The next version (TW3) takes into consideration only RUS bones, and it can be used through a software. Br J Sports Med. Acceleration of growth and bone maturation in childhood thyrotoxicosis. Assessment of a patient's bone age is used in pediatric medicine to help determine if a child is growing normally. Am J Clin Nutr. (2010) 6:145. Since bone age measurements are inherently approximations, they are conventionally reported with a standard deviation which serves as an estimate of the associated error. Sweden Begins New Asylum Seeker Age Assessment Tests. doi: 10.1016/S0022-3476(73)80481-0, 19. The other primary skeletal component of height is the spine and skull. Thodberg HH. (1998) 49:3740. Bone maturation along the spectrum from normal weight to obesity: a complex interplay of sex, growth factors and weight gain. Note: All information on KidsHealth is for educational purposes only. The most common measurement standards used for bone age are the Greulich and Pyle Atlas2 and the Tanner-Whitehouse3 assessments.4. Horm Res. doi: 10.1016/j.jpeds.2013.11.065, 23. 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: 10.1055/s-2000-3766, 89. As a child grows the epiphyses become calcified and appear on x-rays, as do the carpal and tarsal bones of the hands and feet, separated on x-rays by a layer of invisible cartilage where most of the growth is occurring. (2016) 170:16370. Mentzel HJ, Vilser C, Eulenstein M, Schwartz T, Vogt S, Bottcher J, et al. Conclusion: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. (1987) 8:4708. 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. The probe is made up of two portions: the first one that emits radiofrequencies (750 kHz) that are directed against the surface of ulna and the radio epithelium and the second probe that receives radiofrequencies. doi: 10.1016/j.jpeds.2008.08.018, 137. Hand radiographs in Russell-Silver syndrome. Morla Baez E, Dorantes Alvarez LM, Chavarria Bonequi C. Growth in children with diabetes insipidus. But perfectly healthy kids also can have bone ages that differ from their actual ages. Samadi M, Rashid RJ, Ghaffari S, Shoaran M. Study on bone age in pediatric patients with congenital heart disease and its relation with cyanosis and pulmonary artery pressure. Int Clin Psychopharmacol. It is based on a computerized system obtained from a series of measurements provided by a large reference population. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the child's measurements with existing standards. A number of factors can help determine your body age. [3] Large differences between a person's bone age and their chronological age may indicate a growth disorder. In a study conducted by King and collaborators in which bone aging was performed by three different operators using either GP or TW method, there was a significant intraindividual variability with values equal to 0.96 and 0.74 years, respectively (94). a systematic review and meta-analysis. Garamendi PM, Landa MI, Ballesteros J, Solano MA. (2010) 23:85561. | Do we take RSV disease seriously enough? Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute or chronic diseases, including endocrine dysfunction (39). doi: 10.1007/s00247-004-1385-3, 136. In this study of prepubertal children with and without obesity and/or PA, obesity was highly associated with BA advancement. When hypothyroidism is acquired during growth, secondary centers of ossification are predominantly affected, with delayed fusion of epiphysis and with an irregular and heterogeneous ossification. In these normal boys, the chronological age at onset of puberty was 11.4 0.8 years (mean S.D.). doi: 10.1016/S0022-3476(95)70347-0, 12. Figure 1. [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. (1998) 13:5007. Am J Hum Biol. [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. However, there are several caveats to the diagnosis of constitutional delay of growth. (2010) 7:26674. ( p =0.67). King DG, Steventon DM, O'Sullivan MP, Cook AM, Hornsby VP, Jefferson IG, et al. 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. 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). Health Phys. [1 2 3]The two major methods of BA assessment used commonly are i . United Nations Treaty Collection. (1995) 126:54550. (1994) 331:62936. Tanner JM, Gibbons RD. Chronological age versus bone age for boys. In fact, bone age can provide important information for athletes in order to distribute physical, human, and monetary resources properly (6567). doi: 10.1109/42.108597, 128. Guidelines on Policies and Procedures in Dealing With Unaccompanied Children Seeking Asylum. Author disclosure: No relevant financial affiliations. Congenital adrenal hyperplasia. Bone age assessments can provide pediatricians with a rough estimate of when a child will enter puberty, Kutney stated. Ann Hum Biol. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). Childrens bones have areas of new bone growth called growth plates at both ends. Tanner JM, Cameron N, Marshall WA, Healy MJ, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height. Medical treatment, either oral or dermal, can affect pubertal effects on bone age. (2018). Sperlich M. Final height and predicted height in boys with untreated constitutional growth delay. 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. Massarano AA, Hollis S, Devlin J, David TJ. 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. 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. [3] In certain instances, abnormal growth conditions may be treated with supplemental hormone therapy. History and physical examination findings should guide further evaluation for pathologic causes of short and tall stature. (2005). Using multivariate linear regression analysis, we determined the relationship of CH to age, sex, and HL type. Table 6 includes the differential diagnosis of tall stature. Ann Hum Biol. Images of hand and wrist x-rays in four female subjects compatible with physiological skeletal maturation in different ages: A (4 years), B (8 years), C (12 years), D (16 years). J Pediatr. Among them, the most used is based on the tables developed by Bayley and Pinneau in 1946 and revised in 1959. Issues and advances in adolescent growth and development. Ahmed ML, Warner JT. Deviations from these patterns, or other signs of delayed bone growth need to be investigated by a specialist, Kutney stated. Cameron N. Can maturity indicators be used to estimate chronological age in children? 83. 29. [24] Since most of the ossification centers counted using this technique appear early in life, this method is only valid for measuring bone age up to around 5 years of age. Horm Res. (1987) 14:35765. 6. (1988) 77:15460. Constitutional delay of growth and puberty is one of the most common causes of delayed bone age (10). Taranger J, Karlberg J, Bruning B, Engstrom I. An X-ray of the left hand and wrist will measure your child's bone age. Olesen T, Egeblad M, Dige-Petersen H, Ahlgren P, Nielsen AM, Vesterdal J. Somatic manifestations in children suspected of having been maltreated. doi: 10.1088/0952-4746/23/1/302, 88. Tanner JM WR, Cameron N, Marshall WA, Healy MJR, Goldstein H. Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 Method). 4 Br J Radiol. Available online at: www.thelocal.se/20170307/sweden-begins-newasylum-seeker-age-assessment-tests. (2014) 16:424. doi: 10.1186/s13075-014-0424-1, 34. They look darker on the image. Moreover, a deficit of thyroid hormones or an excess of corticosteroids causes a cell division reduction in the proliferation zone, inducing a growth delay. doi: 10.1136/adc.68.5.677, 37. Discussion. Prepubertal gynecomastia linked to lavender and tea tree oils. . All rights reserved. Using an atlas-based method gives a great possibility of intra- and interoperator variability, so in the last 20 years, new methods have been studied such as computerized automatic systems. It is important to highlight that all the available methods might be carefully used in the daily clinical approach in order to avoid unreliable expectation in children and parents. Horm Res. doi: 10.1359/jbmr.1998.13.3.500. Lin NH, Ranjitkar S, Macdonald R, Hughes T, Taylor JA, Townsend GC. The applicability of Greulich and Pyle atlas to assess skeletal age for four ethnic groups. The main advantage of this procedure related to the evaluation of each bone segment, thus minimizing the interoperator variability. (2013) 54:10249. It uses age, gender, child height and weight, mother height, and father height. TW2 and TW3 bone ages: time to change? See permissionsforcopyrightquestions and/or permission requests. Multiple regression equations for predicting the adult height of boys and girls from height and bone age at ages 4 and upwards are presented. Speiser PW, White PC. 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. doi: 10.1111/j.1754-4505.2008.00020.x. Gastroenterol Clin Biol. doi: 10.1111/j.1365-2605.2005.00575.x, 17. 