Respiratory Physiology & Neurobiology 150 (2006) 233–239

Sexual dimorphism of human ribs

François Bellemare a,∗ , Tambwe Fuamba a,1 , André Bourgeault b
aLaboratoire du Sommeil, Centre Hospitalier de l’Université de Montréal (CHUM) - Hôtel-Dieu,
3840 St.-Urbain, Montréal (Qué.), Canada H2W 1T8
b Laboratoire de Sciences Judicières et de Médecine Légale, 1701 Rue Parthenais, Montréal (Qué.), Canada H2K 3S7

Received 2 December 2004; received in revised form 1 April 2005; accepted 1 April 2005

Abstract

The volume of the rib cage is about 10% smaller in females than in males having the same height although the reason for
this is presently unclear. The cranio–caudal inclination of ribs is greater in females than males but the length of ribs has not
previously been compared between the sexes. In 23 males and 23 females studied at necropsy, body length, the length of the
upper and lower limbs and the length of the thoracic spine were all smaller in females but the ratios of upper and lower limb
lengths to body length and of thoracic spine length to body length were not different. By contrast, the lengths of the third, sixth
and ninth ribs were not significantly different between males and females and the ratios of rib length to body length were all
significantly greater in females. We conclude that in females the ribs grow longer in relation to the axial skeleton than in males.
© 2005 Elsevier B.V. All rights reserved.

Keywords: Chest wall; Gender; Rib cage; Lung volume

1. Introduction has been attributed to a lower rate of alveolar multipli-

Normal prediction equations for lung volume in
non-smokers predict values in females that are 10–12%
smaller than in males who have the same height and
age (Crapo et al., 1982). The smaller lung volume of
females is established in the first few years of life and
∗ Corresponding author. Tel.: +1 514 890 8000x14730;
fax: +1 514 412 7178.
E-mail addresses: bellemaf@colba.net (F. Bellemare),
drjyf1@hotmail.com (T. Fuamba),
andre.bourgeault@msp.gouv.qc.ca (A. Bourgeault).
1 Present address: Department of Anatomy, Faculty of Medicine,
University of Ottawa, Ottawa, Canada
cation (Thurlbeck, 1982), although in adults, smaller
distending pressure at full active lung inflation may
also contribute (Colebatch et al., 1979; Knudson et al.,
1977).
Recent studies have shown that not only is there
a difference in the volume of lungs between males
and females having the same height, but the volume
of the rib cage is also smaller (Bellemare et al., 2003,
2001). The finding of relatively smaller rib cage volume
in females is surprising since the rib cage contribution
to inspiratory pressure swings is apparently greater and
the contribution of the diaphragm smaller in females
than males (Bellemare et al., 2003). The reason for
the relatively smaller rib cage volume in females than

1569-9048/$ – see front matter © 2005 Elsevier B.V. All rights reserved.
doi:10.1016/j.resp.2005.04.002
234 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239

males is presently unclear. The volume of the rib cage is

determined by the length of ribs and their geometry as
well as by their cranio–caudal inclination relative to the
spine. In a previous study, the cranio–caudal inclination
of ribs was found to be greater in females than males
(Bellemare et al., 2003). However, the length of ribs has
not previously been compared between the sexes. The
primary objective of this investigation, therefore, was
to compare the lengths of ribs in representative groups
of males and females.

2. Methods

2.1. Study population

Studies were conducted in 46 fresh cadavers (23
adult males and 23 adult females). All were cau-
casians less than 60 years of age and 42 were of
French–Canadian descent. Forty-one died by suicide
and five from alcohol intoxication. All were free of tho-
racic deformities. Studies were conducted in the Lab-
oratoire de sciences judicières et de médecine légale,
Government of Quebec.
Fig. 1. Ratio of thoracic spine length/body length.
of the lower limb from the iliac crest to the lateral
malleolus, with a metric tape.
Other measures: Height and weight were noted from
the pathology report.
2.3. Statistical analysis

