Discrepancies between bone age and biological age can be seen in people with stunted growth, where bone age may be less than biological age. (2017) 37:1925. doi: 10.1136/bjsports-2012-091296. Available from: Constitutional delay in growth and development, "Infant bone age estimation based on fibular shaft length: model development and clinical validation", "Bone age assessment practices in infants and older children among Society for Pediatric Radiology members", "Bone age: assessment methods and clinical applications", "Is the use of the cervical vertebrae maturation method justified to determine skeletal age? Bone age continues to be a valuable tool in assessing children's health. Br J Sports Med. Huda W, Gkanatsios NA. [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. Premature thelarche in the setting of high lavender oil exposure. (2006) 91:420514. 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]. During this stage of development, the ossification centers for the epiphyses increase in width and thickness, becoming as wide as the metaphyses. Endocr Rev. doi: 10.1159/000185511, 141. doi: 10.1016/j.forsciint.2012.08.030, 105. Another method is the RocheWainerThissen (RWT) algorithm, which calculates predicted adult height directly from a linear combination of the child's weight, recumbent length, and bone age, together with parental height, by using a gender- and age-specific coefficients. Treatments alter the natural progression of SMA. 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. 70. A newborn's size and growth are a result of the intrauterine environment, and growth hormone does not play a major role. Viii + 339 pp. Dysmorphic characteristics suggest a genetic disorder, whereas midline defects suggest an abnormality of the growth hormone axis. doi: 10.1006/clim.2000.4838, 35. 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. In this study of prepubertal children with and without obesity and/or PA, obesity was highly associated with BA advancement. Am J Dis Child. In 1991, Pietka et al. Forensic Sci Int. Constitutional delay of growth and pubertal development. Because of this, those who are short with an advanced bone age, need medical attention before their bones fully fuse. doi: 10.1038/oby.2010.305, 51. New York, NY: Springer (2012). Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM. J Coll Physicians Surg Pak. JAMA Pediatr. This software is validated for different ethnic groups and for children with different endocrine disorders (132134). Bayley N, Pinneau S. Tables for predicting adult height from skeletal age. The Local. doi: 10.1520/JFS2005020. Tanner J, Oshman D, Bahhage F, Healy M. Tanner-Whitehouse bone age reference values for North American children. Standard deviation score charts of skeletal maturity and its velocity in Swedish children assessed by the Tanner-Whitehouse method (TW2-20). To note, a proper assessment of bone age must always take into account differences between ethnic groups, sex, and any present pathological conditions. The BoneXpert method for automated determination of skeletal maturity. Bassett JH, Williams GR. The next version (TW3) takes into consideration only RUS bones, and it can be used through a software. However, the bone age was significantly different from each other ( p =0001). The height age (HA) refers to the CA at which a child's height would be at the 50th percentile for age and sex. Mansourvar M, Ismail MA, Raj RG, Kareem SA, Aik S, Gunalan R, et al. (1987) 8:4708. So the confidence interval around the chronological age estimated from bone age is 30 months (i.e. This was followed by a comparison between the skeletal age estimates and the chronological ages of the patients. doi: 10.1007/s00414-008-0237-3, 65. Few pediatric devices were approved after a clinical trial involving children. Front. 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. (1980) 37:110311. (2005) 19:20915. Ann Hum Biol. 113. At this stage, children should track along a percentile, and variation should stay within two large bands on the growth chart. Tanner JM, Gibbons RD. (2010) 60:5525. An X-ray of the left hand and wrist will measure your child's bone age. Dental age assessment among Tunisian children using the Demirjian method. Skeletal Development of the Hand and Wrist: A Radiographis Atlas and Digital Bone Age Companion. Effect of a gluten-free diet on bone mineral density in children with celiac disease. Bone age assessment can be of utmost importance in various complicated situations involving medical, surgical, forensic, and legal issues. It is administered through daily injections over several years. Growth Horm IGF Res. Schlesinger S, MacGillivray MH, Munschauer RW. Br J Radiol. These include lifestyle factors such as diet, exercise, activity level and history of illness or injury. [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. [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. Chronological age vs. bone age in 169 children with Cystic Fibrosis Dots under the line represented a delay in bone age. [7][8][16], The two most common techniques for estimating bone age are based on a posterior-anterior x-ray of a patient's left hand, fingers, and wrist. Rofo. [8][16], An atlas based on knee maturation has also been compiled. 