Single versus serial assessment of skeletal age: Either,both or neither?

Assessments of skeletal age are a valuable adjunct to the clinical evaluation of physical maturity but are more meaningful when considered in relation to chronological age, especially over time, than as separate entities. Data on 51 girls from the Child Research Council study series gave a correlation coefficient of 0.51 between skeletal age (SA) at menarche and chronological age (CA) at menarche — a value in close agreement with data reported from other studies. With a range in SA of 11.58 to 14.89 years, these data were examined further for changes in SA related to timing of adolescence. SA was greater than CA in each of the nine girls whose menarche occurred between 10.5 and 12 years of age. SA was equal to CA in one girl, greater than CA in eight girls and less than CA in 11 girls with menarche between 12.15 and 13.4 years. Of the 22 girls with menarche after 13.5 years, one had SA = CA at 14.89 years and the other 21 all had SA less than CA. An r of 0.84 was calculated between the values of CA minus SA at menarche and CA at menarche. Similar relationships were found between SA and CA at age of maximum increment in growth in height for these girls and for 53 boys in the study series. Longitudinal data for height, weight and SA for four boys and five girls demonstrate the problems of prediction of the timing of adolescence and of adult size from skeletal ages in the childhood years.     

Skeletal growth in school children: maturation and bone mass

Skeletal growth and development was evaluated in 322 white children (age 6 to 14) using three different methods: (1) ¹²⁵I photon absorptiometry, (2) compact bone measures on radiographs, and (3) Greulich-Pyle skeletal age from hand-wrist radiographs. Bone mineral content, measured by photon absorptiometry, increased at an incremental rate of about 8.5% each year. Skeletal age was a poor predictor of skeletal status, i.e., bone mineral content (14% error), and did not decrease the predictive error substantially more than did chronological age. Gross morphology (height and weight) was in fact a better predictor of bone mineral content than were skeletal age, chronological age, and radiographic morphometry. Skeletal age deviations were correlated with deviations in body size. A bone mineral index was devised which was independent of body size and this index was also independent of skeletal age. Skeletal age is imprecise (3 to 6 months error) and the range of variation in normal children (13 months) overlaps the maturational delay of the malnourished and diseased. The difficulties in using skeletal maturation are discussed and it is suggested that particular maturational indices be used which better indicate skeletal growth than does a composite skeletal age.     

Physical and psychological changes in relation to the period before and after onset of the menarche

This cross-sectional study on 452 girls between 11 and 16 years of age examines the physical and psychological changes in the period 30 months before and 60 months after onset of menarche. Indicators of maturity showed the strongest alterations around menarche. In the majority of the physical characters (e. g. thickness of skinfold) adult values are achieved only a longer period after menarche, whereas others (e. g. dimensions of the head) terminate growth already largely by onset of menarche. We found out a minimum in development of thickness of skinfold at the time of menarche indicating a "second loss of body fat" in girls. In four different dimensions of personality (health, anxiety, neuroticism, power of concentration) menarche causes an interruption of the psychic development, and that in an adverse sense.     

The interrelation between the number of deciduous teeth and the morphological maturity of a child

The process of the first dentition is part of a very short period during human development characterised by an extraordinary intensity of growth processes. The main purpose of the present study is to provide information on the relationship between three criteria of biological maturity of children: body height, body weight and the number of milk teeth. The present study is based on a cross-sectional material collected in 30 nurseries in ?ód? (Poland). The analysis was carried out on 1901 children (981 boys and 920 girls) aged from 2 to 36 months. All coefficients of Pearson correlation and partial correlations between the analysed variables are statistically significant at the 0.01 level. The highest value of coefficient correlation was noticed for the relation between dental and chronological age, as well as between dental and morphological age based on body height (about 0.90 and 0.85, respectively). Through an analysis of regression (backward) equations for predicting the number of teeth from chronological age, body weight and body height were calculated. These mathematical equations were confirmed in practice in about 80% of the children. Coefficients of determinations between the analysed variables are high for boys and girls (about 72% and 74%, respectively). This observations demonstrate conclusively that there exists a highly significant relation between deciduous tooth age and morphological age.     