2.2. Measurements Descriptive statistics are reported as mean ± 1S.D.

The following dimensions were measured on the
right side of the body:
Length of ribs: The length of the third, sixth and ninth
ribs was measured with a lead wire 1 mm in diame-
ter and molded to fit the internal aspect of each rib.
Because the ribs were sectioned at thoracotomy, the
lengths of the two sections were measured separately
and the two measures added to obtain rib length. Mea-
surements were taken from the cut end of each rib to
the head of the rib on one side, and to the costal car-
tilage on the other. These limits were marked on the
lead wire with a felt pen, and the inter-marker distance
was measured with the lead wire laid flat on a ruler.
Length of thoracic spine: The length of the thoracic
spine was measured with the lead wire technique from
the superior limit of the first thoracic vertebra to the
base of the 12th.
Bisacromial distance: The distance between the
acromions was measured with a pelvic caliper.
Limb length: The length of the upper limb was mea-
sured from the acromion to the wrist, and the length
In addition to the measures just described, the ratios
of all dimensions with body length and thoracic spine
length were calculated. As shown in Fig. 1 for the ratio
of thoracic spine length to body length, the distribution
of these ratios closely approximate the normal distribu-
tion. Between group comparisons were carried out us-
ing the independent sample t-test or the Mann–Whitney
U-test, depending on Levene’s test for equality of vari-
ance of the two samples. Linear regression techniques
based on the least square principle were also employed.
All statistical computations were conducted with com-
mercially available software (SPPS v10 for Windows,
SPSS, Chicago, IL).
3. Results
3.1. Subjects characteristics
As shown in Table 1, height and weight were sig-
nificantly lower in females than in males whereas age
was comparable.
 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239 235

Table 1
Anthropometric characteristics in males and females
Males Females Mann–Whitney U-test
Age (years) 32.35 ± 9.57 35.91 ± 7.52 181
Height (cm) 177.17 ± 8.98 160.22 ± 3.41 24.5***
Weight (kg) 76.46 ± 11.79 53.12 ± 1.55 2***
Values are means ± 1S.D.
*** Significant difference between males and females with p < 0.001.

3.2. Sex differences in linear dimensions
As seen in Table 2, the lengths of the thoracic spine
and of the upper and lower limbs as well as bisacromial
distance were all significantly smaller in females than
in males. By contrast, the lengths of the ribs were not
significantly different.
3.3. Sex differences in bodily proportions
As noted in Table 3, the ratio of bisacromial dis-
tance to body length was significantly greater in males
than in females whereas the ratios of upper and lower
limb length to body length and of thoracic spine length
to body length were not different. By contrast, the ra-
tios of rib lengths to body length were all significantly
greater in females. Similar results were obtained when
the lengths of the ribs were reported against thoracic
spine length rather than body length.
3.4. Bivariate correlations between outcome
measures
As enumerated in Table 4, for the groups we found
significant correlations between the length of the tho-
racic spine and all other variables. In addition, the
bisacromial distance, lengths of the upper and lower
limbs and the length of the sixth rib all correlated sig-
nificantly with body length. In most instances, how-
ever, these correlations are dependent on the inclusion
of male series. When considering female series, we de-
tected no significant correlation between the lengths of
ribs and body length, upper and lower limb length or
bisacromial distance. It is noteworthy, however, that
the lengths of the third, sixth and ninth ribs were inter-
correlated with each other, in both male and female se-
ries. The lengths of the upper and lower limbs were sim-
ilarly inter-correlated both in male and female series.
4. Discussion
This study revealed that females have relatively
longer ribs than males and that, in contrast to males,
the length of the ribs in females is not significantly re-
lated to the length of the axial skeleton, suggesting that
different factors govern the growth of ribs in males and
females.
4.1. Critique of the methods
Rib length constitutes the primary outcome vari-
able. Despite their complex geometry, the ribs on their
internal aspect facing the pleural space present a con-

