{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:11:24Z","timestamp":1791411084270,"version":"4.3.3"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Academic Clinical Lectureship and an Academy of Medical Sciences Starter Grant","award":["SGL030\\1057"],"award-info":[{"award-number":["SGL030\\1057"]}]},{"name":"Wellcome Trust collaborative award","award":["209\u2009233\/Z\/17\/Z"],"award-info":[{"award-number":["209\u2009233\/Z\/17\/Z"]}]},{"name":"Wellcome Trust and the Royal Society","award":["223267\/Z\/21\/Z"],"award-info":[{"award-number":["223267\/Z\/21\/Z"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Despite advancements in fracture prediction tools and osteoporosis management, hip fractures remain a significant consequence of bone fragility, carrying a 22% 1-yr mortality rate. Hip geometric measures (GMs) have been associated with fracture risk; however, their strong correlation hinders the identification of independent influences, leaving their relative predictive value unclear. Statistical shape modeling (SSM) provides a more holistic assessment of hip shape compared to using predetermined GMs. This study aimed to evaluate whether SSM-derived hip shape from DXA scans can predict hip fracture, independently of individual GMs. Previously, we applied SSM to left hip DXA images in UK Biobank\u2014a large prospective cohort with linked hospital records\u2014generating 10 orthogonal hip shape modes (HSMs) that explained 86% of shape variance. Additionally, FN width (FNW), femoral head diameter (FHD), and hip axis length (HAL) were derived from these DXAs. In the current analysis, Cox proportional hazard models, adjusted for age, sex, height, weight, BMD, and GMs (FNW, HAL, and FHD), were used to examine the longitudinal associations between each HSM and first incident hospital diagnosed hip fracture. A Bonferroni adjusted p-value threshold (p\u2009&amp;lt;\u2009.004) was used to account for the 13 exposures. Among the 38\u2009123 participants (mean age 63.7\u00a0yr; 52% female; mean follow-up 5\u00a0yr), 133 (0.35%) experienced subsequent hip fracture. HSM2, characterized by a narrower FNW, a higher neck shaft angle, and reduced acetabular coverage, showed a strong association with hip fracture risk (HR: 1.32, 95% CI: 1.11-1.58, p: 1.47\u2009\u00d7\u200910\u22123), which persisted after full adjustment (1.30, 1.09-1.55, 3.27\u2009\u00d7\u200910\u22123). There was no evidence for an association with other HSMs. These findings suggest that DXA-derived hip shape is associated with hip fracture risk independently of BMD and GMs. Incorporating global hip shape into fracture risk assessment tools could enhance prediction accuracy and inform targeted interventions.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf171","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T12:49:55Z","timestamp":1763470195000},"page":"396-405","source":"Crossref","is-referenced-by-count":4,"title":["DXA-derived hip shape is associated with hip fracture: a longitudinal study of 38\u2009123 UK Biobank participants"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5211-4581","authenticated-orcid":false,"given":"Sophie","family":"Scott","sequence":"first","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol , Bristol, BS10 5NB ,","place":["United 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Musculoskeletal Health, University of Aberdeen , Aberdeen , AB24 2ZD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Gregory","sequence":"additional","affiliation":[{"name":"Centre for Arthritis and Musculoskeletal Health, University of Aberdeen , Aberdeen , AB24 2ZD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0693-1194","authenticated-orcid":false,"given":"Richard M","family":"Aspden","sequence":"additional","affiliation":[{"name":"Centre for Arthritis and Musculoskeletal Health, University of Aberdeen , Aberdeen , AB24 2ZD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9396-3436","authenticated-orcid":false,"given":"Claudia","family":"Lindner","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, The University of Manchester , Manchester , M13 9PL,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Cootes","sequence":"additional","affiliation":[{"name":"Division of Informatics, Imaging and Data Sciences, The University of Manchester , Manchester , M13 9PL,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-2512","authenticated-orcid":false,"given":"Nicholas C","family":"Harvey","sequence":"additional","affiliation":[{"name":"Medical Research Council Lifecourse Epidemiology Centre, University of Southampton , Southampton , SO16 6YD,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust , Southampton , SO16 6YD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H","family":"Tobias","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol , Bristol, BS10 5NB ,","place":["United Kingdom"]},{"name":"Medical Research Council Integrative Epidemiology Unit, University of Bristol , Bristol , BS1 5DS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4102-0190","authenticated-orcid":false,"given":"Benjamin G","family":"Faber","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol , Bristol, BS10 5NB ,","place":["United Kingdom"]},{"name":"Medical Research Council Integrative Epidemiology Unit, University of Bristol , Bristol , BS1 5DS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhona A","family":"Beynon","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research Unit, University of Bristol , Bristol, BS10 5NB ,","place":["United 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