Sex differences in proximal femur shape: findings from a population-based study in adolescents

Monika Frysz* (Corresponding Author), Jennifer Gregory, Richard M Aspden, Lavinia Paternoster, Jonathan H. Tobias

*Corresponding author for this work

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Hip shape is an important determinant of hip osteoarthritis (OA), which occurs more commonly in women. However, it remains unclear to what extent differences in OA prevalence are attributed to sex differences in hip shape. Here, we explore sex differences in proximal femur shape in a cohort of adolescents. Hip morphology was quantified using hip DXA scans from the Avon Longitudinal Study of Parents and Children. Independent modes of variation (hip shape mode (HSM) scores) were generated for each image using an adult reference statistical shape model (N = 19,379). Linear regression was used to examine sex differences for the top ten HSMs, adjusting for age, height, lean and fat mass. Complete outcome and covariate data were available for 4,428 and 4,369 participants at ages 14 and 18 years, respectively. Several HSMs showed sex differences at both time points. The combined effect of sex on hip shape at age 14 reflected flatter femoral head and smaller lesser trochanter in females compared with males and, following adjustment for age and body size, these differences became more pronounced. At age 18, smaller lesser trochanter and femoral neck width (FNW) in females still remained although differences in femoral head, femoral shaft and FNW were largely attenuated following adjustment. Sexual dimorphism in proximal femur shape can be discerned in adolescence and early adulthood. Observed differences in proximal femur shape, particularly at age 14 were largely independent of body size, however to what extent differences in hip shape in early life play a role in predisposing to hip OA in later life remains to be determined.

Original languageEnglish
Article number4612
JournalScientific Reports
Publication statusPublished - 12 Mar 2020

Bibliographical note

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses. The UK Medical Research Council and the Wellcome Trust (ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. MF was supported by a Wellcome Trust PhD studentship (ref: 105504/Z/14/Z). LP works in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol which is supported by the Medical Research Council and the University of Bristol (MC_UU_00011/1). Arthritis Research UK project grant (ref: 20244) supported the generation of adult reference statistical shape model. This publication is the work of the authors and MF will serve as guarantor for the contents of this paper. None of the funders had any influence on data collection, analysis, interpretation of the results, or writing of the paper.


  • bone
  • epidemiology
  • RISK


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