Table 2
Comparison of bodily dimensions in males and females
Males Females t Mann–Whitney U-test
Thoracic spine (cm) 27.32 ± 1.75 (23.5–30.5) 24.76 ± 1.65 (20.7–28) −5.1*** 76.5***
Upper limba (cm) 61.07 ± 4.94 (52–68) 53.86 ± 2.68 (48–58) 52***
Lower limb (cm) 96.07 ± 5.13 (86–106) 86.34 ± 3.27 (80–91) −7.67*** 27***
Bisacromiala (cm) 39.05 ± 3.66 (33–47) 32.69 ± 1.32 (31–35) 14***
Third rib (cm) 25.73 ± 1.22 (23–27) 26.07 ± 1.42 (24–29) 0.88 230
Sixth rib (cm) 31.73 ± 1.74 (30–35) 30.80 ± 1.54 (27–34) −1.92 190.5
Ninth rib (cm) 28.13 ± .89 (26–29) 28.00 ± 1.29 (25–30) −0.41 258
Values are means ± 1S.D. Values in parentheses are minimums and maximums.
a Variable did not satisfy Levene’s test for equality of variance of the two samples.
*** Significant difference between males and females with p < 0.001.
236 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239

Table 3
Comparisons of bodily proportions between males and females
Num. Deno. Males Females t

Mean S.D. Mean S.D.

TS H 0.154 1.059E−02 0.155 1.085E−02 0.069
BA TS 1.433 0.142 1.327 0.121 −2.734**
H 0.220 1.523E−02 0.204 7.789E−03 −4.555***
Third rib TS 0.944 4.965E−02 1.056 6.779E−02 6.383***
H 0.145 6.819E−03 0.163 8.850E−03 7.456***
Sixth rib TS 1.164 7.125E−02 1.248 9.414E−02 3.419***
H 0.179 1.055E−02 0.192 9.766E−03 4.313***
Ninth rib TS 1.033 5.432E−02 1.134 7.134E−02 5.424***
H 0.159 8.253E−03 0.174 8.035E−03 6.529***
LL TS 3.523 0.174 3.502 0.278 −0.304
H 0.543 2.666E−02 0.539 1.975E−02 −0.547
UL TS 2.238 0.159 2.184 0.184 −1.064
H 0.345 2.210E−02 0.336 1.354E−02 −1.59
Values are group means ± 1S.D. for the ratios of measured lengths (in cm) over thoracic spine length (TS) or body length (H) in cm. Num.,
numerator; deno., denominator; BA, bisacromial distance; third rib, third rib length; sixth rib, sixth rib length; ninth rib, ninth rib length; LL,
lower limb length; UL, upper limb length.
** Denotes a significant difference between males and females at p < 0.01.
*** Denotes a significant difference between males and females at p < 0.001.

tinuous and smooth surface, well delineated on each
side by the intercostal muscles. Furthermore, when all
intra-thoracic and intra-abdominal organs are removed,
as in our study, the head of the ribs is easily identified
by displacing the cut end manually. The costo-chondral
articulation is also easily identified, both visually and
by palpation. The lead wire technique employed in our
study is well suited to measure the length of a curved
structure, such as a rib. However, because the skeletons
of males are generally sturdier than those of females,
this method may have introduced a bias in favour of
females. Indeed, if the ribs were thicker in males, their
lengths measured along the inside would be smaller
than their lengths measured along the central axis.
The thickness of the ribs is a difficult parameter to
estimate as it varies continuously along their length
(Roberts and Chen, 1972). In a study of the sternal
end of the fourth rib, Iscan (1985) reported a thickness
of 8.24 ± 1.17 mm in males and 6.91 ± 1.03 mm in
females, a 1.33 mm difference. Combining these
values with the principal radii of curvature of the third,
sixth and ninth ribs reported by Roberts and Chen
(1972), we estimate that this difference in thickness
would introduce a bias less than 1% in favour of
females. We consider this bias sufficiently small to be
neglected.
In preliminary experiments, the error associated
with the lead wire technique was estimated as the dif-
ference between the predicted and measured lengths
of circular arcs having a known diameter of 19.3 and
23.5 cm. Measured lengths differed from predicted
lengths by 3%. The coefficients of variation for five re-
peated measurements of the same rib were in all cases
less than 5%. We, therefore, considered the method
to be valid. Radiographic techniques have also been
employed to measure rib length in humans (Cassart
et al., 1996; Dansereau and Stokes, 1988; Guignon et
al., 1995). In general, the values obtained with these
techniques are comparable to those reported here, but
a direct comparison would be warranted.
4.2. Comparison between males and females
The impetus for this study came from previous
ones in which the radial dimensions of the rib cage and
lungs were shown to be smaller in relation to height
in females than males (Bellemare et al., 2003, 2001).
The present study was also motivated by the lack of
 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239 237

