Sexual Dimorphism in Cortical and Trabecular Bone Microstructure Appears During Puberty in Chinese Children

Ka Yee Cheuk, Xiao Fang Wang, Ji Wang, Zhendong Zhang, Fiona Wai Ping Yu, Elisa Man Shan Tam, Vivian Wing Yin Hung, Wayne Yuk Wai Lee, Ali Ghasem-Zadeh, Roger Zebaze, Tracy Y. Zhu, X. Edward Guo, Jack Chun Yiu Cheng, Tsz Ping Lam, Ego Seeman

Research output: Contribution to journalArticleResearchpeer-review

8 Citations (Scopus)


Distal forearm fractures during growth are more common in males than females. Because metaphyseal cortical bone is formed by coalescence of trabeculae emerging from the periphery of the growth plate, we hypothesized that the later onset of puberty in males produces a longer delay in trabecular bone formation and coalescence, which leaves a transient phase of high cortical porosity, low matrix mineral density, and high trabecular density relative to females. We quantified the nondominant distal radial microstructure using high-resolution peripheral quantitative computed tomography in 214 healthy Chinese boys and 219 Chinese girls aged between 7 and 17 years living in Hong Kong. Measurements of 110 slices (9.02 mm) were acquired 5 mm proximal to the growth plate of the nondominant distal radius. Porosity was measured using StrAx1.0 (Straxcorp, Melbourne, VIC, Australia) and trabecular plate and rod structure were measured using individual trabecula segmentation (ITS). Mechanical properties were estimated using finite element analysis (FEA). Results were adjusted for age, total bone cross-sectional area (CSA), dietary calcium intake, and physical activity. In boys, total bone CSA was 17.2% to 22.9% larger throughout puberty, cortical/total bone CSA was 5.1% smaller in Tanner stage 2 only, cortical porosity was 9.4% to 17.5% higher, and matrix mineral density was 1.0% to 2.5% lower in Tanner stage 2 to 5, than girls. Boys had higher trabecular rod BV/TV in Tanner stage 3 and 4, but higher trabecular plate BV/TV and plate to rod ratio in Tanner stage 5, than girls. Boys had 17.0% lower apparent modulus than girls in Tanner stage 2. A transient phase of higher porosity due to dissociation between bone mineral accrual and linear growth may contribute to higher distal radial bone fragility in Chinese boys compared to girls.

Original languageEnglish
Pages (from-to)1948-1955
Number of pages8
JournalJournal of Bone and Mineral Research
Issue number11
Publication statusPublished - 1 Nov 2018
Externally publishedYes


  • BONE
  • SEX

Cite this