Formula feeding in infancy is associated with adolescent body fat and earlier menarche.

The tempo, level of growth and maturation during adolescence may have important implications to future adult health. The purpose of the study was to examine factors associated with menarche. Three hundred and forty girls, 9 to 14 years old, were selected from all age eligible girls at Kaiser Permanente Oahu (Honolulu). Girls' age, ethnicity, menstrual status and feeding pattern during infancy were obtained by questionnaire. The mean age of girls was 11.5 +/- 1.4 yr and the mean age at menarche among 112 (33%) girls who had reached menarche was 11.6 +/- 1.1 yr. In logistic regression, achievement of menarche was positively explained by age, Asian ethnicity and formula feeding during infancy. In simple linear regression, higher body mass index (BMI) and subcutaneous fat were also positively associated with formula feeding during infancy. The study suggests that girls who were formula fed deposit more body fat than girls who were breast-fed, resulting in early attainment of menarche.     

Height, weight, and lines of arrested growth in young Guatemalan children

A cross-sectional study of height, weight and skeletal maturity as judged from radiographs of hand and wrist, of 1,412 children under seven years of age (694 boys and 718 girls) living in rural Guatemala was performed. Height and weight were compared to standards prepared by the Institute of Nutrition of Central America and Panama (INCAP). Skeletal age was assessed by the Tanner-Whitehouse and the Greulich and Pyle methods. All x-rays were read by the senior author. The children surveyed were significantly shorter and lighter than well noruished Guatemalan children. Differences were evident by age six months and at a maximum by age five years. Both methods showed skeletal age to lag behind chronological age so that the Guatemalan rural children mature at slower rates than either the British children or the Ohio, U.S.A., children, from whom the two sets of standards were developed. Children of both sexes with radio-opaque transverse lines at the metaphysis showed a consistent tendency to be shorter than children without such lines. Boys but not girls showed similar trends for weight. In general, the data are consistent with the view that the physical development in boys is more severely retarded by an adverse environment than that of girls.     

月经初潮对女孩体格发育和体型分布的影响

目的：分析初潮对女孩体格发育和体型分布的影响。方法：询问初潮发生时间。根据初潮发生状况分组,比较各组的体格发育状况,并作Heath-Carter体型分析。结果：同年龄已来潮女孩无论骨骼、肌肉、体脂、身高等都明显较未来潮女孩提前,年龄越小越明显。月经初潮后1年内,体格发育的增长趋势仍很明显,由此造成已、未来潮,刚来潮和来潮时间较久的女孩间,在体型分布上的显著差异。结论：初潮发生早晚对女孩体型有明显影响,其中受影响最大的是反映体脂累积的内因子。本研究无论对体质人类学研究或是在专门人才的早期选拔方面,都将提供一定的科学依据。     

Endocrine characteristics of adolescent menstrual cycles: impact of early menarche

An initial group of 200 girls, 7-17 years old, was investigated longitudinally 4 times at 1.5-, 1.5- and 5-year intervals. The present study gives information of the impact of early menarche, a risk factor for breast cancer, on some physical and endocrine characteristics in these subjects. The frequency of ovulation depended significantly on both the time since menarche and the age at menarche. Early menarche was associated with early onset of ovulatory cycles. Even in early puberty, before menarche, the subjects who displayed early menarche during follow-up had higher serum FSH and estradiol concentrations than the girls whose menarche took place after the age of 13.0 years. Adrenal androgen secretion (dehydroepiandrosterone) was not influenced by age at menarche but it increased, as expected, on the basis of chronological age. The group with early menarche was characterized by high circulating estradiol concentrations also after menarche, even in the oldest subjects so far studied, 17-25 years of chronological age. At these ages, the differences in the frequencies of ovulatory cycles were disappearing between the groups formed on the basis of age at menarche. The present findings in pre- and postmenarcheal subjects suggest that the increased risk of breast cancer associated with early menarche is created over several years of exposure to high-level estrogen stimulus.     

