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Limited data are available on fractures and bone geometry in men, and the relation with sex steroids is incompletely understood. We investigated prevalent fractures in relation to peak bone mass, bone geometry, and sex steroids in healthy young men. Healthy male siblings (n?=?677) at the age of peak bone mass (25 to 45 years) were recruited in a cross-sectional population-based study. Trabecular and cortical bone parameters of the radius and cortical bone parameters of the tibia were assessed using peripheral quantitative computed tomography (pQCT). Areal bone mineral density (aBMD) was determined using dual-energy X-ray absorptiometry (DXA). Sex steroids were determined using immunoassays, and fracture prevalence was assessed using questionnaires. Fractures in young men were associated with a longer limb length, shorter trunk, lower trabecular BMD, smaller http://www.selleckchem.com/products/z-vad-fmk.html cortical bone area, and smaller cortical thickness (p? http://www.selleckchem.com/products/ly2157299.html later than 15 years of age were associated with a thinner bone cortex (?3%, p?��?.05) http://www.selleck.cn/products/BIBW2992.html and larger endosteal circumference (+3%, p?��?.05) without differences in periosteal bone size. In conclusion, prevalent fractures in healthy young men are associated with unfavorable bone geometry and not with cortical vBMD when adjusting for bone size. Moreover, the data suggest different mechanisms of childhood fractures and fractures during adult life. ? 2010 American Society for Bone and Mineral Research Bone mass at any stage in adult life is determined by the growth and mineralization of the skeleton during the first two decades of life leading to the peak bone mass (PBM) and by subsequent net changes in bone mass, usually bone loss, starting in the middle of the third decade.1 Although fracture risk in old age is lower in men than in women, fracture risk is higher in boys and young men than in girls or young women.2, 3 In both young and older subjects, low areal bone mineral density (aBMD) has been associated with increased fracture prevalence, although most evidence has been obtained in women4, 5 or elderly men,6 and only limited data are available in boys or young men.7�C9 An important limitation of dual-energy X-ray absorptiometry (DXA) is that it measures projected aBMD and not volumetric BMD (vBMD).