(1973) 83:2336. (1997). Among these, three methods were the most representative and used worldwide: The GreulichPyle method, the TannerWhitehouse, and the Fels method. The long bones are those that grow primarily by elongation at an epiphysis at one end of the growing bone. J Pediatr Gastroenterol Nutr. Copyright 2021 Cavallo, Mohn, Chiarelli and Giannini. Age determination in refugee children: A narrative history tool for use in holistic age assessment. (2018). For the Fels method, the prediction of adult height is calculated with the RocheWainerThissen formula. (2010) 2010:298937. doi: 10.1186/1687-9856-2010-298937, 56. Most infants with the congenital form are normal size at birth, but may have episodes of hypoglycemia or prolonged jaundice. The determination of bone age is important to properly assess and guide the evaluation of short or tall stature, impaired or accelerated growth, and delayed or early puberty (10). In fact, the bone maturation process lasts longer in male than in female individuals (8385), and the moment of closure of the epiphyseal region occurs is roughly 2 years earlier in girls than in boys. For example, according to Martin et al. Arends NJ, Boonstra VH, Mulder PG, Odink RJ, Stokvis-Brantsma WH, Rongen-Westerlaken C, et al. Correlation of bone age, dental age, and chronological age in survivors of childhood acute lymphoblastic leukaemia. Angle Orthod. doi: 10.1016/j.ajodo.2006.07.037, 99. (2009) 33:10914. (2010) 7:26674. Comparison between Greulich-Pyle and Girdany-Golden methods for estimating skeletal age of children in Pakistan. 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. Serinelli S, Panetta V, Pasqualetti P, Marchetti D. Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. [24] Then, a radiologist counts the number of ossification centers present and uses a chart to convert the sum of ossification centers to a bone age. Moreover, according to recent studies, BoneXpert computer-automated bone age determination method showed a significant positive correlation with chronological age and GreulichPyle. The child's hand/ wrist X-ray is interpreted based on the appearance . This means that a girl who will have a final adult height of 55 but will undergo puberty earlier than average may grow along the 80th percentile in early childhood. Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain. A total 156 samples were selected convenient sampling to make comparison of bone age and chronological age between thalassaemic children (age 9-15years) and age sex matched normal control. Bol Med Hosp Infant Mex. These are based on longitudinal data from 116 boys and 95 girls of the Harpenden Growth Study and the London group of the . The applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups. 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. Pediatr Endocrinol Rev. (2016) 8:4751. As well several differences can be characterized according to the numerous standardized methods developed over the past decades. Over the years, numerous standardized methods have been developed to evaluate a skeletal maturity score for the hand and wrist radiographs (3, 5, 9092). The diagnosis can be made by a decreased insulinlike growth factor 1 or insulinlike growth factor binding protein 3, followed by negative growth hormone provocation test results.23, Small for Gestational Age. In addition, studies have shown that, in some bones, ossification typically begins at birth, while in others, it typically begins between 14 and 17 years of life. 47. Bone age and factors affecting skeletal maturation at diagnosis of paediatric Cushing's disease. Pediatricians have relied on methods for determining skeletal maturation for >75 years. Physical examination may reveal microphallus or midline craniofacial abnormalities. Coefficients used in the RWT method are tabulated to 14 years of age for girls and 16 years of age for boys (138). *Correspondence: Cosimo Giannini, cosimogiannini@hotmail.it, Debates in Clinical Management in Pediatric Endocrinology, View all
Moreover, even when there is a good correlation between predicted and actual adult height, there is a wide individual variation, with almost 30% of adults differing by more than 5.0 cm from the BP predicted height (141). Horm Res. Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods. Projected height can be estimated by projecting the current growth curve to adulthood in children with normal bone age, or by using a bone age atlas in those with delayed bone age.. Soudack M, Ben-Shlush A, Jacobson J, Raviv-Zilka L, Eshed I, Hamiel O. 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. King DG, Steventon DM, O'Sullivan MP, Cook AM, Hornsby VP, Jefferson IG, et al. Tanner JM. 103. Ann Hum Biol. Am J Phys Anthropol. 107. Radiograph Atlas of Skeletal Development of the Hand and Wrist. Standard deviation score charts of skeletal maturity and its velocity in Swedish children assessed by the Tanner-Whitehouse method (TW2-20). (10), adult height may be overestimated in constitutional delay, and at the same time, it may be underestimated in idiopathic short stature. Growth at Adolescence. Although most children with short or tall stature do not have a pathologic condition, extremes of height, especially beyond three standard deviations, require further workup. Hackman L, Black S. The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. Premature thelarche in the setting of high lavender oil exposure. Between six and 18 months of age, children exhibit catch-up or catch-down growth until they reach their genetically determined growth curve based on midparental height. Assessment of bone age is often required during international immigration programs (68, 69). (1993) 21:148. All rights reserved. [2], In the United States, bone age is usually determined by comparing an x-ray of the patient's left hand and wrist to a set of reference images contained in the Greulich and Pyle atlas. Revised for use with the Greulich-Pyle hands standards. Projected height can be estimated by projecting the current growth curve to adulthood in children with normal bone age, or by using a bone age atlas in those with delayed bone age. J Pediatr. Health Phys. (2006) 22:110. Evaluation for pathologic etiologies is guided by history and physical examination findings. doi: 10.1111/jog.12181, 18. These tables, the Bayley-Pinneau tables, are included as an appendix in the Greulich and Pyle atlas. Greulich WW. 69. The injections are generally well tolerated, but rare adverse reactions have been reported. 