Assessment of developmental age: cross-sectional analysis of secondary sexual characteristics

The developmental age of a growing person does not necessarily correspond to his or her chronological age. The two sexes differ considerably in their developmental tempo, and there are tempo differences also within the same sex. Early developers appear older, late developers appear younger than their chronological age might suggest. Based on a sample of 8675 German boys and 8689 girls of the same ethnicity, aged between 8 and 17 years sex differences of height, weight and secondary sexual characteristics are analyzed. Girls on average, develop faster than boys. Their peak of highest increments of height occurs at 10.2 years and is positioned early within the events of sexual maturity. The peak of highest increments of height in boys occurs at age 11.2 on average and is positioned relatively early within the sequences of secondary sexual characteristics. Maturing development starts with breast-stage 2 in girls at age 10.9 and penis-stage as well as scrotum-stage 2 in boys at age 11.1 on average. The development of pubic hair follows and menarche in girls at age 12.7, respectively spermarche in boys at age 13.8, marks the border to theoretical fertility. There are remarkable differences in the tempo of sexual development between the different types of body shape. In girls the pyknomorphic types are the early developers. Breast stage 2 for instance occurs at age 10.1 in the stocky and corpulent pyknomorphic girls and at age 13.0 in the tall and slender leptomorphic girls. This is different in boys. Here are much less differences between the types of body shape, but generally it is the leptomorphic type, at whom the stages of his secondary sexual characteristics are developed a little earlier.     

Growth and pubertal development during and after treatment with a slow-release gonadotropin-releasing hormone agonist in central precocious puberty.

The auxological data of 25 patients (21 girls, 4 boys) with central precocious puberty (CPP), treated for 4 years with a slow-release gonadotropin-releasing hormone agonist [Decapeptyl-controlled release (D-CR) 3.75] every 4 weeks intramuscularly, and of 6 patients (3 girls, 3 boys), treated for 5 years, are presented. After 3 years of D-CR a stabilization of height velocity (HV) at about 4 cm/year was observed. Bone maturation (ratio of change in bone age to change in chronological age; delta BA/delta CA) slowed down to a mean delta BA/delta CA ratio of 0.5 +/- 0.2 (mean +/- SD) measured over 48 months. As a result, predicted adult height (PAH) improved from 156.3 +/- 7.4 to 162.2 +/- 6.8 cm in girls (p less than 0.001) and from 174.4 +/- 18.6 to 184.3 +/- 17.1 cm in boys after 4 years. In the 5th year an ongoing improvement of PAH was observed. 20 additional girls discontinued D-CR for at least 12 months after treatment with D-CR for 2 years or more. In 11 girls menses started after 10.6 +/- 3.1 months; 9 girls had no menarche after 12-16 months. HV increased in the first and second 6 months to a level of about 6.0 cm/year, decreased in the third 6 months after cessation to the level before discontinuing D-CR and decreased further afterwards. Bone maturation (delta BA/delta CA) increased progressively in the first 18 months after discontinuation, with a stabilization at about 1.3. PAH did not change in the first 12 months after discontinuation of D-CR, but showed a decrease afterwards.(ABSTRACT TRUNCATED AT 250 WORDS)     

Critical period for menarche derived by the wavelet interpolation method from changes in BMI with age in South Korean girls

