These tables have been formulated on bone age assessment according to the standards of Greulich and Pyle. Prediction of adult height from height, bone age, and occurrence of doi: 10.1007/978-1-4419-1795-9_176, 124. Constitutional delay of growth and pubertal development. doi: 10.1203/00006450-200111000-00015, 85. In particular, the method of medical age assessment proposed consisted of taking X-rays of wisdom teeth and MRI scans of knee joints, which are then analyzed by dentists and radiologists. Chaillet N, Nystrom M, Demirjian A. Buken B, Safak AA, Yazici B, Buken E, Mayda AS. 3rd ed. Every 6-12 months, height and bone age should be assessed. The bones on the X-ray image are compared with X-ray images in a standard atlas of bone development. This system does not take into account the state of carpus bones maturation and allows a bone age assessment between 2.5 and 17 years and 2.0 and 15.0 years for male and female individuals, respectively. The bone age study can help evaluate how fast or slowly a child's skeleton is maturing, which can help doctors diagnose conditions that slow down or speed up physical growth and development. doi: 10.4158/EP13193.OR, 52. As sex steroid levels rise during puberty, bone maturation accelerates. Patel PS, Chaudhary AR, Dudhia BB, Bhatia PV, Soni NC, Jani YV. In fact, bone age can provide important information for athletes in order to distribute physical, human, and monetary resources properly (6567). 102. Presentation, diagnosis, and therapy. Kim JR, Lee YS, Yu J. Therefore, the complete characterization of the main methods and procedure available and particularly of all their advantages and disadvantages need to be known in order to properly utilized this information for all its medical and non-medical main fields of application. (2014) 24:88993. (2015) 61:1903. Hackman L, Black S. The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. Cox LA. But perfectly healthy kids also can have bone ages that differ from their actual ages. Therefore, during the procedure, the standard that seems similar is initially chosen, and then, the examination of each bone segment in an ordered sequence is performed by assigning the corresponding bone age to the individual segments, according to the instructions contained in the atlas text. (1978) 93:74955. Handbook of Growth and Growth Monitoring in Health and Disease. doi: 10.1016/B978-0-323-04883-5.50052-0, 43. MSK Taskforce Recommendation on Bone age for chronological age - ESPR 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. Am J Phys Anthropol. According to a recent study, the BoneXpert method is affected by obesity to a lesser extent than the GreulichPyle method. The issue here is the size of the standard deviation (SD) of the difference between bone age and chronological age, which is 15 months or more. (1970) 108:5115. (127) started a computerization project of reading using phalanxes length compared to atlas. J Radiol Prot. The remaining cartilaginous portions of the epiphyses become thinner. Pediatr Radiol. In order to achieve a greater accuracy and diagnostic reproducibility, it is important that bone age determination has the lowest intra- and interoperator variability. Means and standard deviations of weight, height, chronological age, SA, P-TW3 and P-KR were determined by group 1 and 2 (model and validation groups) and by sex, for all 497 (group 1 = 252; group . By simple arithmetic, a predicted adult height can be computed from a child's height and bone age. Forensic Sci Int. Few pediatric devices were approved after a clinical trial involving children. 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. (2011) 19:125964. Over the years, numerous standardized methods have been developed to evaluate a skeletal maturity score for the hand and wrist radiographs (3, 5, 9092). At birth, only the metaphyses of the "long bones" are present. They look darker on the image. The issue here is the size of the standard deviation (SD) of the difference between bone age and chronological age, which is 15 months or more. 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. doi: 10.1111/jog.12181, 18. Revised for use with the Greulich-Pyle hands standards. Bergeron MF, Bahr R, Bartsch P, Bourdon L, Calbet JA, Carlsen KH, et al. This means a child's height is part of his or her family's pattern of inherited tall height. (2012) 42:3438. (2001) 50:6248. (2016) 31:939. Hand and wrist X-rays are considered as an important indicator of children's biological age. [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. Skeletal Development of the Hand and Wrist: A Radiographis Atlas and Digital Bone Age Companion. Arq Bras Endocrinol Metabol. Spec Care Dentist. Data described in the TW3 method show a progression of bone age typically between 10 and 12 years compared to that reported in the TW2 method; in particular, TW3 estimates of bone age are younger than TW2 especially in children with idiopathic short stature and constitutional delay in growth and puberty. 