Gender differences in fractures may be related to body size, bone size, geometry, or density. We studied this in 18-year-old males (n = 36) and females (n = 36) matched for height and weight. Despite comparable body size, males have greater BMC and BMD at the hip and distal tibia and greater tibial cortical thickness. This may confer greater skeletal integrity in males.Introduction: Gender differences in fractures may be related to body size, bone size, geometry, or density. We studied this in males (n ‫ס‬ 36) and females (n ‫ס‬ 36; mean age ‫ס‬ 18 years) pair-matched for height and weight. Materials and Methods: BMC, bone area (BA), and BMD were measured in the spine and hip using DXA. Distal tibia was measured by pQCT. Results and Conclusions: Males had a higher lean mass (92%) compared with females (79%). No gender differences were observed for vertebral BMC or vertebral height, although males had greater width and thus BA at the spine. Males had greater BMC and BA at the femoral neck and total femur (p < 0.02). Geometric variables of the hip including neck diameter and neck-axis length were also greater in males (p < 0.02). There was greater cross-sectional moment of inertia, safety factor, and fall index in males (all p < 0.02). Males had greater tibial BMC, volumetric BMD, and cortical area and thickness compared with females (p < 0.01), with both greater periosteal circumference (p ‫ס‬ 0.011) and smaller endosteal circumference (p ‫ס‬ 0.058). Statistically controlling for lean mass reduced gender differences, but males still had 8% higher hip BMD (p ‫ס‬ 0.24) and 5.3% higher total tibial BMD (p ‫ס‬ 0.05). A subset of males and females were matched (n ‫ס‬ 14 pairs) for total hip BA. Males in this subset still had greater BMC and BMD at the total hip (p < 0.05) than females, despite similar BA. In summary, despite comparable body size, males have greater BMC and BMD than females at the hip and distal tibia but not at the spine. Differences in BMC and BMD were related to greater cortical thickness in the tibia. We conclude that differences in bone mass and geometry confer greater skeletal integrity in males, which may contribute to the lower incidence of stress and osteoporotic fractures in males.

Although prior physical training in men, length of prior estrogen exposure in women and leg bone dimensions in both genders played a role, the maximum variance explained by all of these factors was below 10%. We conclude these factors play a minor role in the development of stress fractures in physically fit USMA cadets.

No abstract