Recently, few studies regarding the changes in BMI with age have been reported. In the present study, the wavelet interpolation method (WIM) was applied to the changes in BMI with age from the first grade of elementary school until the second year of high school in Korean girls, and the relationship between age at the maximum peak velocity (MPV) of BMI and age at menarche was confirmed by determining the age at MPV of BMI. Age at menarche and activity status were obtained from questionnaires given to 263 second grade high school girls in the Pusan area of South Korea. Moreover, longitudinal growth data on height and weight from the first grade of elementary school until the second year of high school (from 1997 to 2008) were obtained from health examination records. BMI was calculated from height and weight values from the first grade of elementary school until the second year of high school, and wavelet interpolation was applied to the distances of BMI in each grade. The change curve of BMI with age was determined by wavelet interpolation, and the age at MPV of BMI was determined from the changes in the velocity curve with age as the differentiation curve. Age at MPV of BMI was found to be 12.76 +/- 1.6 years, and age at menarche to be 12.34 +/- 1.1 years. The interval in age at the two times was -0.42 +/- 1.6 years, and a significant difference was seen between age at menarche and age at MPV of BMI. The reason that the age at menarche was a little earlier than the age at MPV of BMI is hypothesized to be abnormal melatonin levels influenced by lack of sleep in Korean school girls. However, it is proposed that the age at MPV of BMI is valid as the critical period for the age at menarche.     

Ability of Young Women to Recall Past Body Size and Age at Menarche

Objective: The ability of young women (n = 132, average age 17 years) to recall body size and age at menarche was examined. The use of body silhouettes to assist women in recalling their body size at menarche and to represent their current body size was also evaluated. Research Methods and Procedures: Subjects, who previously participated in a cohort study, were asked to recall height and weight at the time of menarche, to select body silhouettes that best reflected their body shape at the time of menarche and their current body shape, and to recall age at menarche. Two sets of body silhouettes were developed, one representative of an adult body shape and another representative of an adolescent body shape. Results: Pearson correlation coefficients between the adult and adolescent body figures and actual body mass index (BMI; kg/m²) at the time of menarche were not significantly different (r = 0.82 for adult figures vs. r = 0.72 for adolescent figures, p > 0.05). The correlation between actual BMI at the time of menarche and body silhouette (r = 0.77, all subjects) was similar to the correlation between actual and recalled BMI at the time of menarche (r = 0.83) as well as the correlation between current BMI and current body silhouette (r = 0.75). Recalled and actual ages at menarche were highly correlated (r = 0.83). Discussion: The recall of body shape was considered to be a less precise measure of body size than asking about height and weight, but use of body silhouettes may offer advantages in certain situations.     

Age at menarche in urban Argentinian girls: association with biological and socioeconomic factors

Age at menarche is regarded as a sensitive indicator of physical, biological, and psychosocial environment. The aim of this study was to determine the age at menarche and its association with biological and socioeconomic factors in girls from Santa Rosa (La Pampa, Argentina). An observational cross-sectional study was carried out on 1,221 schoolgirls aged 9-15 years. Menarche data were obtained by the status-quo method. Height, sitting height, weight, arm circumference, tricipital and subscapular skinfolds were measured. We also calculated body mass index, measures of body composition and proportions, and fat distribution. To assess socioeconomic factors, parents completed a self-administered questionnaire about their occupation and education, family size, household, and other family characteristics. The median age at menarche - estimated by the logit method--was 12.84 years (95% CI: 12.71, 12.97). Compared with their premenarcheal age peers, postmenarcheal girls had greater anthropometric dimensions through age 12. After this age, only height was higher in the latter group. Data were processed by fitting two logistic regressions, both including age. The first model included anthropometric variables and birth weight, while the second model included the socioeconomic variables. The significant variables derived from each model were incorporated into a new regression: height, sitting height ratio (first model), and maternal education (second model). These three variables remained significantly associated with menarche. The results suggest a relationship between linear growth and menarche and agree with those found in other populations where the advancement of menarche is associated with improved living conditions. In relatively uniform urban contexts, maternal education may be a good proxy for the standard of living.     

