“…Second, the drivers of misclassification should be identified. Males have generally larger vertebrae than females [8]; however, several lifestyle-related factors may influence the vertebrae and increase inter-individual variation in vertebral geometry and microstructure (e.g., age [12,31], body size [32,33], physical activity [34,35], nutrition [36,37]). Although major vertebral pathologies were ruled out, degenerative changes may also have affected the sex estimation accuracy.…”