2015;24(4):143-152. doi:10.1297/cpe.24.143. Is the Greulich and Pyle atlas applicable to all ethnicities? doi: 10.1016/S0022-3476(52)80205-7, 138. chronological age and bone age in both genders (Females r=0.778; p-value < 0.001, Males r=0.816; p-value < 0.001). (2003) 59:77987. [5] Other techniques for estimating bone age exist, including x-ray comparisons of the bones of the knee or elbow to a reference atlas and magnetic resonance imaging approaches. Ann Hum Biol. March 12, 2021. Congenital adrenal hyperplasia. Crowne EC, Shalet SM, Wallace WH, Eminson DM, Price DA. (2009) 28:5266. (1960) 18:21930. Numerous scales have been produced that can convert bone maturity score into bone age for different European and non-European populations (7, 114119). 2019;29(6):2910-2923. doi:10.1007/s00330-018-5792-5. X-rays should be perpendicular to the rigid plane and usually be performed with a tube of 4560 kVp potential. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. 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. (1990) 65:110912. Harel S, Hursh BE, Chan ES, Avinashi V, Panagiotopoulos C. Adrenal suppression in children treated with oral viscous budesonide for eosinophilic esophagitis. Wong SC, Smyth A, McNeill E, Galloway PJ, Hassan K, McGrogan P, et al. Am J Roentgenol Radium Ther Nucl Med. Skeletal age estimation for forensic purposes: a comparison of GP, TW2 and TW3 methods on an Italian sample. Bone growth estimation using radiology (GreulichPyle and Tanner-Whitehouse Methods). (1952) 40:42341. doi: 10.1093/med/9780199782055.001.0001, 10. doi: 10.1111/j.1365-2605.2005.00575.x, 17. The BoneXpert method for automated determination of skeletal maturity. Ashizawa K, Kumakura C, Zhou X, Jin F, Cao J. RUS skeletal maturity of children in Beijing. Age Determination Procedures for Custody Decisions. 4. basis of physical characteristics such as height, weight and general body shape and a comparison of the results with growth curves [9,20]. Clin Endocrinol Oxford. Bone age - Wikipedia Girls: 8 to 12 cm (3 to 5 in) Boys: 10 to 14 cm (4 to 6 in) However, in children with certain conditions (e.g., growth hormone deficiency), normal . Schlesinger S, MacGillivray MH, Munschauer RW. (2013) 19:615. Sustained decrease in bone-age-to-chronological-age (BA:CA) ratio through 5 years 3 Mean BA:CA ratio decreased throughout the study; . Among these, three methods are the most representative: GreulichPyle method, TannerWhitehouse method, and Fels method. These changes can be seen by x-ray and other imaging techniques. Comparison of height for age and height for bone age with and without The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation. However, data obtained from the assessment of bone age can be widely used both in medical or nonmedical settings. Not only can bone age help in diagnosing a child with a growth abnormality, but it can also play a role in treatment. J Forensic Sci. An X-rayis a safe and painless test that uses a small amount of radiation to make an image of bones, organs, and other parts of the body. doi: 10.1109/TMI.2008.926067, 132. Aicardi G, Vignolo M, Milani S, Naselli A, Magliano P, Garzia P. Assessment of skeletal maturity of the hand-wrist and knee: a comparison among methods. doi: 10.2214/ajr.108.3.511, 108. doi: 10.1016/j.gcb.2008.09.020, 30. 69. Principal pros and cons related to the different methods utilized for the definition of skeletal age [82, 85, 94, 95, 97, 98, 102, 116, 121, 122, 123, 126, 129,132, 135,137, 138]. J Pediatr. Available online at: http://www.ice.gov/doclib/foia/dro_policy_memos/agedeterminationproceduresforcustodydecisionsaug202004.pdf. J Pediatr. Topor LS, Feldman H. Variation in methods of predicting adult height for children with idiopathic short stature. 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. Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. Treatment of the various types of spinal muscular atrophy with approved therapies resulted in an array of improvements, according to a review of 22 studies. AJR Am J Roentgenol. Following the growth charts from the CDC, the average height of adult woman at age 20 is 64-65 in (163 cm). Although encouraging results have been shown, this method still requires improvements in terms of reproducibility and elimination of confounding factors (135, 136). doi: 10.1111/j.1651-2227.1975.tb03936.x. doi: 10.1111/j.1651-2227.1988.tb10615.x, 46. A longitudinal study. [10][11] Since then, updated atlases of the left hand and wrist have appeared,[12][5] along with atlases of the foot and ankle,[13] knee,[14] and elbow. doi: 10.1016/S0022-3476(73)80481-0, 19. Maes M, Vandeweghe M. A valuable improvement of adult height prediction methods in short normal children. Effects of gonadotropin-releasing hormone agonist treatment on final Greulich WW. Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. Idiopathic short stature is defined as a height less than two standard deviations below the mean for age without a known etiology. Radiographic evaluation of skeletal maturation. There have been two updates since the first publication of the TW method in 1962: the TW2 method in 1975 and the TW3 method in 2001. J Adolesc Health Care. [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. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). doi: 10.1038/oby.2010.305, 51. Pediatrics. 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. 2 SDs), a range of 5 years. Hill RJ, Brookes DS, Lewindon PJ, Withers GD, Ee LC, Connor FL, et al. [41] The cells of the mesenchyme can become bone by one of two primary methods: (1) intramembranous ossification where mesenchymal cells differentiate directly into bone or (2) endochondral ossification where mesenchymal cells become a cartilaginous model of chondrocytes which then become bone. As well, height prediction methods might be affected by ethnicity-related differences, thus either underestimating or overestimating adult height, with wide variations in accuracy. (2010) 13:35560. A child whose growth is initially normal but then falls progressively further off the growth curve may have growth hormone deficiency. doi: 10.1016/j.forsciint.2004.08.018, 80. London: Academic Press (1983). The use of bone age in clinical practice - part 1. 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). International Olympic Committee consensus statement on thermoregulatory and altitude challenges for high-level athletes. The following are generally documented (84, 97105): a delay in bone age in Middle-Eastern men and Iranian men and in Southeast Asian children (Indonesian and Indian men and women) and Asian-American men; an advanced age in Afro-American children (more in female than in male) and in Middle Eastern female children (Iranian girls); no variation is documented for Italian, Korean, and Scottish children and in Pakistani girls. doi: 10.1136/bcr-2015-212216, 58. [30][31][32][33][34], There are exceptions with people who have an advanced bone age (bone age is older than chronological age) due to being an early bloomer (someone starting puberty and hitting PHV earlier than average), being an early bloomer with precocious puberty, or having another condition. Moreover, a deficit of thyroid hormones or an excess of corticosteroids causes a cell division reduction in the proliferation zone, inducing a growth delay. Measurement of Bone Mineral Content of the Lumbar Spine by Dual Energy Since then, more than 15 new computerized automatic systems have been developed (128, 129). QJM. For a correct interpretation of data, it is important to follow a correct procedure: the hand (conventionally the left hand) is positioned with the palm side resting on a rigid plane with fingers spread out to obtain an antero-posterior radiograph. The bones on the X-ray image are compared with X-rays images in a standard atlas of bone development, which . (2009) 33:10914. a systematic review and meta-analysis. Data Sources: We searched PubMed, Agency for Healthcare Research and Quality, Cochrane Database of Systematic Reviews, and National Guidelines Clearinghouse. When a child experiences earlier than normal puberty timing, the child would be expected to follow a height percentile above their final adult height percentile. An appraisal of Greulich-Pyle Atlas for skeletal age assessment in Pakistan. [3] Large differences between a person's bone age and their chronological age may indicate a growth disorder. Hand radiographs in Russell-Silver syndrome. Forensic Sci Int. Stature and skeletal maturation of two cohorts of Australian children and young adults over the past two decades. Children do not mature at exactly the same time. Applicability of Greulich and Pyle skeletal age standards to Indian children. London. doi: 10.3109/03014460.2015.1032349, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. doi: 10.1159/000184848. Particularly, in the TW3, the possibility to predict final height has been introduced. Difference between bone age at the hand and elbow at the onset of - LWW (2005) 35:42933. For the Fels method, the prediction of adult height is calculated with the RocheWainerThissen formula. doi: 10.1016/j.ajodo.2006.07.037, 99. Thiago O, Artiol MA, Alvares VS. [24] The Sontag method uses x-rays of all the bones and joints of the upper and lower limbs on the left side of the body. Cerbone M, Dattani MT. Tanner JM, Cameron N, Marshall WA, Healy MJ, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height. In clinical trials, the most common adverse reactions involved the implant site and included discomfort, bruising, soreness, pain . Pediatr Endocrinol Rev. (1995) 126:54550. 