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Fat Content of Hip Muscles: An Anteroposterior Gradient
Edouard Daguet, MD1; Erwan Jolivet, PhD1; Valérie Bousson, PhD1; Carole Boutron, MD1; Natacha Dahmen, MD1; Catherine Bergot, PhD1; Eric Vicaut, PhD1; Jean-Denis Laredo, MD1
1 Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France. E-mail address for E. Daguet: edouard.daguet@free.fr. E-mail address for J.-D. Laredo: jean-denis.laredo@lrb.aphp.fr
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, and the Faculté Denis Diderot Université Paris 7, Paris, France

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Oct 19;93(20):1897-1905. doi: 10.2106/JBJS.J.00509
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Despite the importance of the hip muscles in protecting against hip fracture and in the outcome of hip arthroplasty, the variability in their fat content has not been previously studied. Our objectives were to evaluate the variability in the fat content of the hip muscles in a population without myopathy or a need for hip surgery with the use of computed tomography (CT), to study the relationship between hip muscle fat content and physical performance, and to identify medical conditions and lifestyle habits associated with an increase in hip muscle fat content.


Ten normal subjects without a relevant medical history and ninety-nine consecutive nonsurgical patients without myopathy (age, twenty-one to ninety-four years) underwent a nonenhanced CT scan of the pelvis. Patients were asked to perform physical tests (six-meter walk, repeated chair stands, and Trendelenburg test), and their level of physical activity and medical history were recorded. Evaluation of the fat content of the hip muscles was based on the analysis of four reproducible and representative CT slices with use of custom software.


The fat content varied among the muscles, with an anteroposterior gradient from the hip flexors (mean, 2%) to the hip extensors (mean, 10%). This gradient increased after fifty years of age. Fat content also varied considerably among patients. Higher fat content was associated with poorer performance on physical tests, even after adjustment for the cross-sectional area of the muscle (p < 0.05). Higher fat content was also associated with greater age, higher body-mass index, and lower physical activity (p < 0.001).


The observed variability in the fat content of individuals without myopathy or a need for hip surgery should be useful for comparison with future studies of specific populations of patients, such as those with muscle weakness secondary to hip fracture or hip surgery. Simple lifestyle changes such as dietary restriction, increased physical activity, and vitamin D supplementation may decrease muscle fat content and improve physical performance in the elderly.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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