ESPE Abstracts

Introduction: In cases of precocious puberty, an important factor in making treatment decisions is when adult height estimates based on bone age (BA) determination are behind midparental height. In Turkey, clinicians often use the Greulich Pyle (GP) atlas to determine BA, which can lead to significant differences between assessors. The aim of this study was to compare estimated adult height (EAH) calculations based on BA determined by the automated BoneXpert method with other methods.

Method: This study included 44 girls who were diagnosed with constitutional precocious puberty and admitted to the outpatient clinic between June 2016 and November 2018. BoneXpert was used for the determination of bone age, and the patients were followed up until they reached 'near-final height' (NFH). Three different methods were used for BA determination, including the GP atlas read by a pediatric endocrinologist (Clinician-GP), the GP atlas read by BoneXpert (BoneXpert-GP), and the Tanner-Whitehouse atlas read by BoneXpert (BoneXpert-TW). Seven different EAH calculations were performed using three different estimated height calculation methods, including Bayley Pineau-BP, Roche-Wainer-Thissen-RWT, and BoneXpert adult height predictor (AHP). The study compared the EAH-SDS values and NFH-SDS values of the patients.

Results: The chronological age of the patients at presentation was 9.09±0.89 years, the mean BA was 10.4±1.2 years according to Clinician-GP, 10.3±1.3 years according to BoneXpert-GP, 10.0±1.3 years according to BoneXpert-TW3; the mean height SDS was 0.7, the target height SDS was 0.42. When they reached NFH the height SDS was 0.01. In the whole group, the mean NFH of the children in whom treatment was not initiated (n: 38) and in whom treatment was initiated with the prediction of early menarche (n: 6) were 158.4 cm and 160.8 cm, respectively, and there was no significant difference between them (p: 0.726). When the EAH-SDS - NFH-SDS difference (delta SDS) was compared according to 7 different EAH values, it was found that EAHs calculated according to BoneXpert-TW-RWT and BoneXpert-AHP were the closest (p < 0.001) to the NFH (Table 1).

Conclusion: BoneXpert automated bone age determination may be a more objective option for EAH calculation in cases of precocious puberty; however, larger case series are needed.