Skeletal maturity in Belgian youths assessed by the Tanner-Whitehouse method (TW2)

Reference data for skeletal maturity (TW2 method) of the hand and wrist are provided for large representative samples of Belgian boys and girls. The sample of Belgian boys consisted of 21,174 boys aged 12 to 20 years studied in a nationwide cross-sectional and longitudinal study on the physical fitness of secondary schoolboys (1969-1974). The girls' sample consisted of 9698 6-19-year-old Flemish girls studied cross-sectionally (1979-1980). Both samples were multi-stage stratified cluster samples of entire school classes. All skeletal maturity assessments of the boys were made by the same observer (GB). His estimations agreed quite closely with those of the originators of the method. The skeletal age assessments of the girls were made by two observers trained by GB. Both observers showed high intraobserver reliability after training, and during the assessments. Moreover their ratings compared favourably with those of GB and the originators of the method. Smoothed percentile curves of the maturity scores (TW2-20 bone, RUS and CARP scores) were calculated by means of cubic splines using a stepwise regression procedure for the selection of suitable knots. In the boys, the TW2 scores (20 bone and RUS) increase linearly between 12 and 14.5 years of age, slow down for a while, and then increase again, while the CARP scores increase linearly between 12 and 15 years of age. In girls, the 20-bone maturity scores increase nearly linearly from 6 through 9.5 years of age, accelerate until 11.0 years followed by a smaller increase; RUS scores increase curvilinearly from 6 years of age onwards; and Carp scores increase almost linearly between 6.0 and 12.5 years of age. Belgian boys are advanced in RUS scores but are delayed for the carpal bones as compared with the British standards. The Belgian girls show advancement for both scales as compared with the British reference data. The skeletal maturation of youths from several other continental European countries corresponds more closely with the Belgian than with the British data. The reference data presented herein most probably provide suitable standards for youths of West-European countries.