Whole genome associated studies for age at menarche

Puberty, the transition from childhood to adult body size and sexual maturity, is a complex multi-staged process involving growth acceleration, weight gain and the appearance of secondary sexual physical features over a 2- to 3-year period. Recent genome-wide association (GWA) studies for age at menarche, the onset of the first menstrual period in girls, have identified the first common genetic variants to be robustly associated with pubertal timing. The findings indicate a novel link between microRNA pre-processing and the timing of whole organism growth and development. Our studies also demonstrate that the use of easily measured phenotypic markers, such as age at menarche in girls, in GWA studies can uncover genetic variants with wider relevance to more complex phenotypes, such as pubertal onset and the tempo of growth in both sexes.     

Selected auxological aspects of anorexia nervosa--relations of body weight to body height and menstrual cycle

Specific aspects of therapy of eating disorders in pubescent and adolescent girls are related to unfinished biological development in time of severe malnutrition. Namely the issues of 1) exact determination of recommended body weight (target weight, weight for discharge etc.) on the basis of the exact analysis of the weight history, 2) relation between body weight and menstrual cycle (menarche, amenorrhoea and remenorrhoea) and 3) risk of non-realization of the genetic growth potential (status of linear growth and skeletal maturity) are discussed in this article. The article brings the results of the data analysis of 90 inpatients with anorexia nervosa and the tables of the recommended target weight for adolescents with finished linear growth. The authors emphasize the importance of an exact analysis of growth and weight history and of reflection of biological age in girls with eating disorders for successful and reasonable realimentation therapy.     

Of Lichens,Caribou and Tuna

Delayed skeletal maturation has been long accepted as a correlate of mental retardation. Three hundred mentally retarded children were examined for skeletal age and failed to show any overall delay of bone age as compared to chronological age. Further, birth weight was found to be unrelated to bone age maturity. Children with severe levels of retardation displayed significant delay in bone development only when profound physical disability was also present. In eight diagnostic categories of mental retardation, only those with metabolic syndromes showed any significant delay in skeletal system maturation. Conversely, mongoloid children showed a larger-than-chance percentage of advanced bone maturation. Skeletal measures therefore are perhaps more reflective of etiological states than of diagnostic classifications in mental retardation.     

Plasma androgens in children and adolescents. Part I: control subjects

In this cross-sectional study, plasma levels of dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), delta 4-androstenedione (delta 4) and testosterone (T) were measured by RIA in 232 normal subjects of both sexes, aged 2 weeks to 20 years. The results were analyzed in relation to chronological age, body surface and pubertal stage. High levels of plasma androgens were found in newborn infants of both sexes. After 3 months of age, androgen levels were uniformly low and rose with increasing chronological age and body surface. The first significant increase in mean androgen levels was found for DHEA-S. It occurred after 6 years of age in girls and after 8 years in boys. DHEA and T rose in both sexes after 8 years of age. delta 4 increased steadily with chronological age and body surface in both sexes. When androgen levels were related to body surface, a first significant increase was observed above 1.00 m2 for the four androgens, in both boys and girls. Above 1.20 m2 and 12 years of age, girls had higher mean levels of DHEA-S, DHEA and delta 4, but lower mean T levels than boys of the same body surface and chronological age. Before puberty, a positive correlation was found in both sexes between the plasma androgen levels on the one hand, and both chronological age and body surface on the other. Plasma androgen levels markedly increased at stage P2 in both sexes, and further increased with pubertal development. During puberty, girls had higher plasma delta 4, but lower plasma T levels than boys of the same pubertal stage. Plasma DHEA-S and DHEA levels were similar in both sexes. In contrast to the plasma androgens, plasma cortisol levels did not show any change in relation either to chronological age or to body surface or pubertal development. Body surface appears to be as good a discriminating factor as chronological age, at least in young children. It also appears from this study that DHEA-S is a good guide for the clinical evaluation of adrenal maturation and may be very useful in evaluating patients with growth or pubertal disturbances.     

