I. What is bone age?
Human growth and development can be expressed in two “ages”, namely physiological age (calendar age) and biological age (bone age). The growth of a person’s height depends more on the growth of the skeleton than on the biological age alone. Bone age is short for skeletal age and is determined with the help of a specific image of the bone in an X-ray camera. When it comes to understanding a person’s bone age, the wrist contains a large concentration of long, short and round bones that reflect the growth and maturation of the whole body, and is easy to use and accurate in its conclusions. Usually, an X-ray of the left wrist is taken to observe the development of the metacarpal phalanges, carpal bones and the ossification center of the lower radius and ulna of the left hand to determine the bone age.
Second, the significance of determining bone age
In general, the bone age of children is consistent with their actual age. However, in disease states, the bone age is often inconsistent with the actual age.
The changes of human bone development are basically similar, and the development process of each bone has continuity and stages. Bones at different stages have different morphological characteristics; therefore, bone age assessment can more accurately reflect the level of growth and maturity of an individual. It not only can determine the biological age of children, but also can understand the growth potential of children and the trend of sexual maturity through bone age at an early stage, and the height of children in adulthood can be predicted through bone age, and the determination of bone age is also very helpful for the diagnosis of some pediatric endocrine diseases.
Methods of measuring bone age
The most commonly used methods are G-P atlas and TW2 (TW3) scoring method; the prediction of adult height includes B-P method, RWT method, TW2 method and so on. In recent years, a new BonAge ultrasound technique for bone age assessment has been developed in Israel, which has no radiation effect and the results are not subjectively influenced by physicians.
Fourth, the disease of abnormal bone age
1.The difference between bone age and age (SA-CA) ± 1 year or less is called normal development.
2.The difference between bone age and age (SA-CA) > 1 year is called early development (precocious).
3.The difference between bone age and age (SA-CA) <1 year is called developmental lag (late maturity).
Abnormalities in bone age are often an aspect of certain endocrine disorders manifested in pediatrics. Many diseases will affect skeletal development, either making it earlier or making it later, such as adrenocortical hyperplasia or tumor, Alreb-ert syndrome, precocious puberty, hyperthyroidism, and ovarian granulosa cell tumor will lead to earlier bone age; while ovarian hypoplasia (Turner syndrome), chondrodysplasia, and hypothyroidism will lead to significantly later bone age.
V. Bone age measurement to predict height
There is an extremely close interrelationship between bone age and children’s height, and the height at each age and the height in adulthood have a high correlation. Therefore, based on the current bone age, it is possible to predict the margin of continued possible height growth. For prediction, the current height and bone age are required to be entered, and for girls, whether they are menstruating or not. Different prediction formulas were then used to calculate adult height.
It is important to note that because of the many factors that affect height, the prediction formulas cannot take all factors into account, regardless of the method used to predict. Moreover, after each prediction, many factors such as nutrition, disease, and environment of the predicted subjects cannot be predicted. Although these prediction methods have some scientific basis, the error of height prediction is always inevitable. However, the trend reflected by the predicted results is not wrong.
Sixth, the causes of short stature
One is somatic short, the bone age and life age are the same, which is considered normal development.
Second, bone age is less than life age, which refers to abnormal growth and development of children, and there are many causes of such abnormalities. Once the cause is determined, it can be treated symptomatically.
The same is true for short stature as the main manifestation, primary dwarfism, familial dwarfism, intrauterine growth retardation and somatic pubertal growth retardation, which can be difficult to identify clinically. The diagnosis of primary dwarfism, familial dwarfism, and familial dwarfism can be made by determining the bone age and predicting adult height and combining them with medical history. is basically the same as the height age, and the predicted adult height is not low.
In the case of children with precocious puberty or early puberty, their bone age is often older than their actual age. This advancement in bone age means a loss of time for children to grow taller and to a lifelong short stature in adulthood. This is because sex hormones have an obvious role in promoting epiphyseal closure and increasing bone age.