Table 4
Bivariate correlations between bodily dimensions
BA Third rib Sixth rib Ninth rib LL UL Height
TS
All 0.51** 0.33* 0.45** 0.43** 0.68** 0.63** 0.6**
Males 0.23 0.61** 0.5* 0.62** 0.68** 0.52* 0.38
Females −0.31 0.45* 0.2 0.43* 0.02 0.1 −0.03
BA
All 0.06 0.29* 0.09 0.71** 0.63** 0.85**
Males 0.39 0.15 0.13 0.48* 0.31 0.66**
Females 0.06 0.11 0.01 −0.37 −0.11 0.36
Third rib
All 0.59** 0.8** 0.22 0.16 0.15
Males 0.56** 0.76** 0.73** 0.62** 0.59**
Females 0.78** 0.85** 0.23 −0.03 0.21
Sixth rib
All 0.68** 0.47** 0.26 0.41*
Males 0.6** 0.56** 0.23 0.41
Females 0.81** 0.17 −0.16 0.18
Ninth rib
All 0.32* 0.21 0.21
Males 0.71** 0.49* 0.37
Females 0.16 −0.04 0.24
LL
All 0.8** 0.81**
Males 0.64** 0.6**
Females 0.5* 0.34
UL
All 0.81**
Males 0.62**
Females 0.62**
Values are correlation coefficients with their level of statistical significance. TS, thoracic spinal length; BA, bisacromial distance; third rib, length
of third rib; sixth rib, length of sixth rib; ninth rib, length of ninth rib; LL, length of lower limb; UL, length of upper limb.
* Significant correlation with p < 0.05.
** Significant correlation with p < 0.01.

