Forensic Science International: Reports 2 (2020) 100077

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Forensic Science International: Reports

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Forensic Anthropology

Sex estimation using the proximal end of the femur on a modern

Chilean sample
David Carvallo a, * , Rodrigo Retamal b
a
Independent researcher
b
Department of Anthropology, University of Chile. Ignacio Carrera Pinto 1045, Santiago, Chile

A R T I C L E I N F O A B S T R A C T

Keywords: Sex estimation is fundamental for the identification of skeletonized human remains in forensic contexts. The
Sex estimation methods most often used are based on pelvis and skull morphology evaluation. When these elements are not
Proximal femur available due to poor preservation, other bone elements, such as the femur, can be used given its good preservation
Chile
and marked sexual dimorphism. Particularly, the proximal end of the femur is the most dimorphic region of this
Forensic anthropology population data
bone, so its evaluation is especially useful for sex estimation. A set of new sex estimation models were elaborated
utilizing 8 metric variables from the proximal end of the femur in a modern Chilean sample of 270 individuals (200
individuals for training, 70 individuals for validation) from the Santiago Modern Osteological Collection. Sex
estimation models were calculated using logistic regression. Results showed that the models based on the femoral
neck measurements are the best sex estimators, with up to 92.9% (univariable models) and 95.7% (multivariable
models) of overall accuracy and low sex bias. The models proposed here are the most accurate reported to date for
modern Chilean population and can contribute toward the identification of human remains in cases of Human Rights
violations committed during the Civil-Military Dictatorship in Chile (1973–1990).

Introduction contexts [5,8,10–12,14–17]. Although all dimensions of the femur can be

The estimation of biological sex is a fundamental step toward the
positive identification of human remains because a) it rules out one sex
from further consideration and b) it is required to estimate other
components of the biological profile [1–6]. The pelvis and the skull are
the most commonly evaluated elements for sex estimation [3,7]. However,
the preservation of these elements is frequently affected by taphonomic and
anthropic processes [8–11] which prevent its evaluation for the estimation
of sex. In these cases, other elements of the skeleton must be utilized.
In the post-cranium, the long bones stand out because they have high
levels of sexual dimorphism, arguably higher than the skull [2].
Additionally, long bones report better preservation than both pelvis and
skull given their robusticity and tubular structure [9]. Finally, the
morphology of the long bones allows to easily obtain morphometric
measurements that can be used for sex estimation [12]. Among the long
bones, the femur has some notable advantages for sex estimation that make
it preferable over other elements. It is particularly dimorphic because of its
biomechanical relationship with the pelvis, which is the most sexually
dimorphic element of the human skeleton given its obstetric adaptation on
females [3,8,13]. Besides, the femur is one of the best-preserved elements
of the human skeleton since it is heavy, robust, resistant, and is surrounded
by a large muscle mass. Because of this, is frequently recovered in forensic
used for sex estimation, the proximal end is particularly useful since this
region concentrates most of the dimorphism of the bone. This is because it
has the most direct biomechanical relationship with the pelvis [3,8,13,18]
and houses a group of dimorphic muscle attachments that are relevant in
the body weight transmission [12].
The osteological estimation of sex relies on the assessment of the
sexual dimorphism of the human skeleton, which is determined by the
interaction between genetic and environmental factors. Since this
interaction varies across populations, the osteological estimation of sex
is considered population-specific [3,5,10,17,19–21]. As consequence,
sex-predictive models should be elaborated from a representative sample
of each population to avoid loss of accuracy [5,9–12,15–17,19–23].
Forensic anthropology in Chile is mostly related to Human Rights
violations committed during the Civil-Military Dictatorship (1973–1990)
[1,4,6]. Only a small percentage of victims have been returned to their
families, whereas most victims are still missing or unable to identify as the
location of most of the burials is still officially unknown [Intriago,
personal communication]. In the cases were a burial has been found, it is
common the presence of commingled, highly fragmented and poorly
preserved bone elements due to anthropic action, taphonomic processes
and perimortem trauma. In these contexts, skull and pelvis are
particularly affected [4,24].These circumstances difficult the evaluation

* Corresponding author.
E-mail address: david.carvallo@ug.uchile.cl (D. Carvallo).