Seven, the way to grow taller
Children’s scientific height increase needs to start from reasonable nutrition, appropriate amount of exercise, sufficient sleep, eat more pure sterilized milk, fruits and vegetables and other foods to ensure adequate and comprehensive nutrition, participate in more swimming, basketball, jogging, rope skipping, stair running and other sports, and ensure sufficient sleep.
If you really think your child needs to be taller, you should go to the pediatric department of a regular hospital in time to consult with a doctor who will determine whether artificial intervention, i.e. growth hormone therapy, is needed, and you should not blindly rely on various height-enhancing supplements, height-enhancing drugs and height-enhancing devices. Because some of these height enhancers contain some sex hormone ingredients, sex hormones have the effect of promoting growth, while the maturation of the child’s bone age is accelerated, thus delaying the best time for the child’s growth and development, which is often more than worth the loss.
1.Bone age is used to evaluate the growth and development status.
In addition, the bone development of children from different regions and races generally follows the same rules, and only the speed is slightly different; therefore, the evaluation of development by bone age is both objective and comparable, that is, bone age can more accurately reflect the real biological development level of the body.
The difference between bone age and age (SA-CA) is used as a benchmark to classify the developmental status of children into: early maturity (SA-CA) ≥ 1 year, average (SA-CA) = ± 1 year, and late maturity (SA-CA) < 1 year. It can be found that if all conditions are equal, late maturity has a greater potential for height gain.
The growth spurt period is a period of rapid acceleration of physical development and skeletal development in young children before puberty comes, due to the endocrine effect, which indicates the imminent arrival of puberty.
2.Bone age can be used to evaluate the status of pubertal growth spurt.
(1) Early.
① The pea bone ossification center has just appeared.
(2) The epiphysis of the distal radius and each metacarpal finger bone is as wide as the corresponding epiphysis.
(2) Peak stage.
(① the medial seed bone of the thumb has appeared.
(ii) the epiphysis of the distal radius and the metacarpal phalanges are wider than the corresponding epiphysis and covered, and the epiphysis becomes narrower.
(3) The first metacarpal epiphysis and the epiphysis begin to fuse.
(3) Late stage: the epiphysis of the second and third uncinate fingers and the epiphysis begin to fuse. Orthopedic surgery needs to be combined with skeletal development in the selection of the surgical period. The oral orthopedics of malocclusion should generally be performed before the beginning of the growth spurt because the jaws grow fastest during the growth spurt; epiphyseal fixation to stop the growth of lower limbs in children with unequal limbs should be selected after the growth spurt; the correction of scoliosis should be performed after the bones have stopped developing.
(4) Prediction of menarche time: menarche is an important sign of female pubertal development, the age of menarche time in this century is 3-4 months earlier every 10 years, from the 70s to the 90s, more than one year earlier every 10 years, but the age of menarche bone are relatively stable, the study of bone age provides a better basis for the prediction of menarche time.
(5) Commonly used prediction methods are.
(i) Bone age averaging method: menarcheal bone age = 13.5 ± 0.29 (12.6 – 14.2) years.
(②Marshall regression equation: age at menarche = 13.3-0.68 (SA-CA) years, SD = 0.656 years.
③Visual method: If the first metacarpal and the second and third unsegmented phalanges are basically fused, the likelihood of menarche occurring within 6 months is high.
VIII. Typical characteristics of bone age and growth and development
1.Girls:
(1) Period of sudden increase in height: skeletal age 11-13 years.
(2) puberty: the first menstrual period (first menstruation) occurs about the 9th month after the age of 11 years of bone.
(3) The period of stopping height growth: the age of bone is 17.3 years.
2.Boys:
(1) Period of sudden increase in height: 13-15 years of bone age.
(2) puberty: change of voice, axillary hair, beard and protruding laryngeal nodes appear about the 9th month after the age of 13 years of bone.
(2) Cessation of height growth: 18.4 years of age.