relevant data in the literature on rib length or growth in
humans. Indeed, previous investigations on the growth
of the rib cage have relied on measurements of thoracic
dimensions using surface calipers (DeMuth et al.,
1965) or chest X-rays (Grivas et al., 1991; Openshaw
et al., 1984; Scammon, 1927; Simon et al., 1972).
These measurements reflect the growth of the rib cage
only to the extent that the inclination of the ribs is the
same in all subjects, a condition, which, as was shown
before (Bellemare et al., 2003), is not satisfied. Failure
to account for this led to the false impression that the
growth of the rib cage, like that of the lungs, is impaired
in females compared to males of the same standing
height (DeMuth et al., 1965; Grivas et al., 1991).
As the present study shows, the ribs are longer
in relation to height in females than in males. As
mentioned earlier, the size of the lungs, as reflected
by its volume at a fixed distending pressure in vitro
(Thurlbeck, 1982) or at total lung capacity in vivo
(Crapo et al., 1982) is about 25% and 12% smaller, re-
spectively, in females than in males having the same
height. The present findings of longer ribs that are
more inclined in females than males (Bellemare et
al., 2003) indicate the potential for a relatively greater
rib cage volume in females than males having the
same height and, also the potential for a greater vol-
ume capacity of the rib cage relative to that of the
lungs.
238 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239
The reason for the sex difference in rib length is
unknown. However, other sexual dimorphisms in the
morphology of bones exist that can be linked to func-
tion. As shown in Table 3, bisacrominal distance was
greater in relation to height in males than in females.
This finding is consistent with longer clavicle length
in relation to body length in males than in females
(McCormick et al., 1991). This sexual dimorphism
may reflect male adaptation for manual labour. There
are also well-known differences in the dimensions and
shape of the pelvis between males and females (Walrath
and Glantz, 1996). This sexual dimorphism is consid-
ered to reflect an adaptation of females for parturition.
The functional significance of relatively longer ribs
and greater rib cage volume capacity relative to the
lungs in females is not immediately clear but may have
to do with the dual role of the rib cage in accommo-
dating both lung and abdominal volume displacements
(Mead et al., 1995). Indeed, only part of the rib cage
faces the lung, the other part faces the diaphragm and
the peritoneal cavity. The latter part, also called ab-
dominal rib cage, actually forms part of the abdominal
wall and is thus subjected to a pressure close to ab-
dominal pressure (Loring and Mead, 1982). Mead et al.
(1995) emphasized the role of the rib cage in accommo-
dating abdominal volume displacements, which they
considered is its major contribution to breathing: as
the abdominal rib cage expands, it reduces abdomi-
nal pressure and, in this way, increases the inspiratory
function of the diaphragm by allowing a greater frac-
tion of transdiaphragmatic pressure to be applied to the
lungs. Because the diaphragm is shorter in relation to
height in females than males (Bellemare et al., 2003),
its contribution to breathing can be expected to be less
than in males. In fact, gastric pressure swings during
inspiration, a measure reflecting abdominal pressure
changes caused by the descent of diaphragm dome,
was shown to be smaller in females than males. Fur-
thermore, the ratio of esophageal pressure to transdi-
aphragmatic pressure swings, a measure reflecting the
relative contribution of inspiratory rib cage muscles
and diaphragm to inspiration (Macklem et al., 1978),
was shown to be greater in females than males, indi-
cating an enhanced contribution of inspiratory rib cage
muscles (Bellemare et al., 2003). The finding of rel-
atively longer ribs (present finding) that are more in-
clined in females than in males (Bellemare et al., 2003)
provides an anatomic basis to this observation, as this
should favour a greater rib cage contribution to breath-
ing. Both findings give credence to an old observation
suggesting that females tend to depend more on costal
breathing than males.
The rib cage accommodates abdominal volume dis-
placements not only during breathing but also, and per-
haps even more importantly, when the abdomen is dis-
tended (D’Angelo et al., 2002; Gilroy et al., 1985). As
a result of rib cage expansion, the negative effects of
abdominal distention on lung volume and abdominal
pressure are less than they would otherwise be. If there
is a condition that distinguishes females from males it
is abdominal distension caused by pregnancy. The rel-
atively longer ribs in females, by allowing a greater rib
cage expansion, should thus be well-suited to accom-
modate the large abdominal distension that occurs dur-
ing pregnancy, thereby minimising its effects on lung
function and abdominal pressure (Gilroy et al., 1985).
In this way, the sexual dimorphism in human rib length
could be viewed as a female adaptation for pregnancy.
The genetic and/or humoral factors involved are un-
known. Whether this finding can be extended to other
species or whether this represents an evolutionary adap-