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. An individual weighing 18.5 kg/height/height is considered to be underweight and thus below the 5 th percentile. Assessment of bone age is also important for the correct diagnosis, particularly with the aim of detecting the causes of bone age alteration including mainly endocrine and nutritional causes and chronic nonendocrine disorders and syndromes. (2003) 59:77987. Therefore, while in the TW1 version, the score is derived from the evaluation of all the 20 bones selected, in the TW2 update, three different ways are distinguished: 20 bones score (as in TW1), RUS score (radius, ulna, and metacarpal bones and phalanx), and CARPAL, limited to carpus bones. 4. During growth, biological maturity is defined by several parameters, including the characterization of skeletal maturity, sexual maturity, dental elements eruption, menarche, spermarche, deepening of the voice, growth spurt, and the achievement of 95% of the adult height (13). Many of these parameters, and particularly growth spurt and menarche, correlate better with bone age compared to chronological age (4). By A. F. Roche, W. C. Chumlea, and D. Thissen. doi: 10.1097/YIC.0000000000000109, 44. In multiple linear regression analysis, advanced bone age was most strongly associated with higher Tanner stage of sexual development, and higher weight, height or BMI percentile. doi: 10.1203/00006450-200111000-00015, 85. See permissionsforcopyrightquestions and/or permission requests. Reference standards for this method were published in 1950 and 1960; however, from these initial publications, several studies have shown a shift toward an earlier bone maturation process in the general population worldwide (16). Nurs Res. Intestinal inflammatory chronic conditions. (2009) 58:38290. Bone age may be significantly advanced in genetic overgrowth syndromes, such as Sotos syndrome, Beckwith-Wiedemann syndrome and Marshall-Smith syndrome. 3rd ed. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Since bone age measurements are inherently approximations, they are conventionally reported with a standard deviation which serves as an estimate of the associated error. Growth in atopic eczema. 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]. 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. Because the WHO growth charts are based on an international study of exclusively breastfed infants raised in optimal nutritional conditions, they are less likely to incorrectly identify breastfed infants as underweight. However, data obtained from the assessment of bone age can be widely used both in medical or nonmedical settings. To note, usually the first ossification center to appear is in the contest of Capitate and Hamate at the second month in females and around the fourth month in males. doi: 10.1097/00004032-199811000-00005, 87. Thus, the variability in the bone age at onset of puberty was greater than the variability in the chronological age at onset of puberty ( Fig. Bone age should be compared with chronologic age to help narrow the differential diagnosis of short or tall stature. Int J Androl. This information, associated to the characterization of the shape and changes of bone components configuration, represent an important factor of the biological maturation process of a subject. doi: 10.1590/S0004-27302007000300021, 64. Buken B, Safak AA, Yazici B, Buken E, Mayda AS. Br J Sports Med. Calculating the midparental height (Table 1) is an important part of the evaluation because most short or tall children have short or tall parents. [7][8] Here, a selection of bones are given a score based on their perceived development, a sum is totaled based on the individual bone scores, and the sum is correlated to a final bone age. (2005) 32:31625. The image in the reference atlas that most closely resembles the patient's x-ray is then used to assign a bone age to the patient. A systematic search has been performed in PubMed to identify randomized controlled trials (RCTs), meta-analyses, and retrospective and prospective studies of different methods to evaluate bone age, focusing on strengths and weaknesses of each procedure. (2009) 12:7026. The images obtained by hand and wrist X-ray reflect the maturity of different bones. Pediatr Res. [8][16], An atlas based on knee maturation has also been compiled. J Clin Endocrinol Metab. Several authors have proposed different algorithms for predicting adult height. (2014) 20:627. As sex steroid levels rise during puberty, bone maturation accelerates. Although most children with short or tall stature have variants of normal growth, children who are more than three standard deviations from the mean for age are more likely to have underlying pathology. doi: 10.1159/000184848, Keywords: skeletal development, height, X ray, children, bone age, Citation: Cavallo F, Mohn A, Chiarelli F and Giannini C (2021) Evaluation of Bone Age in Children: A Mini-Review. 91. [24], Lamparski (1972)[25] used the cervical vertebrae and found them to be as reliable and valid as the hand-wrist area for assessing skeletal age. Cameron N. Can maturity indicators be used to estimate chronological age in children? Pietka E, McNitt-Gray MF, Kuo ML, Huang HK. (1994) 331:62936. Applicability of the Greulich and Pyle skeletal age standards to black and white children of today. Several smartphone applications have been developed to facilitate the use of vertebral methods such as Easy Age. Br J Sports Med. doi: 10.1038/nrendo.2009.242, 53. Cambridge. The bone age will determine the maturity of your child's bones, compared to your child's chronological (actual or "birthday") age. Data Sources: We searched PubMed, Agency for Healthcare Research and Quality, Cochrane Database of Systematic Reviews, and National Guidelines Clearinghouse. Variability in the order of ossification of the bony centers of the hand and wrist. Int J Legal Med. This system of prediction is based on the fact that skeletal age correlates with a specific percentage of mature height reached in a specific moment when chronological age is constant. Contemporary Pediatrics sat down with one of our newest editorial advisory board members: Vivian P. Hernandez-Trujillo, MD, FAAP, FAAAAI, FACAAI to discuss what led to her career in medicine and what she thinks the future holds for pediatrics. Then, the remaining centers progressively appear (Figure 1) (80). (2006) 22:4758. Roche AF, Rohmann CG, French NY, Davila GH. 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. Puberty onset according to elbow occurred slightly earlier than expected.