Endocrine Abstracts

JOINT3429

Background: Bone age (BA), a critical measure of growth and skeletal maturity, is influenced by several factors, including ethnicity, gender, race, geographic distribution, environmental conditions, socioeconomic status, systemic diseases, and secular trends. Most BA assessment methods have been predominantly developed and validated in upper-class Caucasian populations. Literature comparing the accuracy and validation of different methods, especially in Indian population, is scanty. The objective of this study was to compare the accuracy of GP Atlas, GR Atlas, and TW-3 method to identify the most reliable tool for BA assessment in Indian children.

Methods: 280 healthy children of both sexes, aged 2-16 years, with normal anthropometric parameters were included in the study and sub grouped equally into: 2–5 years, 5. 1–8 years, 8. 1–12 years, and 12. 1–16 years. Clinical history, pubertal status, accurate date of birth and chronological age at time of hospital visit were recorded for all participants. Digital X-rays of the left hand and wrist were obtained and analysed for BA using above three methods. BA of each was then compared to the chronological age (CA) using mean difference (BA-CA) and Bland Altman agreement analysis.

Results: All three methods underestimated CA across all age groups. TW3 method had the smallest mean difference from chronological age (-0. 24 ± 1. 02 years) overall and particularly in the 2–5-year age subgroup (-0. 07 ± 0. 71 years). Additionally, it had the narrowest limits of agreement across all age groups (-2. 24 to 1. 76 years). The GP atlas highly underestimated the Bone age (-0. 44 ± 1. 07 years), particularly in pre-pubertal males (-0. 54 ± 1. 0 years). In the prepubertal group, the TW3 method was found to have the lowest mean difference (-0. 19 ± 0. 94 years) overall and in both sexes individually, especially in females. In contrast, in the pubertal age group, GR atlas was found to have the best results with the lowest mean difference overall (-0. 13 ± 1. 33 years) and in both males (-0. 15 ± 1. 27 years) and females (-0. 11 ± 1. 39 years).

Conclusion: The GP atlas exhibited significant underestimations across all age groups, so may not be suitable for Indian children without population-specific adaptation. The TW3 method emerged as the preferred choice for detailed clinical evaluations, particularly in the prepubertal age group and showed the highest percentage of correct classifications. GR atlas, while less commonly used, offers potential as an alternative for bone age assessment in older children and adolescents.