Obesity is one of the most recognized risk factors for SCFE. The relationship, however, is more complex than simply an increased load on the hip during growth.
Two recent studies address the topic from different perspectives: a systematic review on epidemiology and a 3D analysis of femoral epiphysis morphology. [1][2]
Incidence and Differences Among Populations
The review by Bouchard and colleagues included 15 studies and 5,467 patients. The incidence of SCFE varied greatly among countries and populations, with an aggregated estimate of 9.62 cases per 100,000. [1]
Obesity emerges as an important risk factor, but the wide geographical variability suggests the contribution of other elements: individual predisposition, socioeconomic factors, access to care, and differences in case recognition.
Body weight therefore increases clinical suspicion but does not alone predict who will develop SCFE.
Epiphyseal Morphology in Adolescents with Obesity
Novais and colleagues analyzed nearly 4,900 3D CT scans of subjects aged 7 to 19 years without known hip pathology using automated techniques. [2]
In adolescents with obesity, the authors described age-related differences in femoral head size, epiphyseal tubercle, posterior epiphyseal tilt, and superior cupping. [2]
The study does not prove that these characteristics cause SCFE. However, it suggests that different morphological trajectories may exist during growth that can influence physeal stability.
No Role for Screening CT
The images used in the study were CT scans already available for other reasons. The results do not justify performing CT scans in adolescents with obesity to look for an anatomical risk of SCFE. [2]
The value of the work is pathophysiological and research-oriented, not diagnostic in daily practice.
Clinical Implications
In an adolescent with overweight or obesity who develops a limp or pain in the hip, thigh, or knee without clear trauma, SCFE should be considered early.
Referred knee pain is a known presentation and can delay hip evaluation. In this context, weight is an element that increases pre-test probability, not a diagnosis.
The two studies thus reinforce an already established management approach: maintaining a low threshold for evaluating the hip in symptomatic adolescents and continuing to study which anatomical and biological factors distinguish truly more vulnerable individuals.
Disclaimer: This content is for informational purposes only and does not replace an individual clinical evaluation.
References
[1] Bouchard MD, Vescio BG, Munir M, et al. The Epidemiology of Slipped Capital Femoral Epiphysis in Children and Adolescents: A Systematic Review of Risk Factors and Incidence Across Populations. JBJS Reviews. 2025;13(5). DOI: 10.2106/JBJS.RVW.25.00052. PMID: 40403127.
[2] Novais EN, Movahhedi M, Pradhan P, et al. Impact of Childhood Obesity on Capital Femoral Epiphysis Morphology: A Large-Scale, Automated 3D-CT Study and Potential Implications for SCFE Pathogenesis. J Bone Joint Surg Am. 2025;107(18):2102–2109. DOI: 10.2106/JBJS.24.01472. PMID: 40811524.
