Bone age assessment in the workup of children with endocrine disorders.

Bone age is a measure of developmental age, or physiological maturity, which represents more truthfully than chronological age, how far an individual has progressed towards full maturity. It is particularly helpful in the clinical workup of children with growth and/or puberty disorders as well as in treating decisions, such as whether to start replacement therapy in a patient with hypogonadism. Skeletal maturity assessment plays a pivotal role in confirming the diagnosis of normal variants of growth such as familial short stature and constitutional delay of growth, in interpreting hormone tests during puberty, and in the diagnosis of precocious puberty and hyperandrogenism. On the other hand, it is important to recognize that overemphasizing bone age evaluation can be misleading if not used in the proper settings. Adult height prediction is based on skeletal maturity assessment and can be used to predict with acceptable accuracy which adult height will be achieved by a 'normal' child. However, the predictions do not apply to children with endocrine or bone pathologies affecting growth.