Skeletal age in idiopathic short stature: An analytical study by the TW3 method, Greulich and Pyle method

Abstract

Background:The skeletal age in short stature and in various other growth abnormalities is well documented. We lack the study pertaining to the analysis of the skeletal age in idiopathic short stature or analyzing the difference in skeletal age delay or advancement between the familial short stature (FSS) and non-familial short stature (non-FSS) groups, hence this study. Present retrospective study is designed to study the variation in patterns of skeletal age in ISS.Materials and Methods:One hundred and eighty six patients, 95 males and 91 females of idiopathic short stature were examined to assess the skeletal age deviation in relation to chronological age. The radiographs of the left hand and wrist were done. The skeletal age was assessed using Tanner and Whitehouse (TW3) method and Greulich and Pyle (GP) atlas. The patients were divided into two groups based on the parental heights. Group A (Familial Short Stature; FSS) with 100 patients (55 males, 45 females) included patients whose at least one parent was short and Group B (non-Familial Short Stature; non-FSS) with 86 patients (40 males, 46 females), included patients whose parental height was normal. The carpal scores, RUS (Radius, Ulna and Short bone) scores and GP age were determined and the respective delay or advances were calculated.Results:The skeletal age in Group A was delayed relative to chronological age by a mean of 1.9 years in males and 2.3 years in females (P<0.05) by RUS method, mean of 2.7 years in males and 2.6 years in females by Carpal score (P<0.05), 2.2 years in males and 2.7 years in females by GP atlas age (P<0.05). The skeletal age in Group B was advanced by a mean of 0.9 years in males and 1.4 years in females (P<0.05) by RUS method, mean of 0.4 years in males and 0.35 years in females by Carpal score (P<0.05), mean of 1.1 years in males and 0.2 years in females by GP atlas method (P<0.05). The Pearson’s coefficient of correlation (P<.001) demonstrated good agreement association between all three scores.Conclusions:There is definite age delay in both males and females in the FSS group while the bone maturation is accelerated in the non-FSS group. Both RUS and GP show good correlation amongst both the genders in both the groups and there is good inter observer correlation for both the methods. We can hypothesize that while treatment protocols to accelerate bone age will be beneficial in the FSS group, these should be avoided in the non-FSS group. Our study also indicates that there definitely exists a difference in normal growth curves in both these groups and a detailed study is required to plot their respective normal growth lines so as to make proper adjustments in the assessment of the remaining growth and limb lengthening protocols.

Artificial intelligence system can achieve comparable results to experts for bone age assessment of Chinese children with abnormal growth and development

“…The phalanges and metacarpal, and carpal bones grew and developed differently in two cases of the 5 patients with a deviation of over 2 years between the AI system and the reference standard; this made the hand radiograph resemble several standard GP images obtained at different ages, thus causing the difficulty in BA assessment for both AI and experienced human readers (Molinari, Gasser & Largo, 2004;Zhang et al, 2008). This unsynchronized bone growth may result from certain diseases or abnormal secretion of hormones (Kim et al, 2010;Polito et al, 1994). Moreover, radius, ulna, and short bones are formed by enchondroplasia, while carpal bones are formed by chondral osteogenesis, which is less dependent on growth hormones (Mari, 2015).…”

Comparison of methods for final height assessment in adolescents with a normal variant short stature

“…The diagnosis of short stature at the end of growth demonstrates that parental height has a significant effect on this outcome, confirming the similarity of these groups regarding familial inheritance of growth 8,19,[21][22][23] . The two methods of assessment of final height, BayleyPinneau and TW3, did not show good agreement when used to predict final height.…”

Body morphology and bone age in obese and non-obese girls aged 8 to 15 years old

“…In addition, some studies point to an association between advanced bone age and idiopathic short stature, comprising a height 2 or more standard deviations below the mean for age and sex 33,34 . Although a combination of short stature and advanced bone age is not so frequent, when it does occur, the result is a poor height prediction and marked short stature in adults 33 .…”