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Sex-specific changes in bone structure and strength during growth: pQCT analysis of the mid-tibia Ahamed, Yasmin


Introduction: The process by which children's bones grow has not been fully charcterised. The current dogma is that girls fill in their medullary canal area by forming bone at the endosteum. It has been argued that the sex difference in how bone strength is conferred -- favouring boys -- may contribute to the relative protection that aging men have over aging women with respect to fracture incidence and the prevalence of osteoporosis. Primary Objectives: 1)To compare bone surface changes at the periosteal and endosteal surface of the tibial midshaft in boys and girls. 2)To compare how bone density at the tibial midshaft is accrued in boys and girls. 3) To compare sex differences in bone strength accrual. Methods: Design and Participants: Participants were obtained from a 20-month randomized, controlled school-based physical activity intervention. As we found no difference in the effect of the intervention on pQCT bone outcome variables, both groups were combined for our current study. A total of 183 participants (93 boys, 89 girls) received a pQCT scan at baseline. Results: Sex-specific comparisons of the pQCT bone outcome variables showed significantly greater rates of change (slope) for boys for the total area (ToA), cortical area (CoA), medullary canal area (MedA) and strength-strain index (SSI) measures, p<0.001. No significant differences were observed for CoD, p=0.904. The magnitude of these differences is 60.8% for ToA, 55.7% for CoA, 75.6% for MedA, 1.3% for CoD, and 54.7% for SSI. Examination of differences between the sexes (intercept) revealed significant differences with greater gains observed for boys for all measures p<0.001 except for CoD where girls exhibited greater gains p<0.001. Conclusion: Girls showed a similar pattern of cortical bone growth at the tibial midshaft- periosteal apposition dominated over endosteal resorption. Boys' increased changes and pattern of growth were of a greater magnitude at both surfaces compared to girls. This resulted in a greater increase in strength as measured by SSI in boys which can partly be explained by their larger size. Girls exhibited greater increases in CoD; however, no significant difference in the change in CoD was observed between the two.

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