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Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Bone age in children of diverse ethnicity
F K Ontell1, M Ivanovic, D S Ablin
1Department of Radiology, Davis Medical Center, University of California, Sacramento 95817, USA.
Insights
The Greulich and Pyle bone age standards may not accurately assess skeletal age in diverse pediatric populations. Reservations are advised, especially for Black, Hispanic, and Asian children during late childhood and adolescence.
Area of Science:
- Pediatrics
- Orthopedics
- Radiology
Background:
- Skeletal age assessment is crucial in pediatrics and orthopedics.
- Current US bone age standards (Greulich and Pyle) are outdated, based on white children from 1931-1942.
- The applicability of these standards to diverse ethnic groups is questionable.
Purpose of the Study:
- To evaluate the accuracy of Greulich and Pyle bone age standards in a contemporary, ethnically diverse pediatric population.
- To identify potential discrepancies between bone age and chronological age across different ethnicities and age groups.
Main Methods:
- Hand radiographs of children under 19 were analyzed using Greulich and Pyle standards.
- Bone age was determined and compared to chronological age.
- Mean differences were analyzed based on sex, age, and ethnicity.
Main Results:
- Bone age generally approximated chronological age in Asian and white girls.
- Discrepancies were noted in Black, Hispanic, and Asian children, with bone age often exceeding chronological age.
- Significant bone age delays were observed in preadolescent white and Asian boys.
Conclusions:
- The Greulich and Pyle standards should be used with caution for bone age determination in diverse populations.
- Particular reservations are recommended for Black and Hispanic girls, and Asian and Hispanic boys in late childhood/adolescence.
- Current standards may overestimate bone age in certain ethnic groups.
Objective:
Determination of skeletal or bone age is often used in pediatrics and orthopedics. The most commonly used bone age standards in the United States, those published by Greulich and Pyle, were derived from white children of the upper socioeconomic class in 1931-1942. We examined whether these standards apply to the current assessment of bone age in children of diverse ethnicity.
Materials And Methods:
Hand radiographs of children less than 19 years old at our institution were evaluated for bone age using the standards of Greulich and Pyle. Differences between bone age and chronologic age were calculated, and the mean differences were compared among subgroups of children on the basis of sex, age, and ethnicity.
Results:
In Asian and white girls, bone age approximated chronologic age throughout childhood, with the only significant discrepancy being in adolescent white girls, in whom bone age exceeded chronologic age by an average of 4 months. In black girls, bone age exceeded chronologic age except during middle childhood. In late childhood and adolescence, bone age exceeded chronologic age by approximately 10 months. In Hispanic adolescent girls, bone age exceeded chronologic age by nearly 9 months. In black adolescent boys, bone age exceeded chronologic age by 5 months, with no significant discrepancies between bone age and chronologic age at other ages. In white preadolescent boys, bone age lagged behind chronologic age to a statistically significant degree, ranging from approximately 4 to 8 months. Preadolescent Asian boys also showed significant delays in bone age, particularly in middle childhood, when bone age lagged behind chronologic age by nearly 15 months. In adolescent Asian boys, bone age exceeded chronologic age by 9 months 15 days. In adolescent Hispanic boys, bone age exceeded chronologic age by 11 months 15 days. In younger Hispanic boys, delays in bone age occurred but were significant only in early childhood (4-month delay).
Conclusion:
Using the standards of Greulich and Pyle to determine bone age must be done with reservations, particularly in black and Hispanic girls and in Asian and Hispanic boys in late childhood and adolescence, when bone age may exceed chronologic age by 9 months to 11 months 15 days.
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