Maturity- and sex-related changes in tibial bone geometry, strength and bone–muscle strength indices during growth: A 20-month pQCT study

Abstract

During growth, bone strength is conferred through subtle adaptations in bone mass and geometry in response to muscle forces. Few studies have examined the changes in bone geometry, strength and the bone–muscle strength relationship across maturity in boys and girls. Our aims were to describe (i) 20-month changes in bone geometry and strength at the tibial midshaft across three maturity groups of boys and girls, (ii) differences in these adaptations between sexes at the same approximate level of maturity and (iii) the bone–muscle strength relationship across maturity groups of boys and girls and between sexes. We used peripheral quantitative computed tomography (pQCT, Stratec XCT-2000) to measure change in total bone cross-sectional area (ToA, mm 2), cortical area (CoA, mm 2), average cortical thickness (C.Th., mm), section modulus (mm 3) and muscle cross-sectional area (mm 2) at the tibial midshaft (50% site) in 128 EARLY-, PERI- and POST-pubertal girls ( n = 69, 11.9 ± 0.6 years) and boys ( n = 59, 12.0 ± 0.6 years) across 20 months. We also calculated two bone–muscle strength indices (BMSI) for compression (CoA/MCSA) and bending [strength index/MCSA; where strength index = Z / (tibial length / 2)]. EARLY boys and girls had smaller ToA at baseline than same sex PERI or POST participants. There were no sex differences in ToA or CoA at baseline; however, boys increased both parameters significantly more than girls in every maturity group (8.5–11.1%, P < 0.01). These changes in bone geometry conferred greater gains in bone strength for boys compared with girls in each maturity group (13.8–15.6%, P < 0.01). Baseline BMSIs did not differ between sexes for EARLY and PERI groups, whereas BMSIs were significantly higher for POST boys compared with POST girls ( P < 0.05). BMSIs decreased for EARLY and PERI girls (−7.4–(−1.1%)) whereas the ratios remained stable for EARLY and PERI boys (−0.6–2.5%). This sex difference in BMSI change was due to a relatively greater increase in CoA among EARLY and PERI boys compared with same-maturity girls. BMSIs remained stable in POST girls and decreased in POST boys due to relatively greater gains in MCSA. This study provides novel longitudinal descriptions of the maturity- and sex-specific changes in bone geometry, strength and bone–muscle strength indices.