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.
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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.
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