ESPE Abstracts (2019) 92 P2-240

Bone Age Determination in Girls with Early Puberty and Limitations of Adult Height Prediction: Can Automated Evaluation (BoneXpert™)be a Solution?

Gul Yesiltepe-Mutlu1, Merve Capaci2, Gizem Uzunkopru2, Şükrü Hatun1


1Koç University, School of Medicine, Department of Pediatric Endocrinology and Diabetes, Istanbul, Turkey. 2Koç University, School of Medicine, 5th grade student, Istanbul, Turkey


Introduction: One of the factors affecting the treatment decision in early puberty is bone age (BA) evaluation and adult height prediction (AHP), accordingly. These calculations have certain limitations. In this study, we aimed to compare the AHP results calculated by Bayley-Pinneau (BP) and Roche-Wainer-Thissen(RWT) methods based on BA evaluation by using Greulich-Pyle(GP) atlas and BoneXpert™ software.

Methods: A total of 77 girls (6.1-10.8 years of age) who presented with early puberty suspicion between June 2016 and November 2018, were included in the study. At the time of presentation, BA was determined by a pediatric endocrinologist by using GP bone age atlas (Standard BA). The same X-rays were also analyzed by BoneXpert software program and bone age was determined by GP (BXpertBA-GP) and TW (BXpertBA-TW) methods. Adult height prediction was calculated by using a national online program named ÇEDD-ÇÖZÜM. Three BA evaluations and two AHP methods (BP and RWT) were used to calculate predicted adult heights (PAH) of participants, thereby 6 different predictions were made (PAH1: BP method with standardBA-GP, PAH2: RWT method with standardBA-GP, PAH3: BP method with BxpertBA-GP, PAH4: RWT method with BA-GP, PAH5: BP method with BxpertBA-TW, PAH6: RWT method with BxpertBA-TW)

Results: The mean age of the participants was 8.7 years, while the mean standard BA was 9.98 years, the mean BXpertBA-GP was 9.87 and the mean BXpertBA-TW was 9.51 years. There was no significant difference between the mean standard BA and BXpert BA-GP. However, BXpert BA-TW was significantly lower than the other two BAs (P <0.001). The mean actual height of the participants was 136 cm while median height SDS was 1.01. The mean PAH1 was similar to PAH3(161.3 vs 162.2 cm), however PAH1 was significantly lower than PAH2 (162.6 cm), PAH4(162.5 cm), PAH5(164.3 cm), PAH6(163.5 cm) (P<0.008). The mean PAH1 was significantly lower than mean mid-parental height of the participants 161.3 vs 163.3 cm, P<0.007).

Conclusions: The PAH which was calculated by the most commonly used BP method based on Standard BA-GP is the lowest, however it is impossible to determine which method is most accurate untill the participants achieve their final heights. We think that, it would be more reasonable to take a range rather than only one result for PAH into consideration before making a decision on treatment.

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