92. Acta Paediatr Scand. Int J Paediatr Dent. The best time to start and stop such therapies can be determined based on a patient's bone age. 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. Likewise, some pathological clinical diseases such as ovarian tumors, Leydig cells or germ cells, as well as adrenal tumors or adrenal diseases (e.g., congenital adrenal hyperplasia) (5255) are typically associated with excessive production of pubertal hormones that cause a rapid progression of bone age, thus advanced bone maturation. Herman TE, Crawford JD, Cleveland RH, Kushner DC. doi: 10.1056/NEJMoa064725, 62. King DG, Steventon DM, O'Sullivan MP, Cook AM, Hornsby VP, Jefferson IG, et al. 102. 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. For specific medical advice, diagnoses, and treatment, consult your doctor. Growth and development: congenital adrenal hyperplasia-glucocorticoids and height. [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. De Martino M, Galli L, Chiarelli F, Verrotti A, Rossi ME, Bindi G, et al. (2012) 216:200 e14. J Forensic Dent Sci. doi: 10.1159/000101336, 25. doi: 10.1002/ajhb.1310010206, 126. Sustained decrease in bone-age-to-chronological-age (BA:CA) ratio through 5 years 3 Mean BA:CA ratio decreased throughout the study; . Chaillet N, Nystrom M, Demirjian A. In the latest episode of our podcast series, Jessica L. Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN shares why she got into medicine, the myths of pediatric, and what the future may hold for the specialty. 4 March 12, 2021. Am J Orthod Dentofacial Orthop. After puberty, all carpals, metacarpals, and phalanges are completely developed, their physes are closed, and the assessment of skeletal maturity is based on the degree of epiphyseal fusion of the ulna and radius (8082). Skeletal age estimation for forensic purposes: a comparison of GP, TW2 and TW3 methods on an Italian sample. Ann Hum Biol. doi: 10.1016/j.forsciint.2007.02.023. Basel; Freiburg; Paris; London; New York, NY; New Delhi; Bangkok; Singapore; Tokyo; Sydney, NSW: Karger Publishers (2002) doi: 10.1159/isbn.978-3-318-00778-7. 9:580314. doi: 10.3389/fped.2021.580314. As kids grow, their growth plates look thinner on X-rays and eventually disappear (called "closed growth plates"). J Clin Endocrinol Metab. Over the years, practitioners have tried to assess bone age by ultrasound. doi: 10.1002/ajpa.1330180309, 81. Numerous scales have been produced that can convert bone maturity score into bone age for different European and non-European populations (7, 114119). Aust Orthod J. Condo R, Costacurta M, Maturo P, Docimo R. The dental age in the child with coeliac disease. doi: 10.1210/jc.82.5.1603, 86. 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. Pathologic causes of short stature include chronic diseases; growth hormone deficiency; and genetic disorders, such as Turner syndrome. 48. Ossification centers are defective, appearing in an irregular and mottled pattern, with multiple foci that coalesce to give a porous or fragmented appearance. 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. Cambridge. Each bone segment begins its maturation first in the primary ossification center and then, through different stages of enlargement and remodeling, reaches the final shape; many bones, like long bones, have many centers of maturation (epiphysis). The remaining cartilaginous portions of the epiphyses become thinner. doi: 10.1210/er.2015-1106, 20. 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. Over the years, numerous standardized methods have been developed to evaluate a skeletal maturity score for the hand and wrist radiographs (3, 5, 9092). In our opinion, this method could be useful also to obtain information about: defects in condrogenesis and/or osteogenesis (commonly found in hypochondroplasia); irregularity of metaphyseal regions and enlargement of the metaphyseal region of the ulna and of the radius (commonly found in subjects with rickets or metaphyseal chondrodysplasias); shortening of the fourth metacarpus, triangularization of radius distal epiphysis, pyramidalization of carpus distal line, or translucency of radius (commonly found in LeriWeil and Turner Syndrome); shortening of the fourth and fifth metacarpus (commonly found in pseudohypoparathyroidism); Harris lines (expression of a temporary arrest of long bones growth); and. They look darker on the image. This chart depicts bone age as compared with chronological age in boys. Figure 2 is an algorithm for the evaluation of tall stature.19 Although the percentage of children with tall stature is equal to that of children with short stature, children with tall stature are much less likely to be referred to subspecialty care. At birth, long bones present different centers of ossification that proliferate continuously until the terminal or epiphyseal part of the bone melt definitively with the diaphyseal one. Accessed November 22, 2021. https://kidshealth.org/en/parents/xray-bone-age.html, 2. The inability to be applied in children younger than 6 years or to perfectly match (equal to 100%) the images or to weigh the differences between bone structures (short and long) represents the main disadvantages of the procedure. Recent data on pubertal milestones in United States children: the secular trend toward earlier development. Wong SC, Smyth A, McNeill E, Galloway PJ, Hassan K, McGrogan P, et al. [1][14][23], The bones in the hand a wrist in a newborn do not change much in the first year of life. 