Gender differences in the ratio between humerus width and length are established prior to puberty

Abstract

Summary: On a sample of 1,317 children aged 9.9 years we developed a novel method of measuring humeral dimensions from total body dual-energy X-ray absorptiometry (DXA) scans and showed that gender differences in the ratio between humeral width and length are established prior to puberty.

Introduction: It is recognised that long bone cross-sectional area is greater in males compared to females, which is thought to reflect more rapid periosteal bone growth in boys. However, it is currently unclear whether these findings reflect gender differences in bone size or shape. In the present study, we investigated whether gender differences exist in the balance between longitudinal and periosteal long bone growth in children, leading to gender differences in bone shape, based on a novel method for evaluating shape of the humerus. We also examined whether these differences are established prior to puberty.

Methods: Length, area and width of the humerus were estimated from total body DXA scans in 1,317 children aged 9.9 +/- 0.33 years, who had participated in a nested case-control study of fractures within the Avon Longitudinal Study of Parents and Children (ALSPAC) (a geographically based birth cohort based in South West England). No differences were observed with respect to parameters of humeral geometry according to fracture history, and so both groups were pooled for further analysis. Aspect ratio (AR) of the humerus was calculated as humeral width divided by length. Total body height and weight were measured at the same time as the DXA scan. Puberty was assessed using self-completion questionnaires.

Results: Humeral width and length were positively associated with age and height in boys and girls combined (P<0.001), and with Tanner stage in girls (P<0.002). In contrast, age, height and Tanner stage were not related to humeral AR. We then examined gender differences in humeral shape according to pubertal stage. In prepubertal children (i.e. Tanner stage 1), humeral length was similar in boys and girls, but width (1.92 vs 1.88 cm, P<0.001) and area (47.7 vs 46.9 cm(2), P<0.001) were greater in boys, resulting in a greater AR (7.78 vs 7.53, P<0.001). Similar gender differences were observed in early pubertal children (i.e. Tanner stage 2).

Conclusion: We conclude that the greater periosteal diameter of boys compared to girls reflects differences in the balance between longitudinal and periosteal bone growth. Interestingly, resulting gender differences in humeral AR are established in prepubertal children.

Fig. 1

Total body DXA scan showing position of the region of interest (ROI) around the right humerus. a Total body scan image. b Image following maximal (i.e. fourfold) magnification, which was selected prior to placement of the ROI and measurement of length by electronic ruler

Fig. 2

Associations between humeral geometry, gender and puberty, as determined in 1,290 boys and girls. Figure shows mean ± SD a humerus width (cm), b humerus length (cm) and c humerus aspect ratio (AR) according to gender and Tanner stage of puberty. P values are for the difference between boys and girls. All analyses are adjusted for age