Varying contributions of growth and ageing to racial and sex differences in femoral neck structure and strength in old age

The structural basis of racial and sex differences in femoral neck (FN) fragility in old age was assessed in a cross-sectional study of 829 healthy Chinese and 1181 healthy Caucasian subjects aged 18 to 93 years in Melbourne, Australia. We measured FN bone mineral density (BMD), periosteal diameter, and estimated endocortical diameter, cortical thickness, volumetric BMD (vBMD), section modulus, and buckling ratio using dual X-ray absorptiometry. Racial and sex differences in structural and strength indices were adjusted for age, bone length and body weight and were expressed in standard deviation (SD) unit. In young adulthood, Chinese women had a 0.85 SD narrower FN, a 0.47 SD thinner cortex and a 0.79 SD shorter FN axis length (FNAL) than Caucasian women. Across age, Chinese and Caucasian women had similar increments in endocortical and periosteal diameters and similar decrements in cortical thickness and vBMD (both ∼20%). In young adult males, FN periosteal diameter did not differ by race, but cortical thickness was 0.35 SD lower in Chinese than Caucasians. Across age, increments in periosteal and endocortical diameters were less in Chinese than Caucasian men so cortical thickness and vBMD diminished less in Chinese than in Caucasian men. In both races, young adult women had narrower FN than men. As Chinese women had a greater increment in periosteal diameter than Chinese men across age, the sex difference in FN periosteal diameter established in young adulthood diminished in old age. As Caucasian men had a greater increment in periosteal diameter than Caucasian women, the sex difference in FN periosteal diameter established in young adulthood increased with age. In old age, for both sexes, Chinese had a higher fracture risk in bending than Caucasians, but a lower fracture risk by buckling. For both races, women had a higher fracture risk in bending than men. Racial and sexual dimorphism in the absolute and relative behavior of the periosteal and endocortical surfaces throughout life produce race- and sex-specific differences in FN size, cortical thickness, and indices of bone strength in old age.