ESPE Abstracts (2016) 86 P-P2-683

Bone Health Index: A Potential Discriminator between Growth Hormone Deficiency and Constitutional Delay in Growth and Puberty in Adolescent Children

Prashant Patila, Poonam Dharmarajb, Ann Povallb, Laurence Abernethyb, Urmi Dasb, Mohommed Didib, Renuka Ramkrishnanb, Senthil Senniappanb & Jo Blairb


aBharti Vidyapith Medical College and Medical Research Centre, Pune, Maharashtra, India; bAlder Hey Children Hospital, Liverpool, UK


Background: Constitutional delay in growth and puberty (CDGP), the most common cause of short stature in children, is a transient state of delayed growth, skeletal maturation and attenuated pubertal growth spurt. It is not always easy to differentiate from GH deficiency (GHD) even with robust clinical and auxological assessment, measurement of IGF1 and bone age evaluation Bone health index (BHI) is a quantitative measure of bone health calculated from a hand and wrist X-ray using a software programme.

Objective and hypotheses: To examine whether measurement of BHI aids differentiation between GHD and CDGP during adolescence.

Method: Retrospective data from 75 patients (43CDGP/32GHD) were analysed. GHD was diagnosed if GH peak was <6.7 μg/l on 2 standard GH stimulation tests; CDGP was diagnosed on clinical grounds and by exclusion of other pathologies causing growth and pubertal delay. Bone age (BA) and BHI estimation (Tanner–Whitehouse −2, 3) were performed by BoneXpert software.

Results: Forty-three children (6F, 13.9%), age 14.69±1.29 years, had CDGP and 32 (2F, 6.3%), age 14.20±2.04 years GHD. Mean height SDS was −1.92±0.87 in the CDGP group and −2.41±0.71 in the GHD group. BA was 12.85±1.41 in the CDGP group and 12.78±2.18 in the GHD group. IGF-I SDS was significantly higher in patients with CDGP compared with GHD, −1.33±1.14 vs −2.54±1.22 (P=0.008). BHI SDS was also significantly higher in patients with CDGP (0.84±0.99) vs (−1.59±0.96) in the GHD group (P=0.007).

Conclusion: These novel data indicate that BHI, a simple measure obtained at the time of BA estimation, is significantly lower in children with GHD than in those with CDGP. This may be a helpful tool to aid in differentiating CDGP from GHD, which is important as the treatment of each disorder is markedly different. Furthermore, there may be potential to reduce the number of GH stimulation tests unnecessarily performed, in short adolescents.