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

Qixing Liu1,2, Cidan Wangjiu3, Tudan Awang4

  • 1Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.

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High altitude may independently delay bone age (BA) development in children. This study reveals the impact of altitude on BA, emphasizing its consideration in evaluations for children in high-altitude regions.

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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.