http://doi.org/10.1016/j.fsir.2020.100077
Received 24 July 2019; Received in revised form 30 January 2020; Accepted 2 February 2020
Available o
2665-9107/© 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
D. Carvallo, R. Retamal FSIR 2 (2020) 100077

of osteological remains for sex estimation, thus the elaboration of sex Table 1
estimation models based on other skeletal elements that can be applied in Composition of the training sample by age and sex, following the classification
fragmentary contexts is crucial for Chilean scenario. However, the proximal proposed by Buikstra & Ubelaker [7].
end of the femur has been poorly evaluated for Chilean population [1,4]. Category Age range (years) Sex Frequency
Therefore, the goal of this study is to elaborate sexestimation models from the
Young Adult 20 – 34 Female 18
proximal end of the femur that can be applicable to forensic contexts Male 15
involving modern Chilean population. Middle Adult 35 – 49 Female 27
Male 38
Old Adult 50+ Female 55
Materials and methods
Male 47

For this study, the Santiago Modern Osteological Collection was employed
(Department of Anthropology, University of Chile). This collection is
composed of Chilean individuals deceased between 1950 and 1973 and
have documented sex, age-at-death and cause of death [25,26]. A training
sample of 200 adult individuals between 20–96 years and equal sex
representation was randomly selected (Table 1). The age ranges are not
equally represented. However, previous studies have shown that age do not
have a significant influence over sex estimation from the proximal femur
[16,22,27,28].
A set of 8 measurements from the proximal end of the femur were
selected from previous studies. The measurements definitions and
references are summarized in Table 2, and in Figs. 1–3 are illustrated
graphically. Measurements were performed using a digital caliper. Intra
and inter-observer measurements errors were estimated using Lin’s
Concordance Correlation Coefficient (rc) [29], employing a random
subsample of 20 individuals (10 females, 10 males) for both errors.
Bilateral asymmetry was assessed using a paired t-test on a random
subsample of 20 individuals with equal sex representation. Descriptive
statistics, including the mean, standard deviation and 95% confidence
intervals of the mean, were obtained for each measurement. Normality
was evaluated through Shapiro-Wilk test and statistically significant
differences in the means between sexes were assessed using Student’s
t-test and Mann-Whitney-Wilcoxon tests.
Sex-predictive models were created using logistic regression. While
discriminant analysis function (DFA) is the statistical approach most
commonly employed for sex estimation, logistic regression is a better
alternative due to the ability to calculate robust models with no
assumptions for the underlying data, including normality, homoscedas-
ticity and multicollinearity [36]. This last point is very important since
the evidence suggest that the relationship between osteometric measure-
ments and the sex of an individual is in fact not linear [28]. For this reason,
logistic regression models can explain better than DFA the relationship
between variables and therefore are more accurate even when the
assumptions for DFA has been satisfied, as previous forensic studies have
shown [5,28,30,37].
A total of 38 sex-predictive models were elaborated, including 8
univariable models and 30 multivariable models. Multivariable models
usually perform better than univariable models because they recover more
variation related to sexual dimorphism, while univariable models are more
sex-biased and less accurate because they rely on absolute differences of only
one measurement [13,30,38]. In contrast, multivariable models require
better preservation, limiting the potential application in fragmentary
contexts, while univariable models can be applied where poor preservation
prevents the evaluation of more than one trait [5,14,22,38,39]. Given the
costs and benefits of each approach, it is important to have both univariable
and multivariable models for sex estimation.
The models classify the individual as female if the logit value is
negative and as male if the logit value is positive. The accuracy of the
models obtained was then assessed employing a validation sample of 70
individuals (35 females, 35 males) and calculating the sensitivity,
specificity, sex bias and overall accuracy. The sensitivity was defined as
the proportion of male individuals correctly classified and the
specificity as the proportion of female individuals correctly classified
[5]. Sex bias was calculated as the difference between sensitivity and
specificity. The overall accuracy represents the proportion of
individuals of both sexes correctly classified over the total of cases.
Sex estimation models were proposed for modern Chilean population
if they meet the following criteria: a) Statistical significance of all
variables included in the model; b) Overall accuracy equal or superior to
80%, according to the literature convention [3,28]; c) Sex bias equal or
inferior to 10%; and d) higher overall accuracy than other models with
fewer variables. The models that failed to meet these criteria were
discarded.
Based on the results obtained, 38 models were calculated because
models with more than 2 variables were not expected to meet the criteria
a) and d). The sex estimation models were named according to the
measurements included, following the order shown in Table 2, and are
identified in italics to avoid confusion with the measurements. The level
of significance was set as a = 0.05 for all tests. Statistical analyses were
conducted with R version 3.4.4

