Objective. To describe progression over 8 years in a community-based sample of elderly women with radiographic findings of hip osteoarthritis (RHOA) with or without hip pain.Methods. Baseline and followup anteroposterior pelvic radiographs were obtained at a mean ؎ SD 8.3 ؎ 0.4 years of followup in women age >65 years at the baseline examination of the Study of Osteoporotic Fractures. We evaluated progression in 936 hips of 745 women with one or more baseline findings of RHOA: summary OA grade >2, minimum joint space (MJS) <1.5 mm, definite femoral or acetabular osteophytes, definite superolateral joint space narrowing (JSN), or moderate or worse superomedial JSN. We separately examined progression in hips with an MJS between 1.5 mm and 2.5 mm. Hip pain and lower extremity disability were assessed by questionnaire and examination. Measures of progression included an increase in summary grade of radiographic findings, increase in total osteophyte score, decrease in MJS of >0.5 mm, total hip replacement (THR), and increase in lower extremity disability score. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for baseline radiographic predictors of progression were estimated using general estimating equations.Results. During followup, 12.9% of women with baseline RHOA underwent THR, and 22.8% had substantial worsening of lower extremity disability, while 64.6% of hips with RHOA showed radiographic progression or were replaced Conclusion. Among women recruited from the community, radiographic and clinical progression was greater in those with symptomatic RHOA, but still substantially less frequent than previously reported for hip OA patients in clinical settings. Asymptomatic RHOA and hips with an isolated finding of mild JSN (MJS of 1.5 mm to 2.5 mm) were unlikely to progress over 8 years.Hip and knee osteoarthritis (OA) are both major causes of disability in elderly populations (1-3). However, compared with knee OA (4,5), there are far fewer studies of the natural history and risk factors for progression of hip OA, and there are no studies of progression of hip OA from community-based radiographic surveys. Such studies are important for identifying those at greatest risk for development of clinically significant disease and disability and for the discovery of factors that may slow progression.Studies of hip OA patients referred to hospitalbased physicians demonstrate a rapid rate of progression in both radiographic and clinical disease. Dougados et al studied 506 patients with clinical hip OA who participated in a randomized controlled trial of diacerein. They

Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.

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Our findings should be interpreted in the context of other limitations. The observed decline occurred in the context of a health care delivery system without direct financial incentives to perform tests. Nevertheless, the substantial reduction in MPI use demonstrates the ability to reduce testing on a large scale with anticipated reductions in health care costs. Cardiol. 2005;46 (8):1587-1605. 4. Levin DC, Parker L, Intenzo CM, Rao VM. Recent reimbursement changes and their effect on hospital and private office use of myocardial perfusion imaging. J Am Coll Radiol. 2013;10(3):198-201. 5. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155-2165.

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