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 . Acta Radiol. Exercise before puberty may confer residual benefits in bone density in adulthood: studies in active prepubertal and retired female gymnasts. (1973) 83:2336. Ann Hum Biol. Separate tables are used for boys and girls because of the sex difference in timing of puberty, and slightly different percentages are used for children with unusually advanced or delayed bone maturation. The presence of hypogonadism with the consequent lack of circulating estrogens, androgens, and other pubertal hormones may cause an important delay in bone maturation during pubertal period (2025). De Martino M, Galli L, Chiarelli F, Verrotti A, Rossi ME, Bindi G, et al. Pediatr. Clin Pediatr Endocrinol. Look for a Mllerian anomaly as well. (1987) 79:7434. In adolescence, growth is affected by the onset of puberty, and sex hormones become the predominant factor in growth. These tables have been formulated on bone age assessment according to the standards of Greulich and Pyle. Bone age in the 21st century: is Greulich and Pyle's atlas accurate for Israeli children? (2009) 94:223944. (2009) 154:2437. J Forensic Dent Sci. doi: 10.1016/S0022-3476(52)80205-7, 138. Similarly, an excessive intake of foods containing phytoestrogens such as soya, according to some studies, may have an effect on bone age progression (5663). [39] Liver weight increases with age and is different between males and females. Bone growth estimation using radiology (GreulichPyle and Tanner-Whitehouse Methods). Kapadia CR, Nebesio TD, Myers SE, Willi S, Miller BS, Allen DB, et al. 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). A survey on a Moroccan origin population. 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. (2007) 173:14653. 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). In particular, bone age is more advanced in female than in male individuals with the same chronological age. After dividing the population into two different age groups: children < 11 years and adolescents 11 years, children showed an average delay in bone age of 3.4 months and adolescents of 2.4 months. (2005) 32:31625. (2005) 50:116474. Each of the bones that is evaluated is compared to a standard set of bones at different stages of maturation. Moreover, the score based on 20 bone segments was abolished, and the reference values and the graphs were modified and based on data obtained from native North American children. By contrast, subjects with hyperthyroidism may present precocious puberty associated with advanced bone age (18, 19). If a child has bone age 10 years, it means that the child maturation is as advanced as the average of the 10-year old children from Ohio in 1930-1940 that Greulich and Pyle studied. [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. 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). 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. If bone age reading is performed with the TannerWhitehouse method, there are some equations proposed by Tanner to calculate growth prognosis (10, 122, 123). In fact, if a simple comparison is made, it is likely inadequate when the proximal and distal bones vary in maturation, sometimes by several years. doi: 10.1001/jamapediatrics.2015.3526, 59. No use, distribution or reproduction is permitted which does not comply with these terms. The X-ray image is black and white. Birth Date Issues. 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. Tall stature is defined as a height more than two standard deviations above the mean for age (greater than the 97th percentile). 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. The chronological age for confirming puberty onset using the elbow was 12.2 years in boys and 10.3 years in girls. doi: 10.1093/qjmed/hcs230, 66. (2017) 37:1925. Patil ST, Parchand MP, Meshram MM, Kamdi NY. Table 5 lists the indications for referral.2,6,22. (2015) 61:1903. Tanner J, Oshman D, Bahhage F, Healy M. Tanner-Whitehouse bone age reference values for North American children. 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. Bone age assessment can be of utmost importance in various complicated situations involving medical, surgical, forensic, and legal issues. Linklater A, Hewitt JK. Sustained decrease in bone-age-to-chronological-age (BA:CA) ratio through 5 years 3 Mean BA:CA ratio decreased throughout the study; . doi: 10.1097/MPG.0000000000000848, 57. 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). 1988, $57.50. 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. (2012) 223:372 e14. J Bone Miner Res. Therefore, chronological age differs from bone age, so the two indexes need to be distinguished: chronological age is defined as the age in years between birth and the evaluation of a subject; bone age is defined by the age expressed in years that corresponds to the level of maturation of bones. Cavallo F, Mohn A, Chiarelli F, Giannini C. Evaluation of bone age in children: a mini review. Ranjitkar S, Lin NH, Macdonald R, Taylor JA, Townsend GC. Bone age may be significantly advanced in genetic overgrowth syndromes, such as Sotos syndrome, Beckwith-Wiedemann syndrome and Marshall-Smith syndrome. Several smartphone applications have been developed to facilitate the use of vertebral methods such as Easy Age. Bone age is distinct from an individual's biological or chronological age, which is the amount of time that has elapsed since birth. Int J Paediatr Dent. IEEE Trans Med Imaging. Next, the scores for all evaluated bones are compiled into a sum, and that sum is correlated to bone age through a lookup table for males or females depending on the sex of the patient. New MI. Over the years, this system has been refinished by moving from an initial system known as TannerWhitehouse method 1 (TW1) to two subsequent methods known as TannerWhitehouse 2 (TW2) and 3 (TW3) (3, 113, 114). (1997) 82:16037. 