Paediatric Growth Workbook

Case 6

Bone age

The growth status of bones can be used to make an assessment of bone age.

The numerous hand and wrist bones provide multiple sites for comparison of a child’s X ray with standard X-rays recorded in an assessment Atlas/standard.

The assessment utilises the different ossification centres in the wrist and the different timing over which this process is expected to occur.

Image by Trace Meek from Flickr, used under Creative Commons license.

Bone age is necessary:

in the diagnosis of Familial Short Stature and Constitutional Growth Delay;
for interpreting hormone levels in pubertal age;
for diagnosis of precocious puberty or hyperandrogenism;
for deciding whether to treat or not the above mentioned conditions;
for predicting adult height in normal children.

Bone age is useful:

in evaluating any child with growth and/or puberty disorders;
in deciding the time to start replacement therapy in hypogonadism;
in monitoring children on growth hormone therapy.

Bone age can be misleading:

in evaluating children with disorders of bone mineralization;
in predicting adult height in pathological conditions;
if considered an absolute diagnostic marker;
if, during the follow-up of a patient or in comparing groups of patients, different readers are involved or different methods are employed.

References

Usefulness of bone age in Paediatric Endocrinology. Spadoni GL, Cianfarani S.