Osteophyte size and location on hip DXA scans are associated with hip pain: findings from a cross sectional study in UK Biobank

Benjamin G. Faber* (Corresponding Author), Raja Ebsim, Fiona R. Saunders, Monika Frysz, Claudia Lindner, Jennifer S. Gregory, Richard M. Aspden, Nicholas C. Harvey, George Davey Smith, Timothy Cootes, Jonathan H. Tobias

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)
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It remains unclear how the different features of radiographic hip osteoarthritis (rHOA) contribute to hip pain. We examined the relationship between rHOA, including its individual components, and hip pain using a novel dual-energy x-ray absorptiometry (DXA)-based method. Methods Hip DXAs were obtained from UK Biobank. A novel automated method obtained minimum joint space width (mJSW) from points placed around the femoral head and acetabulum. Osteophyte areas at the lateral acetabulum, superior and inferior femoral head were derived manually. Semi-quantitative measures of osteophytes and joint space narrowing (JSN) were combined to define rHOA. Logistic regression was used to examine the relationships between these variables and hip pain, obtained via questionnaires. Results 6,807 hip DXAs were examined. rHOA was present in 353 (5.2%) individuals and was associated with hip pain [OR 2.42 (1.78-3.29)] and hospital diagnosed OA [6.01 (2.98–12.16)]. Total osteophyte area but not mJSW was associated with hip pain in mutually adjusted models [1.31 (1.23-1.39), 0.95 (0.87-1.04) respectively]. On the other hand, JSN as a categorical variable showed weak associations between grade≥1 and grade≥2 JSN with hip pain [1.30 (1.06-1.60), 1.80 (1.34-2.42) respectively]. Acetabular, superior and inferior femoral osteophyte areas were all independently associated with hip pain [1.13 (1.06-1.20), 1.13 (1.05-1.24), 1.10 (1.03-1.17) respectively]. Conclusion In this cohort, the relationship between rHOA and prevalent hip pain was explained by 2-dimensional osteophyte area, but not by the apparent mJSW. Osteophytes at different locations showed important, potentially independent, associations with hip pain, possibly reflecting the contribution of distinct biomechanical pathways.
Original languageEnglish
Article number116146
Number of pages8
Early online date11 Aug 2021
Publication statusPublished - 31 Dec 2021

Bibliographical note

The authors would like to thank Dr Martin Williams, Consultant Musculoskeletal Radiologist North Bristol NHS Trust, who provided substantial training and expertise for this study. This work has been conducted using the UK Biobank resource, access application 17295.

Financial Support
BGF is supported by a Medical Research Council (MRC) clinical research training fellowship (MR/S021280/1). RE, MF, FS are supported, and this work is funded by a Wellcome Trust collaborative award (reference number 209233). CL was funded by the MRC, UK (MR/S00405X/1). NCH acknowledges support from the MRC and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton. George Davey Smith works in the MRC Integrative Epidemiology Unit at the University of Bristol, which is supported by the MRC (MC_UU_00011/1).


  • Osteoarthritis
  • Dual-energy x-ray absorptiometry
  • osteophyte
  • joint space narrowing
  • hip pain


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