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). 2nd ed. Different population groups mature at different speeds. It is important that not a simple comparison but an in-depth bone-by-bone evaluation is needed in order to properly characterized bone maturation. doi: 10.1359/jbmr.1998.13.3.500. (2000) 12:6105. Bone growth estimation using radiology (GreulichPyle and Tanner-Whitehouse Methods). (2003) 23:2942. 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. In a recent poll, only 1 in 5 parents believed it is unsafe for children to take medicine past its expiration date, while many did not know how to properly dispose medicine. Arq Bras Endocrinol Metabol. Roche AF, Rohmann CG, French NY, Davila GH. | 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, | Update in Pediatric COVID-19 Vaccines, https://kidshealth.org/en/parents/xray-bone-age.html. doi: 10.1515/JPEM.1994.7.2.141, 129. Factors influencing skeletal maturation at diagnosis of paediatric Cushing's disease. In addition, 11 patients with multiple scans at different ages were assessed for change in CH with age. Moreover, weight gain and obesity are one of the most important causes of pediatric advanced bone age; the mechanisms underlying these alterations are not fully clarified, although insulin resistance and hormonal factors produced by adipose tissue might play an important role (50, 51). doi: 10.1097/MPG.0000000000000848, 57. In some psychiatric conditions, such as anorexia and in subjects with states of psychosocial stress or abuse, the presence of delayed skeletal maturation is documented (4345). GH treatment and its effect on bone mineral density, bone maturation and growth in short children born small for gestational age: 3-year results of a randomized, controlled GH trial. They add length and width to the bone. Buckwalter JA, Einhorn TA, Simon SR. Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. The Khamis-Roche Method predicts adult stature, without determining the bone age. Search terms included short stature, tall stature, and growth hormone. A number of factors can help determine your body age. (1970) 108:5115. (2008) 18:21723. Reliability of the methods applied to assess age minority in living subjects around 18 years old. 2019;29(6):2910-2923. doi:10.1007/s00330-018-5792-5. IEEE Trans Med Imaging. Then, the final report is done, making an average of the measurements. Growth in atopic eczema. Accuracy of two dental and one skeletal age estimation methods in 6-16 year old Gujarati children. doi: 10.1080/03014468700009141, 118. Clin Immunol. Tables are provided for ages 718 years. There are extremes to be mindful of, Kutney added. (2008) 122:30914. doi: 10.1080/03014469700004982, 120. History and physical examination findings should guide further evaluation for pathologic causes of short and tall stature. Each of the bones that is evaluated is compared to a standard set of bones at different stages of maturation. The keywords for the research have been bone age and skeletal maturation.. Lin NH, Ranjitkar S, Macdonald R, Hughes T, Taylor JA, Townsend GC. Loder RT, Estle DT, Morrison K, Eggleston D, Fish DN, Greenfield ML, et al. They can be seen on an X-ray because they're softer and contain less mineral, making them appear darker on an X-ray image than the rest of the bone. 73. 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 . The bone ages of hand and elbow were different at puberty, and the elbow was a more reliable location for bone-age assessment at puberty. Bone age (BA) is a measure of the skeletal maturity of an individual and tells us about the growth potential of a child. All authors contributed to manuscript revision and read and approved the submitted version. Br J Sports Med. The CDC and WHO growth charts are available at http://www.cdc.gov/growthcharts/ and http://www.who.int/childgrowth/standards/en/. 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. 