In the last 20 years, newer methods have also been studied with the principal aim to mainly eliminate the variability related to interpretation according to the different methods. United Nations Treaty Collection. Martin DD, Wit JM, Hochberg Z, Savendahl L, van Rijn RR, Fricke O, et al. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. (1996) 167:13958. It is also common in chronic inflammatory states or infectious diseases, such as juvenile idiopathic arthritis and states of immunodeficiency (3037). Wong SC, Smyth A, McNeill E, Galloway PJ, Hassan K, McGrogan P, et al. Bone age (BA) is a measure of the development of the skeleton incorporating the size, shape and degree of mineralization of the epiphyses and physeal plates of a bone to define their proximity to full maturity [1].BA differs from chronological age (CA), which is calculated from the date of birth and does not necessarily reflect an individual's stage of puberty. Images provided by The Nemours Foundation, iStock, Getty Images, Veer, Shutterstock, and Clipart.com. J Coll Physicians Surg Pak. [1][2][3] As a person grows from fetal life through childhood, puberty, and finishes growth as a young adult, the bones of the skeleton change in size and shape. Bone age is distinct from an individual's biological or chronological age, which is the amount of time that has elapsed since birth. Forensic Sci Int. [8][16], An atlas based on knee maturation has also been compiled. Pediatr Radiol. Below the 5 th percentile or from below-1.96SD reported as thinness or leanness. Introduction: Bone age (BA) is a quantitative determination of skeletal maturation. (2011) 13:12033. In this way, a maturity score is obtained for each area of clinical interest, generally categorized as A, B, C, D, E, F, G, H, and I. Table 3. . Growth and reproductive outcomes in congenital adrenal hyperplasia. Furthermore, the GP method has not been updated from its initial publication, representing important limits of applications especially in some ethnic groups such as African or Hispanic female subjects and in Asian and Hispanic male subjects during late infancy and adolescence (95, 96). The images obtained by hand and wrist X-ray reflect the maturity of different bones. The Fels method was developed by Roche through a longitudinal study, based on a total of 13,823 serial X-rays of the left hand and wrist. (2005) 50:116474. 2019;29(6):2910-2923. doi:10.1007/s00330-018-5792-5. /content/kidshealth/misc/medicalcodes/parents/articles/xray-bone-age, diseases that affect the levels of growth hormones, such as growth hormone deficiency, hypothyroidism, precocious puberty, and adrenal gland disorders, orthopedic or orthodontic problems in which the timing and type of treatment (surgery, bracing, etc.) A number of conditions could contribute to delayed bone age, including5: Any child crossing up or down percentiles in childhoodafter age 3 years and before pubertyshould be referred, Kutney said. (1994) 67:84851. Revised for use with the Greulich-Pyle hands standards. Numerous scales have been produced that can convert bone maturity score into bone age for different European and non-European populations (7, 114119). Performing bone age assessments can assist clinicians in diagnosing central precocious puberty. (2015) 7:1827. (1998) 49:3740. For this reason, in the TW3 method, skeletal age evaluation ends at 15 years in women and 16.5 years in men (while in the TW2 set, 18 and 19 years, respectively, with a bone maturity anticipation of 2.53 years) (120). 104. Forensic Sci Int. (2005) 35:42933. Assessment of a patient's bone age is used in pediatric medicine to help determine if a child is growing normally. Assessment of bone age is often required during international immigration programs (68, 69). GreulichPyle distinguished two standard templates: 31 and 27 radiographic images, in male and female individuals, respectively, which illustrate different phases of bone maturation between 0 and 18 or 19 years, respectively. Condo R, Costacurta M, Maturo P, Docimo R. The dental age in the child with coeliac disease. doi: 10.1515/JPEM.1994.7.2.141, 129. doi: 10.1111/j.1651-2227.2011.02476.x, 74. (2010) 13:35560. (2009) 48:53843. Braz Oral Res. Vignolo M, Milani S, DiBattista E, Naselli A, Mostert M, Aicardi G. Modified Greulich-Pyle, Tanner-Whitehouse, and Roche-Wainer-Thissen (knee) methods for skeletal age assessment in a group of Italian children and adolescents. For example if a girl will have a normal timed puberty and a final height of 55, she would be expected to grow along the 50th percentile through childhood. First the capitate forms at an average age of 2 months, followed shortly by the hamate, then the triquetrum around 14 months, and so on.[44]. doi: 10.1093/med/9780199782055.001.0001, 10. 5. Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, et al. Constitutional delay of growth and pubertal development. . Furthermore, the impact of being overweight or obese on bone age could be identified correctly by BoneExpert. Bull RK, Edwards PD, Kemp PM, Fry S, Hughes IA. J Forensic Sci. This system allows the computer to perform reading operations. 114. (2005) 32:31625. [1 2 3]The two major methods of BA assessment used commonly are i . It is also possible to evaluate a physiological variant of familial early puberty (14), especially in some ethnic groups (15, 16). In terms of height growth and height growth related to bone age, average females stop growing taller two years earlier than average males. doi: 10.1111/j.1651-2227.1984.tb09966.x, 15. Horm Res Paediatr. For females, one takes the paternal height and subtracts 5 inches or 13 centimeters, and averages this value with the maternal height to obtain the mid-parental height. Horm Res. 1, Fig. Softer body tissues, such as the skin and muscles, allow the X-ray beams to pass through them. (2007) 92:3712. The best time to start and stop such therapies can be determined based on a patient's bone age. Bone age assessment: a large scale comparison of the Greulich and Pyle, and Tanner and Whitehouse (TW2) methods. For a child's bone age to be considered abnormal, the chronological age must differ from the assigned bone age by more than 2 standard deviations. Although aromatase inhibitors have been used in children with idiopathic short stature, long-term effectiveness and safety data are not available.27. Different population groups mature at different speeds. Mentzel HJ, Vilser C, Eulenstein M, Schwartz T, Vogt S, Bottcher J, et al. Meet the board: Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN. [3] In certain instances, abnormal growth conditions may be treated with supplemental hormone therapy. Among these, three methods were the most representative and used worldwide: The GreulichPyle method, the TannerWhitehouse, and the Fels method. (1978) 93:74955. (2005) 154:312. 1996;45:5355. Massarano AA, Hollis S, Devlin J, David TJ. Age Determination Procedures for Custody Decisions. doi: 10.1297/cpe.24.143, 9. Tamminga RY, Zweens M, Kamps W, Drayer N. Longitudinal study of bone age in acute lymphoblastic leukaemia. doi: 10.1007/s00247-008-1090-8, 131. March 12, 2021. (1987) 8:4708. (2009) 154:2437. Among these, three methods are the most representative: GreulichPyle method, TannerWhitehouse method, and Fels method. (2010) 23:85561. Cavallo F, Mohn A, Chiarelli F, Giannini C. Evaluation of bone age in children: a mini review. doi: 10.1159/000185511, 141. Short or tall parents may themselves have a pathologic reason for their height, especially if they are more than two standard deviations from the adult norm.68, Growth velocity is a measurement of growth rate. defects in bone mineralization process (commonly found in osteochondrodysplasia). When do boys stop growing? (2003) 349:77688. A child whose growth is initially normal but then falls progressively further off the growth curve may have growth hormone deficiency. Clin Endocrinol Oxford. (2013) 19:615. (2009) 39:5917. Issues and advances in adolescent growth and development. 135. Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan. (1989) 1:17583. These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the . Ann Hum Biol. p. 293753. Pediatrics. doi: 10.1016/j.jpeds.2013.11.065, 23. Vignolo M, Naselli A, Magliano P, Di Battista E, Aicardi M, Aicardi G. Use of the new US90 standards for TW-RUS skeletal maturity scores in youths from the Italian population. (2009) 58:38290. Other causes include renal, hepatic, and gastrointestinal diseases, and other genetic syndromes.1015, The initial evaluation of short stature (Figure 1) should include a history and physical examination, accurate growth assessment, calculation of the growth velocity and midparental height, and radiography to evaluate bone age.16 Drugs known to cause short stature include steroids (chronic use), attention-deficit/hyperactivity disorder medications, and anticonvulsants. Berlin; Heidelberg. doi: 10.1111/jpc.13114, 75. In this study of prepubertal children with and without obesity and/or PA, obesity was highly associated with BA advancement. Author disclosure: No relevant financial affiliations. Ann Hum Biol. Bone age continues to be a valuable tool in assessing children's health. Applicability of Greulich and Pyle skeletal age standards to Indian children. Medical treatment, either oral or dermal, can affect pubertal effects on bone age. 90. (2001) 50:6248. The use of AI as a monotherapy for children with NC-CAH has never been reported. [16], The bones considered in the TW3 method include the distal radius and ulna, the metacarpals and phalanges of the 1st, 3rd, and 5th fingers, and all of the carpal bones except the pisiform. The bone age at onset of puberty was 11.0 1.5 years. Lodish MB, Gourgari E, Sinaii N, Hill S, Libuit L, Mastroyannis S, et al. As well, height prediction methods might be affected by ethnicity-related differences, thus either underestimating or overestimating adult height, with wide variations in accuracy. The numbers of participants with data from each age are presented in Figure 1 and in a footnote to the Table. doi: 10.4103/0975-1475.150298, 77. doi: 10.1080/03014469000001142, 117. Every 6-12 months, height and bone age should be assessed. 