Table 2
Definitions and references of the measurements evaluated.
Measurement Definition References

FNAL Distance between the base of the greater trochanter and the apex of the femoral head [5,11,21,27,30]

FNW Minimum supero-inferior diameter of the femoral neck [5,10,11,16,18,19,21,31,32,33]

AB Distance between the most lateral point on the articular margin of the femoral head (A) and the most medial point on the greater
trochanter (B)
AC Distance between the most lateral point on the articular margin of the head (A) and the most postero-medial point on the lesser [15,16,34,35]
trochanter (C)
BC Distance between the most medial point on the greater trochanter (B) and the most postero-medial point on the lesser trochanter (C)

GTFC Distance between the most lateral point on the greater trochanter (GT) and the most superior point on the fovea capitis (FC)
GTLT Distance between the most lateral point on the greater trochanter (GT) and the most superior point on the facet of the lesser
trochanter (LT) [8,10]
LTFC Distance between the most superior point on the facet of the lesser trochanter (LT) and the most superior point on the fovea capitis
(FC)

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D. Carvallo, R. Retamal FSIR 2 (2020) 100077

Fig. 1. Anterior view of the proximal end of the femur showing FNAL and FNW measurements.

Fig. 2. Posterior view of the proximal end of the femur showing AB, AC and BC measurements.

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D. Carvallo, R. Retamal FSIR 2 (2020) 100077

Fig. 3. Posterior view of the proximal end of the femur showing GTFC, GTLT and LTFC measurements.

Table 3 Univariable models achieved an overall accuracy from 81.4% (GTLT) to

Intra and inter-observer errors for the measurements evaluated. All values were 92.9% (FNAL and GTFC), while multivariable models reported an overall
statistically significant. accuracy between 82.9% (AB+BC and AC+GTLT) and 95.7% (FNW
Measurement Intra-observer error Inter-observer error +GTFC). Four multivariable models (GTFC+GTLT, BC+GTFC, AB
+GTFC and FNW+GTFC) showed higher overall accuracy than the
FNAL 0.997 0.992
FNW 0.993 0.994 highest overall accuracy observed in univariable models.
AB 0.963 0.987 In univariable models, sensitivity ranged between 82.9% (GTLT) and
AC 0.927 0.964 97.1% (FNAL and GTFC), while multivariable models reported a
BC 0.925 0.977
GTFC 0.999 0.997
GTLT 0.907 0.984
LTFC 0.991 0.992 Table 4
Bilateral asymmetry for the measurements evaluated. S.D. = Standard deviation.

Results Measurement Side Mean S.D. p-value (paired t-test)

Left 89.408 6.509

FNAL 0.823
Table 3 shows the intra and inter-observer errors results for each Right 89.272 6.484

measurement. All measurements reported high concordance between

Left 29.555 3.145
observations, with the measurements FNAL, FNW, GTFC and LTFC FNW 0.362
Right 29.768 3.295
showing almost perfect agreement between observations. Table 4 shows
the results of bilateral asymmetry. There is not statistically significant Left 26.222 3.982
AB 0.407
Right 26.771 3.754
difference between both sides in any measurement except GTLT, which
showed higher mean in the right side compared to the left side. Left 50.174 6.489
Table 5 summarizes the descriptive statistics of the measurements AC 0.265
Right 51.711 4.927
segregated by sex. All measurements showed that males had higher means
compared to females, and there is no overlap of the confidence intervals Left 55.635 6.047
BC 0.471
Right 56.200 6.349
between sexes. Tests conducted indicated that there are statistically
significant differences between sexes in all measurements. Left 90.409 6.483
Following the exclusion criteria, 19 sex-predictive models were GTFC 0.143
Right 89.656 6.425
selected from the 38 logistic regressions performed. Table 6 summarized
Left 53.366 5.008
the equations, sensitivity, specificity, sex bias and overall accuracy of the GTLT 0.022
Right 54.605 4.936
models proposed for sex estimation on modern Chilean population from
the proximal end of the femur. Left 69.078 6.389
LTFC 0.538
The results showed that the multivariable models had higher overall Right 68.733 6.184
accuracy and sex-specific accuracies compared to univariable models.