tation dictated by the relatively large human foetal size
is also unknown.
4.3. Study limitations
There was little overlap in height between males and
females. Thus, although our sample is representative of
each gender, caution should be exercised when extrap-
olating our results to males and females with the same
height. Furthermore, because of the smaller height vari-
ation in the female group, a relationship between rib
length and other bodily dimensions may be more diffi-
cult to detect than in the male group. Finally, because
all subjects were caucasians, the present findings may
not be extrapolated to other races.
5. Summary
In summary, this study has shown a sexual dimor-
phism in human ribs, which are longer in relation to
height in females than in males. Furthermore, in con-
trast to males, the lengths of the ribs are not significantly
correlated with body length. We hypothesise that this
sexual dimorphism in human ribs may be coupled to
 F. Bellemare et al. / Respiratory Physiology & Neurobiology 150 (2006) 233–239
that of the pelvis and to the role of the rib cage in
pregnancy.
Acknowledgements
This work was accomplished in partial fulfilment
for the degree of Master of Science attributed by the
University of Montreal to Tambwe Fuamba MD. The
authors are indebted to Dr. André Lauzon of the Lab-
oratoires de sciences judicières et de médecine légale
for making our collaboration possible. Thanks are also
extended to Ovid Da Silva, Research Support Office,
CHUM Research Centre, for editing this manuscript.
References
Bellemare, F., Jeanneret, A., Couture, J., 2003. Sex differences in
thoracic dimensions and configuration. Am. J. Respir. Crit. Care
Med. 168, 305–312.
Bellemare, J.F., Cordeau, M.P., Leblanc, P., Bellemare, F., 2001. Tho-
racic dimensions at maximum lung inflation in normal subjects
and in patients with obstructive and restrictive lung diseases.
Chest 119, 376–386.
Cassart, M., Gevenois, P.A., Estenne, M., 1996. Rib cage dimensions
in hyperinflated patients with severe chronic obstructive pul-
monaray disease. Am. J. Respir. Crit. Care Med. 154, 800–805.
Colebatch, H.J.H., Greaves, I.A., Ng, K.Y., 1979. Exponential anal-
ysis of elastic recoil and aging in healthy males and females. J.
Appl. Physiol. 47, 683–691.
Crapo, R.O., Morris, A.H., Clayton, P.D., Nixon, C.R., 1982. Lung
volumes in healthy nonsmoking adults. Bull. Eur. Physiopathol.
Respir. 18, 419–425.
D’Angelo, E., Pecchiari, M., Acocella, F., Monaco, A., Bellemare,
F., 2002. Effects of abdominal distension on breathing pattern
and respiratory mechanics in rabbits. Respir. Physiol. Neurobiol.
130, 293–304.
Dansereau, J., Stokes, I.A.F., 1988. Measurements of the three-
dimensional shape of the rib cage. J. Biomech. 21, 893–901.
DeMuth, G.R., Howatt, W.F., Hill, B.M., 1965. Growth of lung func-
tion. Part 1. Lung volumes. Part 2. Configuration of the chest.
Pediatrics 35, 162–184.
239
Gilroy, R., Lavietes, M., Loring, S., Mangura, B., Mead, J., 1985.
Respiratory mechanical effects of abdominal distension. J. Appl.
Physiol. 58, 1997–2003.
Grivas, T.B., Burwell, R.G., Purdue, M., Webb, J.K., Moulton, A.,
1991. A segmental analysis of thoracic shape in chest radio-
graphs of children. Changes related to spinal level, age, sex,
side and significance for lung growth and scoliosis. J. Anat. 178,
21–38.
Guignon, I., Cassart, M., Gevenois, P.A., Knoop, C., Antoine, M.,
Yernault, J.C., Estenne, M., 1995. Persistent hyperinflation after
heart-lung transplantation for cystic fibrosis. Am. J. Respir. Crit.
Care Med. 151, 534–540.
Iscan, M.Y., 1985. Osteometric analysis of sexual dimorphism in the
sternal end of the rib. J. Forensic Sci. 30, 1090–1099.
Knudson, R.J., Clark, D.F., Kennedy, T.C., Knudson, D.E., 1977.
Effect of aging alone on mechanical properties of the normal
adult human lung. J. Appl. Physiol. 43, 1054–1062.
Loring, S., Mead, J., 1982. Action of the diaphragm on the rib
cage inferred from a force-balance analysis. J. Appl. Physiol.
53, 197–204.
Macklem, P.T., Gross, D., Grassino, A., Roussos, C., 1978. Par-
titioning of inspiratory pressure swings between diaphragm
and intercostal/accessory muscles. J. Appl. Physiol. 44, 200–
208.
McCormick, W.F., Stewart, J.F., Green, H., 1991. Sexing of human
clavicles using length and circumference measurements. Am. J.
Forensic Med. Pathol. 12, 175–181.
Mead, J., Loring, S., Smith, J., 1995. Volume displacements of the
chest wall and their mechanical significance. In: Roussos, C.
(Ed.), Lung Biology in Health and Disease, vol. 85: The Thorax,
Part A. Marcel Dekker, New York, pp. 565–586.
Openshaw, P., Edwards, S., Helms, P., 1984. Changes in rib cage
geometry during childhood. Thorax 39, 624–627.
Roberts, S.B., Chen, P.H., 1972. Global geometric characteristics of
typical human ribs. J. Biomech. 5, 191–201.
Scammon, R.E., 1927. Studies on the growth and structure of the
infant thorax. Radiology 9, 89–103.
Simon, G., Reid, L., Tanner, J.M., Goldstein, H., Benjamin, B., 1972.
Growth of radiologically determined heart diameter, lung width,
and lung length from 5–19 years, with standards for clinical use.
Arch. Dis. Child. 47, 373–381.
Thurlbeck, W.M., 1982. Postnatal human lung growth. Thorax 37,
564–571.
Walrath, D.E., Glantz, M.M., 1996. Sexual dimorphism in the pelvic
midplane and its relationship to Neandertal reproductive patterns.
Am. J. Phys. Anthropol. 100, 89–100.