5. Powell SG, Frydenberg M, Thomsen PH. [3] If a patient's x-ray is found to be very close in appearance to two contiguous images in the atlas, then an average of the chronological ages in the atlas may be used as the patient's bone age, although some evaluators choose to interpolate the closest age while others report a range of possible bone ages. doi: 10.1016/S0022-3476(78)81071-3, 139. (2008) 134:21726. N Engl J Med. Berlin; Heidelberg. Eur J Paediatr Dent. [29] A girl has reached 99% of her adult height at a bone age of 15 years and has a small amount of height growth left from this point on. Olesen T, Egeblad M, Dige-Petersen H, Ahlgren P, Nielsen AM, Vesterdal J. Somatic manifestations in children suspected of having been maltreated. Thus, gender-specific images are compared with the one obtained by patients by evaluating first the nearest chronological age and subsequently the adjacent standards. Acta Paediatr. At birth, only the metaphyses of the "long bones" are present. [5][9] The first atlas published in 1898 by John Poland consisted of x-ray images of the left hand and wrist. A score is assigned to each bone based on maturation and sex of the patient. Skeletal maturation is based on the activation and interaction of a complex series of physiological mechanisms. doi: 10.1590/S0004-27302007000300021, 64. Biological maturation of youth athletes: assessment and implications. A difference between a child's bone age and their chronological age might indicate a growth problem. A survey on a Moroccan origin population. Bone age delay is also associated with genetic syndromes such as trisomy 21, Turner syndrome, and RussellSilver syndrome (10, 4648). For children with idiopathic short stature, four years of treatment results in an increased height of 3.7 cm (1.46 in) and costs between $100,000 and $120,000.25,26, Oxandrolone (Oxandrin) is an oral anabolic steroid that has been shown to increase height velocity but has little effect on final height. Arntzenius A, van Galen L. Budesonide-related adrenal insufficiency. Haffner D, Nissel R. Growth and puberty in chronic kidney disease. Ostojic SM. medicolegal cases). Gilsanz RO. As growth nears conclusion and attainment of adult height, bones begin to approach the size and shape of adult bones. The bone age/chronological age ratio decreased significantly to 1.120.1 at the end of treatment (P<0.05). 47. basis of physical characteristics such as height, weight and general body shape and a comparison of the results with growth curves [9,20]. Constitutional advancement of growth in tall children is the equivalent of constitutional delay of growth and puberty in short children.1,19,20 Children with constitutional advancement of growth have accelerated growth until two to four years of age and then track parallel to the growth curve. Using an atlas-based method gives a great possibility of intra- and interoperator variability (142). When do boys stop growing? Thiago O, Artiol MA, Alvares VS. [12] The Greulich and Pyle atlas contains x-ray images of the left hands and wrists of different children deemed to be good models of the average appearance of the bones of the hand at a given age. (1987) 14:35765. Garamendi PM, Landa MI, Ballesteros J, Solano MA. BA/CA, bone age divided by chronological age. A renal anomaly? Assessing bone age is also important to predict adult height. The bibliographies of review articles and textbook chapters were also reviewed for original research articles. Kim JR, Lee YS, Yu J. Peters CJ, Ahmed ML, Storr HL, Davies KM, Martin LJ, Allgrove J, et al. United Nations Treaty Collection. X-ray exam: bone age study. (1960) 18:21930. Genetic potential is determined by mid-parental height, which is calculated by averaging sex-adjusted parental heights.Kutney shared the following examples. During puberty, the contours of the epiphyses begin to overlap, or cap, the metaphyses. (2016) 29:3118. Forensic Sci Int. Data obtained by hand and wrist radiography during bone age assessment are also used in many nonmedical fields for example in sports (64) and for national policy in many countries (10). Figure 1. doi: 10.1297/cpe.24.143, 9. The middle finger axis should be in line with the forearm axis, and the center of the X-ray tube should be over the distal end of the third metacarpus. Age determination in refugee children: A narrative history tool for use in holistic age assessment. defects in bone mineralization process (commonly found in osteochondrodysplasia). Arthritis Res Ther. Since bone age measurements are inherently approximations, they are conventionally reported with a standard deviation which serves as an estimate of the associated error. Interleukin-6 release by cultured peripheral blood mononuclear cells inversely correlates with height velocity, bone age, insulin-like growth factor-I, and insulin-like growth factor binding protein-3 serum levels in children with perinatal HIV-1 infection. Evaluation for pathologic etiologies is guided by history and physical examination findings. doi: 10.1111/jog.12181, 18. J Obstet Gynaecol Res. (2007) 92:3712. (2012) 102:1742. (2009). doi: 10.1111/j.1651-2227.1975.tb03936.x. Arch Dis Child. Short stature is defined as a height more than two standard deviations below the mean for age, or less than the 3rd percentile. 83. 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. Spec Care Dentist. Tanner-Whitehouse method of assessing skeletal maturity: problems and common errors. When the bone age reaches 16 years in females and 18 years in males, growth in height is over, and they have reached their full adult height. doi: 10.3109/03014460.2015.1032349, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain. Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Bone age for chronological age determination - statement of the European Society of Paediatric Radiology musculoskeletal task force group Authors 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. I NTRODUCTION. 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). [1 2 3]The two major methods of BA assessment used commonly are i . (2012) 223:372 e14. These characteristics are mainly documented in large cartilaginous centers, such as the head of the femur, head of humerus, and the tarsal navicular bone and are known as stippled epiphyseal dysgenesis. Gaskin CM, Kahn SL, Bertozzi JC, Bunch PM. Pietka E, McNitt-Gray MF, Kuo ML, Huang HK. The long-term effects of protein energy malnutrition in early childhood on bone age, bone cortical thickness and height. doi: 10.1046/j.1365-2265.2003.01905.x, 50. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Garn SM, Rohmann CG. Pediatrics. J Adolesc Health Care. High intake of phytoestrogens and precocious thelarche: case report with a possible correlation. In premature babies, there is often a delayed skeletal maturation (49). (2015) 61:1903. (1996) 45 Suppl 2:535. 135. Puberty onset according to elbow occurred slightly earlier than expected. There is a chart for males and another for females with possible bone ages ranging from 1 month to 5 years. Pinchi V, De Luca F, Ricciardi F, Focardi M, Piredda V, Mazzeo E, et al. Br Med Bull. are guided by the child's expected growth. (2015) 173:63342. Children's bones have areas of new bone growth called growth plates at both ends. 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. Constitutional delay of growth and puberty is one of the most common causes of delayed bone age (10). J Pediatr. This method is valid for children above the age of 4. [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. In children, bone age serves as a measure of physiological maturity and aids in the diagnosis of growth abnormalities, endocrine disorders, and other medical conditions. 28. 114. Further, there can be moderate levels of variability in the bone ages assigned to the same patient by different assessors. J Bone Miner Res. doi: 10.1111/j.1651-2227.1988.tb10615.x, 46. Pediatr Endocrinol Rev. In: Geary DF, Schaefer F, editors. Constitutional Delay of Growth and Puberty. (2014) 23:2734. 9 Articles, This article is part of the Research Topic, Standardization of Hand and Wrist Radiography, Assessment Methods for Evaluating Bone Age, Computerized Automatic Systems for Reading Bone Age: Potentials and Limits, Relevance of the Variability Related to the Operator and Between the Operators, https://treaties.un.org/Pages/ViewDetails.aspx?src=IND&mtdsg_no=IV-1&chapter=4&clang=_en, http://www.ice.gov/doclib/foia/dro_policy_memos/agedeterminationproceduresforcustodydecisionsaug202004.pdf, http://www.unhcr.org/publications/legal/3d4f91cf4/guidelines-policies-procedures-dealing-unaccompanied-children-seeking-asylum.html, https://www.rch.org.au/immigranthealth/clinical/Birth_date_issues/, www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests, Creative Commons Attribution License (CC BY), Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy. doi: 10.1080/03014469000001142, 117. Instead, the variability among different operators (intervariability) is defined by the degree of variability in the interpretation of same data made by two different operators at the same time. High-dose sex steroids have been used to promote growth plate closure, but use has decreased over the past 20 years because of adverse effects.28 Surgical destruction of the growth plates has also been performed, but this procedure is controversial. The long bones of the leg comprise nearly half of adult height. The effects of long-term medication on growth in children and adolescents with ADHD: an observational study of a large cohort of real-life patients. [4] Other uses of bone age measurements include assisting in the diagnosis of medical conditions affecting children, such as constitutional growth delay, precocious puberty, thyroid dysfunction, growth hormone deficiency, and other causes of abnormally short or tall stature. doi: 10.1016/j.forsciint.2014.02.030. doi: 10.1118/1.598153. However, the GP method requires a continuous and long experience in order to optimize bone age determination. Dense body parts, such as bones, block the passage of the X-ray beam through the body. Zafar AM, Nadeem N, Husen Y, Ahmad MN. Growth Hormone Deficiency. In these normal boys, the chronological age at onset of puberty was 11.4 0.8 years (mean S.D.). Just as there is wide variation among the normal population in age of losing teeth or experiencing the first menstrual period, the bone age of a healthy child may be a year or two advanced or delayed.