9:580314. doi: 10.3389/fped.2021.580314. Guidelines on Policies and Procedures in Dealing With Unaccompanied Children Seeking Asylum. Contemporary Pediatrics Resident Writer Program, Food Insecurity and the Dangers of Infant Formula Dilution, Getting into the Roots of Childhood Atopic Dermatitis, Opt-Out Chlamydia Screening in Adolescent Care, The Role of the Healthcare Provider Community in Increasing Public Awareness of RSV in All Infants, | Obstetrics-Gynecology & Women's Health. (2009) 48:53843. Background radiation: natural and man-made. Angle Orthod. A boy has reached 99% of his adult height at a bone age of 17 years and has a small amount of height growth left from this point on. doi: 10.1159/000101336, 25. (2012) 101:47. (2008) 28:1016. Obesity (Silver Spring). (1989). History and physical examination findings should guide further evaluation for pathologic causes of short and tall stature. As kids grow, their growth plates look thinner on X-rays and eventually disappear (called "closed growth plates"). Below the 5 th percentile or from below-1.96SD reported as thinness or leanness. However, this system has some limits that must be considered, in particular, the absence of carpal bones evaluation, the opposition of local administrations to install the software, and the higher cost compared to available methods (GP and TW) (134). 4 The emergence of the primary ossification centers of the carpal bones appear in a predictable order that can help in determining bone age. Therefore, newer methods, such as artificial intelligence, might be used with the aim to guide endocrinologists and radiologists in the daily routine approach. For example, in children born small for gestational age who remain short after birth, bone age is a poor predictor of adult height. doi: 10.1590/S0004-27302007000300021, 64. Growth Hormone Deficiency. J Pediatr. This test is usually ordered by pediatricians or pediatric endocrinologists. (1973) 83:2336. (2015) 7:1827. Haffner D, Nissel R. Growth and puberty in chronic kidney disease. N Engl J Med. Table 3. . During late puberty, the fusion of the epiphyses to the metaphyses in the long bones of the hand tends to occur in a characteristic pattern: (3) fusion of the proximal phalanges, and. (2009) 154:2437. doi: 10.1159/000185511, 141. This condition may be congenital or acquired, and has an incidence of one in 3,000 to 9,000 children.13 A history of head trauma, central nervous system infection, birth trauma, or cranial irradiation may suggest an acquired cause of growth hormone deficiency. doi: 10.1111/j.1651-2227.2011.02476.x, 74. (2006) 29:2416; discussion 8690. 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). Tamminga RY, Zweens M, Kamps W, Drayer N. Longitudinal study of bone age in acute lymphoblastic leukaemia. Leg Med. 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. Arends NJ, Boonstra VH, Mulder PG, Odink RJ, Stokvis-Brantsma WH, Rongen-Westerlaken C, et al. 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. In another study on 62 boys and 28 girls with short stature, BP method is more accurate for short boys than short girls (140). Pituitary. The mean of SDS, bone age, chronological age, height age and growth Horm Res. Bone age is the degree of maturation of a child's skeleton ().The assessment of bone age and its comparison with chronological age are particularly useful in pediatric endocrinology for estimations of an individual's final height and to study other growth problems in clinical pediatrics (2,3). Bone Age Corresponds With Chronological Age at Type 1 Diabetes Onset in doi: 10.1016/j.forsciint.2007.02.023. (2008) 122:30914. Satoh M. Bone age: assessment methods and clinical applications. Reliability of the methods applied to assess age minority in living subjects around 18 years old. (1994) 7:1415. 135. [21] Other downsides are that the atlas has not been updated since 1959 and the images in the atlas were acquired from healthy white children living in Cleveland, Ohio in the 1930s and 1940s and therefore may not yield accurate bone age assignments when applied to non-white patients or unhealthy children. Acta Paediatr Scand. Childrens bones have areas of new bone growth called growth plates at both ends. Introduction: Bone age (BA) is a quantitative determination of skeletal maturation. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. Mansourvar M, Ismail MA, Raj RG, Kareem SA, Aik S, Gunalan R, et al. In the United States, the most common technique for estimating a person's bone age is to compare an x-ray of the patient's left hand and wrist to a reference atlas containing x-ray images of the left hands of children considered to be representative of how the skeletal structure of the hand appears for the average person at a given age. doi: 10.1097/NNR.0b013e3181b4b921, 16. Poulton AS, Bui Q, Melzer E, Evans R. Stimulant medication effects on growth and bone age in children with attention-deficit/hyperactivity disorder: a prospective cohort study. Bone age assessments: What they can tell you about growth Arch Dis Child. doi: 10.1016/j.jpeds.2008.08.018, 137. Children with normal variants of height tend to have a normal growth velocity (5 cm [2 in] per year for children between five years of age and puberty) after catch-up or catch-down growth. Calculating the midparental height (Table 1) is an important part of the evaluation because most short or tall children have short or tall parents. Inflamm Bowel Dis. (1993) 68:6779. (2016) 37:13587. 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). Included criteria were age below 18 years, height more than 2 SD below the mean for age (< 3rd percentile), growth failure (< 4 cm/year), small for mid-parental height, and adequate. [7][8] Features of bone development assessed in determining bone age include the presence of bones (have certain bones ossified yet), the size and shape of bones, the amount of mineralization (also called ossification), and the degree of fusion between the epiphyses and metaphyses. doi: 10.1136/adc.81.2.172, 94. Mentzel HJ, Vilser C, Eulenstein M, Schwartz T, Vogt S, Bottcher J, et al. (1997). Acta Radiol. 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. Am J Clin Nutr. The height age (HA) refers to the CA at which a child's height would be at the 50th percentile for age and sex. Cambridge. p. 293753. It is also common in chronic inflammatory states or infectious diseases, such as juvenile idiopathic arthritis and states of immunodeficiency (3037). [8][16], An atlas based on knee maturation has also been compiled. doi: 10.1111/jpc.13114, 75. Arntzenius A, van Galen L. Budesonide-related adrenal insufficiency. [15] An alternative approach to the atlas method just described is the so-called "single-bone method" where maturity scales are assigned to individual bones. (2015) 16:2015. Massarano AA, Hollis S, Devlin J, David TJ. Horm Res. (2014) 22:269. An X-ray of the left hand and wrist will measure your child's bone age. 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. (2011) 12:1848. [2][5], To assign a bone age to the patient under review, a radiologist compares the patient's hand and wrist x-ray to images in the Greulich and Pyle atlas. Discussion. Eur J Endocrinol. Bone Age Article - StatPearls The Knee Joint as a Biological Indicator", "Rate of Appearance of Ossification Centers from Birth to the Age of Five Years", "Use of cervical vertebral dimensions for assessment of children growth", "Management of the Child Born Small for Gestational Age through to Adulthood: A Consensus Statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society", "2 to 20 years: Girls Stature-for-age and Weight-for-age percentiles", "2 to 20 years: Boys Stature-for-age and Weight-for-age percentiles", "Physical Development, Ages 11 to 14 Years", "Bone age and onset of puberty in normal boys", "Overgrowth SyndromesEvaluation, Diagnosis, and Management", "An approach to constitutional delay of growth and puberty", http://www.jfsmonline.com/text.asp?2019/5/4/177/272723. The bone age at onset of puberty was 11.0 1.5 years. The injections are generally well tolerated, but rare adverse reactions have been reported. doi: 10.1080/03014460500087725, 119. doi: 10.1097/MPG.0000000000000848, 57. Zafar AM, Nadeem N, Husen Y, Ahmad MN. By evaluating the data obtained from bone age in the clinical setting, it is possible to distinguish three main groups of subjects: patients with delayed bone age, patients with bone age appropriate to chronological age, and patients with advanced bone age (3, 810). All Rights Reserved. Variation from this normal pattern of growth may be a sign of pathologic conditions. Children with cardiac diseases, or those with chronic kidney or liver disease, may experience a delay in skeletal maturation (3842). Prediction of adult height by Tanner-Whitehouse method in young Caucasian male athletes. IEEE Trans Med Imaging. (1990) 149:3147. Pediatricians have relied on methods for determining skeletal maturation for >75 years. doi: 10.1056/NEJMoa064725, 62. (2005) 50:116474. There is a chart for males and another for females with possible bone ages ranging from 1 month to 5 years. Ann Hum Biol. Search dates: June and December 2014, and March 2015. doi: 10.1016/j.ghir.2017.10.005. J Forensic Leg Med. It is administered through daily injections over several years. The fingers are spread out so that they are not close together and the thumb is rotated in a natural position about 30 from the first finger. doi: 10.1007/s00414-008-0237-3, 65. [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. Growth at Adolescence. doi: 10.1159/000023352, 115. De Sanctis V, Soliman AT, Di Maio S, Bedair S. Are the new automated methods for bone age estimation advantageous over the manual approaches? (2015) 173:63342. Aust Orthod J. Vaska AI, Benson J, Eliott JA, Williams J. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB, et al. Pediatr Radiol. Assessment of bone age is often required during international immigration programs (68, 69). Growth and reproductive outcomes in congenital adrenal hyperplasia. Eur J Pediatr. Horm Res. Evaluation of two methods of bone age assessment in peripubertal Ontell FK, Ivanovic M, Ablin DS, Barlow TW. Bone age should be compared with chronologic age to narrow the differential diagnosis of short stature.5,10,11 The traditional method compares a plain radiograph of the left wrist and hand to a database of norms, although various methods are now available.1012 Children with normal variations of growth may have advanced or delayed bone age, but a bone age that is more than two standard deviations from the mean for age is likely due to a pathologic condition.
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