title: Disk degeneration of the upper lumbar disks is associated with hip pain.
abstract: OBJECTIVE
  A possible cause of hip pain is the presence of radiating pain from the higher lumbar spine. Identification of factors associated with hip pain arising from the lumbar spine would aid the physician. The first step in identifying possible factors is to look at the association between hip pain and osteoarthritis of the lumbar spine.
  
  
  METHODS
  In an open population based study of people 55 years and older (Rotterdam study), 2,819 lumbar radiographs were scored for the presence and severity of individual radiographic features of disk degeneration. Hip osteoarthritis was scored on anteroposterior pelvic radiographs, and questionnaires including self-reported hip pain were taken. Logistic regression adjusted for possible confounders was used to determine the association between self-reported hip pain and the individual radiographic features of lumbar disk degeneration.
  
  
  RESULTS
  The presence of dis space narrowing grade ≥1 at level L1/L2 was significantly associated with hip pain in the last month (men OR = 2.0; 95 % CI 1.1-3.8 and women OR = 1.7; 95 % CI 1.1-2.5). The presence of disk space narrowing grade ≥1 at level L2/L3 was only significantly associated with hip pain in women. The strength of the associations increased for self-reported chronic hip pain, especially in men (L1/L2 OR = 2.5; 95 % CI 1.3-5.0). The presence of disk space narrowing at the lower levels (L3/L4/L5/S1) was not significantly associated with hip pain.
  
  
  CONCLUSIONS
  Our data provide evidence for an association between hip pain and disk space narrowing at disk level L1/L2 and L2/L3. In case of uncertainty of the cause of hip pain, evaluation of lumbar radiographs may help to identify those hip pain patients who might have pain arising from the lumbar spine.
authors.affiliation: Department of General Practice, Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. e.deschepper@erasmusmc.nl
authors.forename: Evelien I T
authors.initials: EI
authors.lastname: de Schepper
authors.forename: Jurgen
authors.initials: J
authors.lastname: Damen
authors.forename: Pieter K
authors.initials: PK
authors.lastname: Bos
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Sita M
authors.initials: SM
authors.lastname: Bierma-Zeinstra
mesh_terms: D000368:Aged; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000000981:diagnostic imaging; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D055013:Osteoarthritis, Spine / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires