Children's bone age development is delayed with increasing altitude: a multicentre study

Area of Science:

• Pediatric Endocrinology
• Skeletal Development
• Environmental Health

Background:

• Bone age (BA) assessment is crucial for evaluating pediatric growth and development.
• Environmental factors, such as altitude, may influence skeletal maturation.
• Limited research exists on the specific impact of high altitude on children's bone age.

Purpose of the Study:

• To investigate bone age (BA) characteristics in children residing at different altitudes.
• To determine the independent effect of geographical altitude on the development of BA in children.
• To establish the relationship between altitude and predicted age difference (PAD), an indicator of growth delay or advancement.

Main Methods:

• Retrospective analysis of 1318 children's left-hand-wrist radiographs from June 2014 to July 2022.
• Comparison of predicted age difference (PAD) across three altitude groups: Beijing (43.5 m asl), Lhasa (3650 m asl), and Nagqu (4500 m asl).
• Linear regression modeling to assess the influence of altitude on PAD, controlling for age, gender, and ethnicity.

Main Results:

• A total of 1284 children were analyzed, with PAD values of 0.1 years in Beijing, -0.40 years in Lhasa, and -1.42 years in Nagqu.
• Linear regression confirmed a significant negative correlation between altitude and PAD (Lhasa coefficient = -0.57, P < .001; Nagqu coefficient = -1.55, P < .001).
• Higher altitudes were associated with a greater delay in bone age development relative to chronological age.

Conclusions:

• High altitude appears to be an independent factor contributing to delayed bone age development in children.
• The findings underscore the importance of considering residential altitude when assessing bone age in pediatric populations.
• This study provides novel insights into the impact of high-altitude environments on skeletal maturation in children.