4
D. Carvallo, R. Retamal FSIR 2 (2020) 100077

Table 5
Descriptive statistics for the measurements evaluated. S.D. = Standard Deviation; C.I. = Confidence Interval; M-W-W = Mann-Whitney-Wilcoxon test.
Measurement Sex Mean S.D. C.I. (95%) p-value (t-test/M-W-W test)

Female 82.894 4.572 81.986 - 83.801

FNAL <0.001
Male 95.060 4.749 94.118 - 96.003
Female 27.311 1.862 26.942 - 27.681
FNW <0.001
Male 31.789 2.152 31.362 - 32.216
Female 25.153 3.981 24.363 - 25.943
AB <0.001
Male 28.275 4.903 27.302 - 29.248
Female 46.606 4.339 45.745 - 47.467
AC <0.001
Male 51.869 5.671 50.744 - 52.994
Female 51.462 3.880 50.692 - 52.232
BC <0.001
Male 57.330 4.337 56.469 - 58.190
Female 83.588 4.700 82.655 - 84.520
GTFC <0.001
Male 96.268 4.830 95.309 - 97.226
Female 48.592 4.017 47.794 - 49.389
GTLT <0.001
Male 55.155 3.516 54.457 - 55.853
Female 63.051 4.627 62.132 - 63.969
LTFC <0.001
Male 70.746 5.456 69.664 - 71.829

Table 6
Proposed models for sex estimation on modern Chilean population from the proximal end of the femur.
Model Equation Sensitivity Specificity Sex Bias Overall Accuracy

FNAL 57.513 + 0.646*FNAL 97.1% 88.6% 8.5% 92.9%

FNW 32.727 + 1.115*FNW 85.7% 85.7% 0% 85.7%
GTFC 57.525 + 0.639*GTFC 97.1% 88.6% 8.5% 92.9%
GTLT 24.376 + 0.469*GTLT 82.9% 80.0% 2.9% 81.4%
LTFC 20.255 + 0.304*LTFC 85.7% 80.0% 5.7% 82.9%
FNAL + FNW 61.222 + 0.495*FNAL + 0.580*FNW 94.3% 91.4% 2.9% 92.9%
FNAL + BC 62.143 + 0.609*FNAL + 0.144*BC 94.3% 91.4% 2.9% 92.9%
FNAL + GTLT 71.124 + 0.594*FNAL + 0.345*GTLT 94.3% 91.4% 2.9% 92.9%
FNW + AC 35.963 + 1.064*FNW + 0.098*AC 88.6% 88.6% 0% 88.6%
FNW + BC 39.301 + 0.996*FNW + 0.186*BC 88.6% 91.4% 2.8% 90.0%
FNW + GTFC 64.519 + 0.606*FNW + 0.518*GTFC 100% 91.4% 8.6% 95.7%
FNW + LTFC 38.981 + 0.962*FNW + 0.161*LTFC 91.4% 88.6% 2.8% 90.0%
AB + BC 20.233 + 0.089*AB + 0.329*BC 85.7% 80.0% 5.7% 82.9%
AB + GTFC 58.458 + -0.173*AB + 0.700*GTFC 97.1% 91.4% 5.7% 94.3%
AB + GTLT 28.009 + 0.136*AB + 0.467*GTLT 91.4% 85.7% 5.7% 88.6%
AC + GTLT 31.291 + 0.165*AC + 0.445*GTLT 85.7% 80.0% 5.7% 82.9%
BC + GTFC 64.325 + 0.157*BC + 0.618*GTFC 97.1% 91.4% 5.7% 94.3%
GTFC + GTLT 66.268 + 0.562*GTFC + 0.297*GTLT 97.1% 91.4% 5.7% 94.3%
GTLT + LTFC 38.731 + 0.429*GTLT + 0.244*LTFC 91.4% 82.9% 8.5% 87.1%