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. p. 70932. 2 ). Several authors have proposed different algorithms for predicting adult height. doi: 10.3348/kjr.2015.16.1.201, 100. (2012) 101:47. Factors influencing skeletal maturation at diagnosis of paediatric Cushing's disease. Bone age is measured in years and assigned by a trained radiologist or endocrinologist by comparing the childs measurements with existing standards. Standard deviation score charts of skeletal maturity and its velocity in Swedish children assessed by the Tanner-Whitehouse method (TW2-20). [1][2], Bone age acts as a surrogate for physiological development because growth and maturation of the skeletal system depend on the presence of hormones like growth hormone, sex steroids (e.g., estrogen and testosterone), and thyroxine. doi: 10.1016/B978-0-323-04883-5.50052-0, 43. Huda W, Gkanatsios NA. 2nd ed. J Forensic Sci. Haffner D, Nissel R. Growth and puberty in chronic kidney disease. Children with familial short stature or idiopathic short stature have a bone age equivalent to their chronologic age, and children with constitutional delay of growth and puberty or endocrine disorders have a bone age that is less than their chronologic age. QJM. Accuracy of two dental and one skeletal age estimation methods in 6-16 year old Gujarati children. 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. Short stature is defined as a height more than two standard deviations below the mean for age, or less than the 3rd percentile. 4. Children with cardiac diseases, or those with chronic kidney or liver disease, may experience a delay in skeletal maturation (3842). Among these, three methods were the most representative and used worldwide: The GreulichPyle method, the TannerWhitehouse, and the Fels method. This process is strongly affected by numerous factors, including GH and insulin-like growth factor-1 (IGF-1). Acta Paediatr. Furthermore, the image was digitized and transformed into a series of mathematical coefficients produced mostly from standard image of the left hand and wrist X-rays. doi: 10.1007/s11102-010-0246-3, 26. This method is valid for children above the age of 4. Peak height velocity (PHV) occurs at the average age of 11 years for girls and at the average age of 13 years for boys. Available online at: http://www.unhcr.org/publications/legal/3d4f91cf4/guidelines-policies-procedures-dealing-unaccompanied-children-seeking-asylum.html. [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. Vignolo M, Milani S, DiBattista E, Naselli A, Mostert M, Aicardi G. Modified Greulich-Pyle, Tanner-Whitehouse, and Roche-Wainer-Thissen (knee) methods for skeletal age assessment in a group of Italian children and adolescents. Dysmorphic characteristics suggest a genetic disorder, whereas midline defects suggest an abnormality of the growth hormone axis. doi: 10.1159/000184848. Pediatr Radiol. 111. Different population groups mature at different speeds. 114. 21. Aissaoui A, Salem NH, Mougou M, Maatouk F, Chadly A. 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. J Adolesc Health Care. Table 2 includes normal growth velocity by age.1,9. doi: 10.1136/adc.65.10.1109, 14. Fishman LS. 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. (2003) 23:2942. 107. On this Wikipedia the language links are at the top of the page across from the article title. Bass S, Pearce G, Bradney M, Hendrich E, Delmas PD, Harding A, et al. Computer-assisted phalangeal analysis in skeletal age assessment. 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. 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. 104. Correlation of bone age, dental age, and chronological age in survivors of childhood acute lymphoblastic leukaemia. 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? It is based on the determination of a score obtained from hand and wrist skeletal maturation. Speiser PW. A comparison of radiation dose of two strategies for skeletal age estimation", "Bone age assessment of children using a digital hand atlas", "Traditional and New Methods of Bone Age Assessment-An Overview", "Book Review: Skeletal Maturity. 