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Constitutional morphological features and risk of hip osteoarthritis: a case–control study using standard radiographs
  1. Hunar Abdulrahim1,
  2. Qiang Jiao2,
  3. Subhashisa Swain1,
  4. Khosrow Sehat3,
  5. Aliya Sarmanova4,
  6. Kenneth Muir5,
  7. Weiya Zhang1,
  8. Michael Doherty1
  1. 1 Academic Rheumatology, University of Nottingham, Nottingham, UK
  2. 2 Orthopaedic Department, Second Hospital of Shanxi Medical University, Taiyuan, China
  3. 3 Orthopaedic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4 Musculoskeletal Research Unit, University of Bristol, Bristol Medical School, Bristol, UK
  5. 5 Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Weiya Zhang, Academic Rheumatology, University of Nottingham, Nottingham, Nottinghamshire, UK; weiya.zhang{at}


Objectives To evaluate the risk of association with hip osteoarthritis (OA) of 14 morphological features measured on standard antero-posterior pelvis radiographs.

Methods A case–control study of 566 symptomatic unilateral hip OA cases and 1108 controls without hip OA, using the Genetics of OA and Lifestyle database. Unaffected hips of cases were assumed to reflect pre-OA morphology of the contralateral affected hip. ORs with 95% CI adjusted for confounding factors were calculated using logistic regression. Hierarchical clustering on principal component method was used to identify clusters of morphological features. Proportional risk contribution (PRC) of these morphological features in the context of other risk factors of hip OA was estimated using receiver operating characteristic analysis.

Results All morphological features showed right–left symmetry in controls. Each feature was associated with hip OA after adjusting for age, gender and body mass index. Increased sourcil angle had the strongest association (OR: 6.93, 95% CI 5.16 to 9.32). Three clusters were identified. The PRC varied between individual features, as well as between clusters. It was 35% (95% CI 31% to 40%) for all 14 morphological features, compared to 21% (95% CI 19% to 24%) for all other well-established risk factors.

Conclusions Constitutional morphological variation strongly associates with hip OA development and may explain much of its heritability. Relevant morphological measures can be assessed readily on standard radiographs to help predict risk of hip OA. Prospective studies are required to provide further support for causality.

  • osteoarthritis
  • arthritis
  • epidemiology

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  • HA and QJ are joint lead authors.

  • Handling editor Josef S Smolen

  • Contributors Study design: HA, QJ, WZ, MD. Data analysis: HA, QJ, SS, AS, WZ, MD. All authors were responsible for interpretation of the data and for drafting, revising and approving the final submitted manuscript.

  • Funding AstraZeneca UK funded the GOAL study sample and data collection. The Arthritis Research Council (now Versus Arthritis) provided infrastructure support during the GOAL study (grant 14851).

  • Competing interests MD reports grants from AstraZeneca and Versus Arthritis for this study, and personal fees from Grunenthal, Mallinckrodt outside the submitted work; WZ reports personal fees from Regeneron outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The GOAL study was conducted with the approval of the Nottingham Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request by contacting the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.