sensitivity from 85.7% (AB+BC and AC+GTLT) to 100% (FNW+GTFC).
The specificity ranged from 80% (GTLT and LTFC) to 88.6% (FNAL and
GTFC) in univariable models, and between 80% (AB+BC and AC+GTLT)
and 91.4% (FNAL+FNW, FNAL+BC, FNAL+GTLT, FNW+BC, FNW
+GTFC, AB+GTFC, BC+GTFC and GTFC+GTLT) for multivariable
models. The model FNW+GTFC showed both the highest sensitivity and
specificity. The sex bias did not exceed 8.6% in any of the proposed
models. Except for FNW+BC, all models obtained higher accuracy for
males than females.
Discussion
In the present study, we evaluated 8 measurements from the proximal
end of the femur on a modern Chilean sample and elaborated sex
estimation models based on these measurements.
The evaluation of the intra and inter-observer error showed high
concordance between observations for all measurements, indicating that
they are repeatable and the models are replicable. All measurements
showed symmetry between both sides except for GTLT for which the right
side have higher mean than the left side. Considering this, the results here
presented do not support the use of models that include GTLT on right
femora.
The results of this study indicate that all the proximal femur measure-
ments evaluated in the Chilean sample have significant sexual dimorphism,
with higher values in males compared to females. This is in concordance with
the previous studies that evaluated the potential of these measurements for
the estimation of sex [5,8,10,11,15,16,18,19,21,27,30–35].
All the models proposed showed low sex bias and high sensitivity and
specificity. Most of the models achieved higher accuracy for males than
females, pattern commonly reported in the literature [5]. Given than in
this study a sample with equal representation for both sexes was used, this
pattern can be explained by the fact that, from a linear perspective, there
are more females with male characteristics than males with female
characteristics [28].
The present study is the first to deliver both univariable and
multivariable sex estimation models from the femur for Chilean
population. The best univariable models were FNAL and GTFC, with an
overall accuracy of 92.9%. Previous studies conducted on the same
osteological collection have reported an overall accuracy up to 90.5% from
the scapular glenoid cavity height [4]. Therefore, the measurements FNAL
and GTFC are the most accurate individual sex estimators reported for
modern Chilean population. A general increased in overall accuracy was
observed in the multivariable models, with most achieving overall
accuracies over 90%. The best multivariable models were AB + GTFC,
BC + GTFC and GTFC + GTLT with 94.3% overall accuracy, and FNW +
GTFC with 100% of males correctly classified, 91.5% of females correctly
classified and 95.7% of overall accuracy, making it the best sex estimation
model described to the date for modern Chilean population.
The findings of this study are in concordance with the literature
establishing that the long bones, particularly the femur, are reliable sex