Pubertal growth of the short normal girl

OBJECTIVES: To determine the timing, magnitude and duration of the pubertal spurt for short normal and average height girls, to compare these with Tanner's standard and to investigate predictors of pubertal growth. METHODS: The growth of 46 short normal and 55 control girls, identified at school entry, was monitored throughout puberty. Height and weight were measured at 6-month intervals from which body mass index (BMI) was derived. Annual velocities were calculated and used to estimate the age and magnitude of peak height velocity (PHV). Age of menarche was recorded to the nearest month. Parents provided information on the child's medical and social history. RESULTS: The mean age at PHV, the magnitude of PHV and age at menarche were similar for both groups and close to Tanner's 50th centile values. Pre-pubertal BMI predicted age at menarche for short and control girls, accounting for 17% of the variance. There was a tendency for early maturing girls of average stature to have greater PHV. However, this relationship was not observed in short girls, nor did any other variable, genetic or environmental, predict the timing or magnitude of their pubertal spurt. CONCLUSIONS: Delayed puberty in short normal girls is unlikely and their growth during puberty is comparable to girls of average height. The pubertal variables measured remain close to Tanner's original standards for both groups, suggesting the lack of a secular trend towards earlier puberty in girls. The onset of menstruation is influenced by pre-pubertal BMI. However, the clinician should be aware that short normal girls have normal pubertal growth and that no genetic or environmental variable can predict the timing or magnitude of their growth spurt.     

Correlation between chronological age and skeletal age using cvmi and modified MP3 methods

Chronological age conveys only a rough approximation of the maturational status of a person whereas skeletal maturity indicators give a more accurate estimation. Therefore, it is of interest to document the correlation between chronological and skeletal age using CVMI and modified MP3 methods. A total of 39 subjects between the age ranges of 9-16 years were selected for this study. Pre-treatment lateral cephalograms and hand-wrist radiographs of the subjects were used. The skeletal age was analyzed by the Cervical Vertebrae Maturity Index (CVMI) and modified MP3 methods. The data was analyzed with SPSS software version 23.00. Kendall''s Tau correlation test was performed to estimate the correlation between chronological age and skeletal age among the subjects and a linear regression test was also performed. Positive correlation was found between chronological age and skeletal age assessed by CVMI method (r= 0.398) and modified MP3 method (r=0.382) with p value >0.003. Thus it can be concluded that there was a positive correlation between chronological age and skeletal age among all the subjects.     

Trends in Menarcheal Age between 1955 and 2009 in the Netherlands

Aim

To assess and compare the secular trend in age at menarche in Dutch girls (1955–2009) and girls from Turkish and Moroccan descent living in the Netherlands (1997–2009).

Methods

Data on growth and maturation were collected in 20,867 children of Dutch, Turkish and Moroccan descent in 2009 by trained health care professionals. Girls, 9 years and older, of Dutch (n = 2138), Turkish (n = 282), and Moroccan (n = 295) descent were asked whether they had experienced their first period. We compared median menarcheal age in 2009 with data from the previous Dutch Nationwide Growth Studies in 1955, 1965, 1980 and 1997. Age specific body mass index (BMI) z-scores were calculated to assess differences in BMI between pre- and postmenarcheal girls in different age groups.

Results

Median age at menarche in Dutch girls, decreased significantly from 13.66 years in 1955 to 13.15 years in 1997 and 13.05 years in 2009. Compared to Dutch girls there is a larger decrease in median age of menarche in girls of Turkish and Moroccan descent between 1997 and 2009. In Turkish girls age at menarche decreased from 12.80 to 12.50 years and in Moroccan girls from 12.90 to 12.60 years. Thirty-three percent of Turkish girls younger than 12 years start menstruating in primary school. BMI-SDS is significantly higher in postmenarcheal girls than in premenarcheal girls irrespective of age.

Conclusion

There is a continuing secular trend in earlier age at menarche in Dutch girls. An even faster decrease in age at menarche is observed in girls of Turkish and Moroccan descent in the Netherlands.