78. Conclusions: Hormonal effects associated with adiposity and sexual maturity likely influence skeletal maturation. Any child with bone age more than 2 years advanced or delayed, or whose growth pattern deviates from their genetic potential should bereferred to endocrinology for assessment, she noted. 28. To note, a proper assessment of bone age must always take into account differences between ethnic groups, sex, and any present pathological conditions. Spec Care Dentist. Growth at Adolescence. Short or tall parents may themselves have a pathologic reason for their height, especially if they are more than two standard deviations from the adult norm.68, Growth velocity is a measurement of growth rate. Typically, children with this condition have a delayed bone age with a preserved or increased weight for age. They should stay still for 23 seconds so the X-ray image is clear. 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 . 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. Magiakou MA, Mastorakos G, Oldfield EH, Gomez MT, Doppman JL, Cutler GB, et al. A fuller description of the use of bone age films from the University of Utrecht. doi: 10.1159/000329372, 11. Int J Legal Med. As known, operator variability (intravariability) is defined by the degree of variability in the interpretation of same data performed at two different times by the same operator. doi: 10.1159/000101336, 25. 92. Most children with short or tall stature have normal variants of growth. The bone mineral density (BMD) of the lumbar spine (L1-L4) was measured by dual energy x-ray absorptiometry (Hologic QDR 1000) in 135 healthy caucasian children, aged 1-15 yr, and values were correlated with age, height, weight, body surface, bone age, pubertal status, calcium intake, vitamin D supplementation, and serum bone gla protein. doi: 10.1038/nrendo.2009.242, 53. are guided by the child's expected growth. (2009) 39:5917. 69. Rosemont, IL: American Academy of Orthopaedic Surgeons (2000). For infants and toddlers, weight, length, and head circumference should be plotted on a growth curve at every visit. 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. Arch Dis Child. Formation of the human skeletal system begins in fetal life with the development of a loosely ordered connective tissue known as mesenchyme. Table 3. . 72. J Coll Physicians Surg Pak. Endocr Rev. 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. (2007) 92:3712. (2014) 20:627. For this reason, pediatricians should evaluate each prediction of future height on the bases of all the available knowledge about the child, particularly their personal growth history. The pattern of growth in children with constitutional tall stature from birth to age 9 years. Braz Oral Res. Zachmann M, Sobradillo B. Bayley-Pinneau, Roche-Wainer-Thissen, and Tanner height predictions in normal children and in patients with various pathologic conditions. Then, the final report is done, making an average of the measurements. [5][2][3][1] Drs. doi: 10.1515/jpem.2010.138, 63. Radiographic evaluation of skeletal maturation. (2006) 91:420514. Benso L, Vannelli S, Pastorin L, Angius P, Milani S. Main problems associated with bone age and maturity evaluation. However, she will stop growing earlier than her peers to attain a final adult height at the 50th percentile, Kutney noted. Cushing's syndrome in children and adolescents. Chronological age and bone age were 8.7 4.0 and 8.8 4.3 years, respectively, for the entire population. Chronological age vs. bone age in 169 children with Cystic Fibrosis Dots under the line represented a delay in bone age. Forensic Sci Int. Although several bones have been studied to better define bone age, the hand and wrist X-rays are the most used images. doi: 10.1046/j.1365-2265.2003.01905.x, 50. Br J Sports Med. It uses feature extraction techniques and calculates bone age by analyzing the left-hand radiograph based on. doi: 10.1016/j.gcb.2008.09.020, 30. doi: 10.1002/1520-6300(200009/10)12:5<610::AID-AJHB5>3.0.CO;2-D. 82. doi: 10.4103/0975-1475.176956, 76. Am J Dis Child. 134. doi: 10.2214/ajr.108.3.511, 108. For a child with average puberty timing, Kutney said pediatricians should expect the child to follow the height percentile consistent with their final adult height. Forensic Sci Int. (1997) 24:25761. New technology for bone age determination includes computer-automated readings and assessments obtained from alternative imaging modalities. 2 SDs), a range of 5 years. It may take more than four years for a preterm infant who is born small for gestational age to attain a normal height.24, Recombinant growth hormone is approved for a variety of conditions that cause short stature, including Turner syndrome, chronic renal failure, Prader-Willi syndrome, small for gestational age, Noonan syndrome, short stature homeobox-containing gene deficiency, and idiopathic short stature.