Age-related anatomy of the ankle and foot bones on x-rays is normal from birth to 13 years of age.
Bone age may be affected by several factors, including gender, nutrition, as well as metabolic, genetic, and social factors and either acute or chronic diseases, including endocrine dysfunction.
[original: Evaluation of Bone Age in Children: A Mini-Review. Federica Cavallo, Angelika Mohn, Francesco Chiarelli, and Cosimo Giannini].
• In particular, subjects with severe hypothyroidism. Congenital hypothyroidism leads to growth arrest, delayed bone age, and short stature at birth. Ossification centers are defective, appearing in an irregular and mottled pattern, with multiple foci that coalesce to give a porous or fragmented appearance. These characteristics are mainly documented in large cartilaginous centers, such as the head of the femur, head of humerus, and the tarsal navicular bone and are known as stippled epiphyseal dysgenesis.
• hypothyroidism is acquired during growth, secondary centers of ossification are predominantly affected, with delayed fusion of epiphysis and with an irregular and heterogeneous ossification.
• In addition, subjects with long-lasting and untreated growth hormone (GH) deficiency have a delay in bone maturation.
• Hypophyseal alterations secondary to malformation, tumor, or infiltrative pathologies (secondary GH deficiency).
• The presence of hypogonadism with the consequent lack of circulating estrogens, androgens, and other pubertal hormones.
• Chronic diseases such as intestinal inflammatory chronic diseases, celiac disease, and cystic fibrosis.
• Chronic inflammatory states or infectious diseases, such as juvenile idiopathic arthritis and states of immunodeficiency.
• Cardiac diseases, or those with chronic kidney or liver disease, may experience a delay in skeletal maturation.
• Genetic syndromes such as trisomy 21, Turner syndrome, and Russell–Silver syndrome.
• In premature babies, there is often a delayed skeletal maturation.
• By contrast, subjects with hyperthyroidism may present precocious puberty associated with advanced bone age. Moreover, weight gain and obesity are one of the most important causes of pediatric advanced bone age;
• Ovarian tumors, Leydig cells or germ cells, as well as adrenal tumors or adrenal diseases (e.g., congenital adrenal hyperplasia).
• estrogens and oral contraceptives or creams containing testosterone or estrogens can cause an early closure of the growth plate. Foods containing phytoestrogens such as soya.
Skull anatomy CT
Child hand X-ray