142 (27.2)	380 (72.8)
Semi-tandem stand (s)				0.863
<30	22	7 (31.8)	15 (68.2)
30	1087	365 (33.6)	722 (66.4)
Tandem stand (s)				0.822
<30	202	69 (34.2)	133 (65.8)
30	918	306 (33.3)	612 (66.7)
One-leg stand (s)				0.125
<15	205	78 (38.0)	127 (62.0)
≥15	915	297 (32.5)	618 (67.5)
Usual walk gait speed (m/s)				0.343
<1.0	166	61 (36.7)	105 (63.3)
≥1.0	949	313 (33.0)	636 (67.0)
Narrow walk gait speed (m/s)				0.108
<1.0	209	129 (61.7)	80 (38.3)
≥1.0	906	294 (32.5)	612 (67.5)
Blood parameters, n (%)
Vitamin D (ng/ml)				0.382
<20	225	81 (36.0)	144 (64.0)
≥20	887	292 (32.9)	595 (67.1)

^aPoor MSI comprises HGS <18 kg and repeated chair stands ≥12 s; intermediate MSI comprises HGS <18 kg or repeated chair stands ≥12 seconds; normal MSI comprises HGS ≥18 kg and repeated chair stands <12 s.

Values presented as row percentages. Results analyzed using Pearson’s chi-square test. Missing data accounted for 0.1–6.4% of the overall data. DXA, dual-energy X-ray absorptiometry; MET, metabolic equivalent.

Table 2. Adjusted associations of studied risk factors with menopausal arthralgia (moderate or very severe joint muscle discomfort) (n = 1120).

Characteristic	aOR (95% CI)
Demographic and lifestyle factors
Age (years)
45–54	Reference
55–64	0.92 (0.58, 1.45)
≥65	1.65 (0.89, 3.03)
Ethnicity
Chinese	Reference
Malay	1.15 (0.63, 2.08)
Indian	1.38 (0.68, 2.81)
Highest education level attained
No formal or primary	1.06 (0.54, 2.05)
Secondary or pre-university	1.91 (1.19, 3.08)
University	Reference
Smoking	0.18 (0.04, 0.83)
Alcohol consumption	0.58 (0.19, 1.79)
Physical activity, <600 MET-min/week	0.88 (0.59, 1.32)
Menopausal and reproductive symptoms
Hot flushes	1.34 (0.87, 2.08)
Heart discomfort	2.07 (0.98, 4.39)
Physical and mental exhaustion	2.83 (1.79, 4.47)
Sexual problems	1.62 (0.96, 2.72)
Vaginal dryness	2.64 (1.64, 4.24)
Menopausal status
Premenopausal	1.08 (0.58, 2.00)
Perimenopausal	1.10 (0.64, 1.89)
Postmenopausal	Reference
Sleep factors
Poor sleep quality, PSQI > 5	1.14 (0.71, 1.81)
Bedtime
Before 22:00	Reference
22:00–23:59	1.28 (0.51, 3.19)
After 23:59	1.68 (0.65, 4.35)
Time taken to fall asleep, >15 min	1.30 (0.87, 1.95)
Sleep duration (h)
≤6	1.15 (0.74, 1.77)
7–8	Reference
>8	2.18 (0.73, 6.47)
Health conditions
Diabetes	0.87 (0.51, 1.48)
Hypertension	0.72 (0.50, 1.04)
Depression and/or anxiety	0.82 (0.50, 1.34)
Urinary incontinence	1.27 (0.90, 1.80)
Rheumatoid arthritis	7.73 (4.47, 13.36)
Asthma	1.31 (0.67, 2.57)
Poor to fair self-rated health	1.46 (1.02, 2.08)
Anthropometric and DXA measures
Body mass index (BMI) (kg/m^2)
Normal or underweight, <23.0	Reference
Overweight, 23.0–27.49	1.59 (1.08, 2.34)
Obese, ≥27.5	1.94 (1.13, 3.32)
Physical performance measures
Muscle strength index (MSI)^a
Poor	2.20 (1.29, 3.76)
Intermediate	1.69 (1.16, 2.45)
Normal	Reference
Blood parameters
Vitamin D, <20 ng/ml	1.13 (0.74, 1.72)

^a Poor MSI comprises handgrip strength (HGS) <18 kg and repeated chair stands ≥12 s; intermediate MSI comprises HGS <18 kg or repeated chair stands ≥12 s; normal MSI comprises HGS ≥18 kg and repeated chair stands <12 s.

Factors mutually adjusted for were age, ethnicity, education level, smoking, alcohol consumption, physical activity, hot flushes, heart discomfort, physical and mental exhaustion, sexual problems, vaginal dryness, menopausal status, poor sleep quality, bedtime, time taken to fall asleep, sleep duration, diabetes, hypertension, depression and/or anxiety, urinary incontinence, rheumatoid arthritis, asthma, self-rated health, BMI, MSI and vitamin D. Nagelkerke’s R² = 37.2%. Hosmer and Lemeshow’s test yielded a p-value of 0.899 (p > 0.05), indicating good model fit. aOR, adjusted odds ratio; CI, confidence interval; DXA, dual-energy X-ray absorptiometry; MET, metabolic equivalent; PSQI, Pittsburgh Sleep Quality Index.

Data availability statement

De-identified data are available upon reasonable request to the Integrated Women’s Health Governance Committee via the corresponding author: ([email protected]).