The effect of pubertal timing, as reflected by height tempo, on proximal femur shape: findings from a population-based study in adolescents

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

*Corresponding author for this work

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To examine the relationship between pubertal timing (using measures of height tempo) and proximal femur shape in a large adolescent cohort.

Hip DXA scans were obtained in offspring from the Avon Longitudinal Study of Parents and Children. To quantify hip morphology, the images were analyzed using Shape software based on a 53-point statistical shape model and independent modes of variation (hip shape mode (HSM) scores) for each image were generated. Height tempo (which corresponds to age at peak height velocity (aPHV)) was estimated from serial height measurements collected between age 5–20 years. Multivariable linear regression was used to examine cross-sectional associations between height tempo and the top ten HSMs at age 14 and 18, adjusting for sex and fat mass index (FMI).

Complete outcome and covariate data were available from 3827 and 3507 participants at age 14 and 18 years, respectively. Mean aPHV was 13.5 and 11.8 years for males and females, respectively. At age 14, height tempo was associated with a majority of modes, except for HSM4 and there was strong evidence of interaction by sex. In males, all modes showed evidence of an association with tempo, independent of FMI, with the strongest observed for HSM8 (adjusted β 0.38 (0.33, 0.43) p = 4.1 × 10−50). Compared with males, the associations were generally weaker in females, with the strongest effect observed for HSM8 (adjusted β 0.10 (0.05, 0.14) p = 1.6 × 10−5). The overall effect of later pubertal timing on proximal femur shape in males was a narrower femoral neck and larger superolateral head, whereas in females these changes were hard to discern. When assessed at age 18, there was little relationship between tempo and proximal femur shape in either sex.

Our results indicate that significant changes in hip shape occur during puberty, including aspects of shape which may be related to future risk of hip OA and/or fracture. However, puberty timing per se does not appear to exert long lasting effects on proximal femur shape.
Original languageEnglish
Article number115179
Number of pages8
Early online date30 Nov 2019
Publication statusPublished - 1 Feb 2020

Bibliographical note

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). A comprehensive list of grants funding is available on the ALSPAC website ( Age 17 clinical assessment was specifically funded by Wellcome Trust (084632/Z/08/Z).

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.

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.


  • Proximal femur shape
  • Joint shape
  • Statistical shape modelling
  • Pubertal growth
  • SIZE
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