25- What are the methods available for the estimation of bone age?
X-ray of the nondominant hand and wrist AP view is recommended for the
assessment of bone age. However, additional X-ray (e.g., knee AP view)
may be required in adolescent to determine growth potential. Accurate
assessment of bone age can be performed with the help of Greulich and Pyle
(gender based) or Tanner–Whitehouse charts; however, the assessment of
bone age by these charts is subjective and has marked interindividual varia-
tion. These shortcomings can be overcome by the recently introduced soft-
ware “Bone Xpert” which is an automated method for estimation of bone age
from the hand X-ray.- What is the utility of bone age estimation in the evaluation of a short child?
Bone age (BA) estimation is an essential parameter in the evaluation of a child
with short stature as the degree of skeletal maturation in relation to chronologi-
cal age (CA) and height age (HA) helps in the differential diagnosis of short
stature. This is summarized in the table given below.Parameters Differential diagnosis
CA = BA > HA Familial short stature
Intrinsic short stature
(e.g., bone dysplasia, Russell–Silver syndrome)
CA > BA = HA Constitutional delay in growth and puberty
Growth hormone deficiency
Cushing’s syndrome
Hypothyroidism
Chronic systemic disease- How does bone age help in the prediction of adult height?
The bone age-based methods are more accurate in predicting the adult height
potential as compared to the calculated target height. The bone age-based meth-
ods include Tanner–Whitehouse II (TW II), Bayley–Pinneau (BP), and Roche–
Wainer–Thissen (RWT). The 90 % confidence interval for the prediction is
approximately ±6 cm at younger ages. The more advanced the bone age, the
greater the accuracy of the adult height prediction. TW II method tends to
underpredict and BP method tends to overpredict the adult height, especially in
boys. It is important to use the same method to predict adult height during fol-
low- up of a child.1 Disorders of Growth and Development: Clinical Perspectives