Adult height estimation in cases of precocious puberty and normal puberty variants: Can 'automatic bone age determination' eliminate the limitations?

Bone age determination in cases of precocious puberty is mostly performed with the Greulich Pyle atlas and there may be significant differences between evaluators. In this study, we aimed to compare the estimated adult height calculations determined by BoneXpert, an automated bone age determination method, with the estimated adult height based on bone age determined by the clinician according to the Greulich Pyle atlas. Between June 2016 and November 2018, 44 female patients with suspected precocious puberty who underwent bone age determination using the BoneXpert program were included in the study. At presentation, a total of 3 different bone ages were determined by the clinician using the Greulich Pyle atlas and the BoneXpert method. Based on these values, 7 different predicted adult height (PAH) calculations were made using 3 different methods. Predicted adult height and near-final height (NFH) of the subjects were compared. The calendar age of the patients was 9.29 years, 11 years according to the clinician Greulich Pyle atlas, 10.7 years according to BoneXpert-Greulich Pyle, and 10.3 years according to the BoneXpert Tanner-Whitehouse method. The NFH of the untreated and treated patients were 158.4 cm and 160.8 cm, respectively, and there was no significant difference between them. When PAH - NFH was evaluated, it was found that PAHs performed with the Greulich-Pyle atlas, Bayley Pineau formula and both clinician and BoneXpert were more successful compared to other methods (p< 0.001). In the analysis according to the ratio of bone age to height age <110% and ≥110%, NFHs were statistically significantly higher in those <110%. The BoneXpert program may be a more objective method for bone age determination and estimated adult height calculation, but further studies are needed in this regard. In addition, it should be taken into consideration that growth potential is not adversely affected when bone age is less than 110% of height.