5
D. Carvallo, R. Retamal
estimators and support the position that this element should not be
considered as an alternative to pelvis and skull but instead as a first line of
evidence, comparable to the coxae and preferable over other elements
like the cranium [2,13].
The performance of the models can be explained by the nature of the
sexual dimorphism of the measurements evaluated. The combined selective
forces of bipedalism and reproduction are visible in the angle and length of
the femoral neck [8]. Since FNAL and GTFC are both metric approaches of the
length of the femoral neck, it was expectable that these measurements would
be reliable sex estimators. In the Chilean sample obtained for this study, FNAL
showed a 92.9% of overall accuracy in both univariable and multivariable
models, which is higher than the 76% – 83.51% reported in Turkish,
American and Portuguese samples [5,11,21,30]. GTFC, on the other hand,
was more consistent with the literature, with an overall accuracy for
univariable and multivariable models comparable to the around 90% of
success reported for American and Spanish samples [8,10].
FNW was the second-best sex estimator after FNAL and GTFC, with 85.7%
of overall accuracy in the univariable model and over 90% in multivariable
models along with other measurements. The width of the femoral neck is
determined primarily by body weight [33], which is significantly influenced
by biological sexbut also by many other factors [15]. In this way, FNW is a less
direct sex estimator compared to FNAL and GTFC. This can explain in part the
high population variability in FNW sexual dimorphism, with previous studies
reporting lower accuracies in African, Iranian and Portuguese samples
[5,11,18,33] and higher accuracies in American, Guatemalan, Spanish and
Turkish samples [10,16,19,21,31,32].
The results showed that the femoral neck measurements, length and
width, are the best sex estimators among the measurements evaluated.
Accordingly, the best sex-predictive model was FNW + GTFC, which
incorporates both femoral neck dimensions.
When compared, GTLT and LTFC were less accurate than the femoral
neck measurements. As individual estimators, these measurements
reported an overall accuracy of 82.9% and 85.7%, respectively, while
reaching up to 90% (LTFC) and 94.3% (GTLT) along with other
measurements in multivariable models. This is possibly because GTLT
and LTFC do not constitute a metric approach to a specific biomechanical
parameter of the proximal femur like FNAL, FNW or GTFC. Instead, these
measurements seek to represent the overall morphology of the proximal
epiphysis [8], and therefore are indirect approximations of the sexual
dimorphism of the region.
The variables of the “Purkait’s triangle” (AB, AC and BC) showed the
lowest performance among the measurements evaluated, with none of the
univariable models reaching acceptable levels of overall accuracy and/or
sex bias. Only multivariable models that included variables from Purkait’s
triangle along with other measurements meet the established criteria.
This poor performance is consistent with the results reported by previous
authors for these measurements in Indian, American, Greek and Spanish
samples, with comparable accuracies below the 80% [15,16,34,35]. A
possible explanation for this generally low accuracy may be found in the
biomechanical properties of the entheses located in the proximal end of
the femur. Given the difference in size between male and female femora,
greater distances between the points of Purkait’s triangle are expected.
However, points B and C are located in entheses, which tend to be more
prominent in males since they have greater muscle robusticity. This
greater prominence of the muscle attachments have a counterproductive
effect, shortening the distances between the points and thus reducing the
difference with the females. This makes Purkait’s triangle less sexually
dimorphic and the measurements AB, AC and BC less reliable as sex
estimators than other measurements evaluated.
It is well established that sexual dimorphism in the human skeleton
is population-specific. Because of this, the elaboration of sex-predictive
models requires the use of a representative sample of the target
population [3,5,9–12,15–17,19–23]. In the present study, a modern
Chilean sample was employed in order to contribute to the identifica-
tion of victims of the Civil-Military Dictatorship (1973–1990).
Additionally, the models presented here may contribute to identifying
6
FSIR 2 (2020) 100077
victims died during the Chile protests occurring since October 2019
until the present. Burned and calcinated bodies have been found, which
may prevent the identification of the individuals based on DNA, so it is
important to have osteological methods for identify these remains.
However, since sexual dimorphism may change through time due to
secular change [17,20,26], it is essential to validate the models
proposed here in a contemporary Chilean sample. Similar validations
must be done for its application on other Latin American population,
since recent studies had proved that these can differ significantly in
terms of skeletal dimorphism expression despite being frequently
grouped together as a homogeneous group [40].
Conclusions
In the present study, sex estimation models based on osteometric
measurements from the proximal end of the femur were elaborated
using logistic regression on data from a modern Chilean sample. The
proposed models achieved an overall accuracy between 81.4% and
95.7%. Particularly, the results showed that the femoral neck
measurements are the best sex estimators among the variables
evaluated. The models presented here are the most accurate reported
to date for Chilean population. These models could be employed as a
novel tool for the identification of human remains in the contexts of
Human Rights violations committed during the Civic-Military Dicta-
torship in Chile (1973–1990). Validation of these models on proper
samples may extend its utility to contemporary Chilean and Latin
American populations.
Fundings
This research did not receive any grant from funding agencies in the
public, commercial or not-for-profit sectors.
Declaration of Competing Interest
None.
Acknowledgements
The authors would like to thank Franco Castellani for the
photographic material presented here and Dr. Mauricio Hernández
and Dr. Eduardo Machicado for English revision. We thank Marisol
Intriago for the information on the identification process of the Pinochet’s
dictatorship victims, carried out by the Santiago Medico-Legal Service.
We also thank the Department of Anthropology of the University of Chile
for the access to the Modern Santiago Osteological Collection.
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