Bone Abstracts

Objectives: To have a better understanding of the applicability of the Greulich and Pyle and Tanner Whitehouse methods of bone age estimation in children who are of a different ethnicity from those of the original standards.

Method: A systematic search of the Medline database was conducted to include studies published between 1st January 1959 and 1st May 2016 (keywords ‘Greulich Pyle’; ‘Greulich and Pyle’) and 1st January 2001 and 1st May 2016 (keywords ‘Tanner Whitehouse’; ‘TW3’). Each study’s title and abstract were screened. The full text was retrieved when the reviewer could not decide on the study’s eligibility from the title and abstract alone. The following exclusion criteria were then applied, participants with developmental disorders or subjected to nutritional supplementation, studies which used modified methods of G&P or TW3 and/or used other imaging modalities, full text not available within the resources available to the reviewer, full text not in English and review articles.

Results: 376 studies were identified, of which 40 were eligible for inclusion. Five additional studies were identified from the reference lists. In relation to the use of the G&P atlas in Caucasian children, of the 24 studies reviewed, 9 (38%) were unequivocally in support, while 12 (50%) concluded that some modification was required. 72% and 26% of the studies related to African and Asian populations respectively, and concluded that new standards were required. In Hispanic populations, 3 studies (50%) concluded that the standard is applicable, while 3 studies (50%) reported that some modification was required. Socio-economic status was only reported in 8 studies (17.7%). Within these 8 studies, children from lower socioeconomic status tend to be skeletally delayed and show major deviations between bone age and chronological. Seven studies identified were in relation to TW3, of which 1 study suggests poor applicability of TW3 in Hispanics.

Conclusion: The G&P standard may be used in Caucasians, but caution is required when applied to Asian and African populations. There is a complex inter-relationship between the impacts of socioeconomic status and ethnicity on bone age using the G&P atlas, which no study to date has clearly set out to address.

Disclosure: The authors declared no competing interests.