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Peer-reviewedCC BY-NC 4.0Osteoporosis International

Side-to-side differences in hip bone mineral density and associated morphological factors

  • Keisuke Uemura1
  • Yoshito Otake2
  • Mazen Soufi2
  • Sotaro Kono3
  • Ryo Higuchi3
  • Tomoki Asano3
  • Hirokazu Mae3
  • Tetsuro Tani1
  • Kazuma Takashima3
  • Yoshinobu Sato4
  • Seiji Okada3
  • Hidetoshi Hamada1
4 affiliations
  1. 1Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka Japan
  2. 2Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma, Nara, Japan
  3. 3Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka Japan
  4. 4Department of Mathematical and AI Medical Science, Nara Medical University, Kashihara, Nara, Japan
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Abstract

In the analysis of 82 participants using quantitative computed tomography (QCT) images, side-to-side differences in hip bone mineral density were 3.0%. Gluteal muscle volume and femoral anteversion asymmetry contributed to these discrepancies. Bilateral hip assessment may improve the detection of osteoporosis, particularly when QCT data are available.

Purpose: Side-to-side differences in hip bone mineral density (BMD) are occasionally observed in clinical practice. However, the factors contributing to this asymmetry remain unclear. Therefore, this study aimed to quantify differences in BMD between the right and left hips and identify morphological factors associated with these differences using quantitative computed tomography (QCT).

Methods: This prospective study included 82 adults (median age: 75 years) without a history of lower extremity disorders. Bilateral total hip BMD was calculated from the QCT data using a previously validated deep learning method. Side-to-side percentage differences were calculated. Participants with differences exceeding 5%, the least significant change recommended for dual-energy X-ray absorptiometry (DXA), were identified. Morphological variables, including gluteal muscle volume and femoral anteversion, were extracted bilaterally, and multivariate analyses were performed to examine their associations with BMD differences.

Results: The median side-to-side BMD difference was 3.0% (interquartile range: 1.6%–5.8%). In 26% of the participants, the BMD differences exceeded 5%. When bilateral data were used, the proportion of participants with T-scores ≤ − 2.5 increased by 2%. Multivariate analysis revealed that greater differences in gluteal muscle volume and femoral anteversion were independently associated with larger differences in BMD. Specifically, the side with smaller gluteal muscle volume and greater femoral anteversion exhibited lower BMD.

Conclusions: A considerable proportion of older adults exhibited clinically relevant side-to-side differences in hip BMD. Given that unilateral DXA measurements may underestimate the risk of osteoporosis, bilateral hip assessment is recommended whenever possible, particularly when QCT images are available for opportunistic osteoporosis screening.

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Cite

BibTeXRIS
BibTeX
@article{uemura2026sidetoside,
  title = {{Side-to-side differences in hip bone mineral density and associated morphological factors}},
  author = {Keisuke Uemura and Yoshito Otake and Mazen Soufi and Sotaro Kono and Ryo Higuchi and Tomoki Asano and Hirokazu Mae and Tetsuro Tani and Kazuma Takashima and Yoshinobu Sato and Seiji Okada and Hidetoshi Hamada},
  journal = {Osteoporosis International},
  year = {2026},
  month = jul,
  doi = {10.1007/s00198-026-08141-z},
  url = {https://doi.org/10.1007/s00198-026-08141-z},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Side-to-side differences in hip bone mineral density and associated morphological factors
AU  - Keisuke Uemura
AU  - Yoshito Otake
AU  - Mazen Soufi
AU  - Sotaro Kono
AU  - Ryo Higuchi
AU  - Tomoki Asano
AU  - Hirokazu Mae
AU  - Tetsuro Tani
AU  - Kazuma Takashima
AU  - Yoshinobu Sato
AU  - Seiji Okada
AU  - Hidetoshi Hamada
PY  - 2026
DA  - 2026/07/22
JO  - Osteoporosis International
DO  - 10.1007/s00198-026-08141-z
UR  - https://doi.org/10.1007/s00198-026-08141-z
AB  - In the analysis of 82 participants using quantitative computed tomography (QCT) images, side-to-side differences in hip bone mineral density were 3.0%. Gluteal muscle volume and femoral anteversion asymmetry contributed to these discrepancies. Bilateral hip assessment may improve the detection of osteoporosis, particularly when QCT data are available.  Purpose: Side-to-side differences in hip bone mineral density (BMD) are occasionally observed in clinical practice. However, the factors contributing to this asymmetry remain unclear. Therefore, this study aimed to quantify differences in BMD between the right and left hips and identify morphological factors associated with these differences using quantitative computed tomography (QCT).  Methods: This prospective study included 82 adults (median age: 75 years) without a history of lower extremity disorders. Bilateral total hip BMD was calculated from the QCT data using a previously validated deep learning method. Side-to-side percentage differences were calculated. Participants with differences exceeding 5%, the least significant change recommended for dual-energy X-ray absorptiometry (DXA), were identified. Morphological variables, including gluteal muscle volume and femoral anteversion, were extracted bilaterally, and multivariate analyses were performed to examine their associations with BMD differences.  Results: The median side-to-side BMD difference was 3.0% (interquartile range: 1.6%–5.8%). In 26% of the participants, the BMD differences exceeded 5%. When bilateral data were used, the proportion of participants with T-scores ≤ − 2.5 increased by 2%. Multivariate analysis revealed that greater differences in gluteal muscle volume and femoral anteversion were independently associated with larger differences in BMD. Specifically, the side with smaller gluteal muscle volume and greater femoral anteversion exhibited lower BMD.  Conclusions: A considerable proportion of older adults exhibited clinically relevant side-to-side differences in hip BMD. Given that unilateral DXA measurements may underestimate the risk of osteoporosis, bilateral hip assessment is recommended whenever possible, particularly when QCT images are available for opportunistic osteoporosis screening.
SN  - 0937-941X
SN  - 1433-2965
ER  -