This article explores age‐ and sex‐related patterns of cortical bone loss, assessed by radiogrammetry of the second metacarpal, from a skeletal sample excavated from the Imperial Roman port city of Velia (1st and 2nd century ad), to contribute to our understanding of health and disease during the Imperial period. Patterns of age‐ and sex‐related bone loss and health at Velia are also compared with other historical samples and to modern clinical data. It was hypothesised that patterns of age‐ and sex‐related bone loss in this well‐represented Roman sample (n = 71) would mirror those reported in modern populations. Differences in the quantity of cortical bone between three age groups (18–29, 30–49 and 50+ years) are significant in both men and women; however, the pattern of bone loss differs between the sexes. Women show a gradual decline in bone quantity beginning in middle age, whereas men only lose bone in old age. However, there are no significant sex differences at any age group in the metacarpal cortical index. These findings suggest the hypothesis should be refuted because significant sex differences, particularly in old age, are an expected hallmark of bone loss in Western populations today. The possible biocultural and gender‐related factors that may have contributed to the observed patterns of bone maintenance and loss at Velia are discussed. Copyright © 2011 John Wiley & Sons, Ltd.