3. (2010) 73:2208. Endocr Rev. doi: 10.1016/j.forsciint.2004.08.018, 80. Sweden Begins New Asylum Seeker Age Assessment Tests. (2014) 238:8390. (2016) 52:5238. For infants and toddlers, weight, length, and head circumference should be plotted on a growth curve at every visit. The effect of chronic childhood malnutrition on pubertal growth and development. The bone age/chronological age ratio decreased significantly to 1.120.1 at the end of treatment (P<0.05). A clinically oriented method based on hand-wrist films. (2014) 40:60710. Table 5 lists the indications for referral.2,6,22. (2009) 94:223944. These methods differ according to the technique of the procedure and particularly to peculiar advantages and disadvantages (Table 1). Search terms included short stature, tall stature, and growth hormone. Briers PJ, Hoorweg J, Stanfield JP. doi: 10.1097/NNR.0b013e3181b4b921, 16. A child with GHD may have a bone age that is much less than his/her chronological age. a systematic review and meta-analysis. (2011) 19:125964. For patients two to 20 years of age, weight, height, and body mass index should be plotted. *Correspondence: Cosimo Giannini, cosimogiannini@hotmail.it, Debates in Clinical Management in Pediatric Endocrinology, View all
Gastroenterol Clin Biol. Several smartphone applications have been developed to facilitate the use of vertebral methods such as Easy Age. Intestinal inflammatory chronic conditions. They add length and width to the bone. Comparison of dental maturity in children of different ethnic origins: international maturity curves for clinicians. In the table below, you can find a few other numbers for different ages. Garamendi PM, Landa MI, Ballesteros J, Solano MA. New MI. Pediatr Endocrinol Rev. In fact, the images obtained by hand and wrist X-ray reflect the maturity of different types of bones of the skeletal segment evaluated. [1][6], Estimating the bone age of a living child is typically performed by comparing images of their bones to images of models of the average skeleton for a given age and sex acquired from healthy children and compiled in an atlas. This process is characterized by a predictable sequence of development and progression of ossification centers. As known, operator variability (intravariability) is defined by the degree of variability in the interpretation of same data performed at two different times by the same operator. J Pediatr Gastroenterol Nutr. [11][7] Alternative techniques for estimating bone age in infancy include tallying the number of ossification centers present in the left half of the infant's body requiring a hemiskeleton x-ray. The bone age (also called the skeletal age) is measured in years. Role of thyroid hormones in skeletal development and bone maintenance. 107. After dividing the population into two different age groups: children < 11 years and adolescents 11 years, children showed an average delay in bone age of 3.4 months and adolescents of 2.4 months. Mora S, Boechat MI, Pietka E, Huang HK, Gilsanz V. Skeletal age determinations in children of European and African descent: applicability of the Greulich and Pyle standards. An X-ray of the left hand and wrist will measure your child's bone age. A bone age study helps doctors estimate the maturity of a child's skeletal system. Thus, some authors suggest that, whenever possible, the same method should be used, favoring TW2 method if possible (93). doi: 10.1136/adc.2005.090134, 121. chronological and bone age for each sex and age group, the equality of the mean for each age was compared (Student's t-test for paired However, the bone age was significantly different from each other ( p =0001). Bone age represents a common index utilized in pediatric radiology and endocrinology departments worldwide for the definition of skeletal maturity for medical and non-medical purpose. doi: 10.1210/jc.82.5.1603, 86. doi: 10.1016/j.ajodo.2006.07.037, 99. Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. Assessment of bone age in prepubertal healthy Korean children: comparison among the Korean standard bone age chart, Greulich-Pyle method, and Tanner-Whitehouse method. Mansourvar M, Ismail MA, Raj RG, Kareem SA, Aik S, Gunalan R, et al. A newborn's size and growth are a result of the intrauterine environment, and growth hormone does not play a major role. Moreover, a deficit of thyroid hormones or an excess of corticosteroids causes a cell division reduction in the proliferation zone, inducing a growth delay. Ann Hum Biol. Children with short stature and no identified cause and children with certain other identifiable causes of short stature should be referred to a pediatric endocrinologist. The two diseases that were most often identified in the studied cohort were celiac disease and an abnormality of the growth hormone axis.3 If history and physical examination findings do not suggest a cause, a complete blood count, comprehensive metabolic panel, and measurement of bone age, insulinlike growth factor 1, and insulinlike growth factor binding protein 3 might be useful to screen for chronic disease and growth hormone deficiency. In addition, children with PA appeared to be affected by a BA . CRAIG BARSTOW, MD, AND CAITLYN RERUCHA, MD. Soegiharto BM, Cunningham SJ, Moles DR. Skeletal maturation in Indonesian and white children assessed with hand-wrist and cervical vertebrae methods. Int J Androl. Tall stature has the same prevalence as short stature, but it is a much less common reason for referral to subspecialty care. According to a recent study, the BoneXpert method is affected by obesity to a lesser extent than the GreulichPyle method. Then, the final report is done, making an average of the measurements. A small amount of spinal growth concludes an adolescent's growth. Because children grow in spurts, two measurements at least three to six months apart, and preferably six to 12 months apart, are needed to accurately determine growth velocity.4. Midparental height growth velocity should be calculated to evaluate a child's growth vs. potential height. doi: 10.1542/peds.2009-3649, 140. They should stay still for 23 seconds so the X-ray image is clear. 47. Consequently, when a naturally short child has an advanced bone age, it stunts their growth at an early age leaving them even shorter than they would have been. Ostojic SM. The pattern of growth in children with constitutional tall stature from birth to age 9 years. Regardless of the method used, an appropriate and standardized hand positioning procedure and radiographic image acquisition are required in order to better describe the skeletal maturation. (2014) 12:2005. Katherine Kutney, MD, a pediatric endocrinologist at Rainbow Babies and Childrens Hospital in Cleveland, Ohio, said bone age assessments are typically done with an x-ray of the left hand. Because of this, those who are short with an advanced bone age, need medical attention before their bones fully fuse. doi: 10.1159/000329372, 11. Tanner J, Oshman D, Bahhage F, Healy M. Tanner-Whitehouse bone age reference values for North American children. [3] However, most pediatric radiologists still use the Greulich and Pyle technique for estimating bone age in infancy. doi: 10.2214/ajr.108.3.511, 108. The main advantage of this procedure related to the evaluation of each bone segment, thus minimizing the interoperator variability. (127) started a computerization project of reading using phalanxes length compared to atlas. Pietka E, McNitt-Gray MF, Kuo ML, Huang HK. doi: 10.1111/j.1754-4505.2008.00020.x. Copyright 2021 Cavallo, Mohn, Chiarelli and Giannini. Bones and growth plates change over time. Nemours Children's Health and KidsHealth are registered trademarks of The Nemours Foundation. Chronological age and bone age were 8.12 4.1 and 8.4 4.4 years, respectively, for girls and 9.0 3.9 and 9.1 4.2 years, respectively, for boys. N Engl J Med. (1998) 75:4929. (1987) 79:7434. [5][17] The reason for imaging only the left hand and wrist are that a hand is easily x-rayed with minimal radiation[18] and shows many bones in a single view. Because the bone age of a child with endocrine diseases will progressively fall behind chronologic age, calculating bone age every 12 months might be useful to differentiate constitutional delay of growth from endocrine diseases.1, Children with endocrine disorders, such as growth hormone deficiency, hypothyroidism, or glucocorticoid excess, have normal to increased weight, whereas children with systemic disease tend to have decreased height and weight.2,21. Results: At the time of diagnosis, the chronological age was 9.90.6 years, the bone age was 11.61.0 years, and the bone age/chronological age ratio was 1.200.1. Tanner JM. As a child grows the epiphyses become calcified and appear on x-rays, as do the carpal and tarsal bones of the hands and feet, separated on x-rays by a layer of invisible cartilage where most of the growth is occurring. Satoh M. Bone age: assessment methods and clinical applications. doi: 10.1210/jc.2008-2474, 133. In fact, in the beginning, data were obtained from Caucasian children, so it is easy to understand that results assessed by the GP and TW standards are strongly dependent on ethnic group. A delayed bone age is common in malnourished conditions associated with chronic diseases such as intestinal inflammatory chronic diseases, celiac disease, and cystic fibrosis (2629). In particular, these prediction tables are developed from the GreulichPyle standards for hands, thus with the expectation that they will be used in conjunction with these standards (137, 138).