Regular Monitoring of Bone Age Is Not Useful in Children Treated With Growth Hormone

Although bone age estimates are traditionally used to monitor children receiving growth hormone therapy, few data support this practice. Bone age determination is fraught with technical difficulties, resulting in high interobserver differences. Longitudinal studies show that an individual's bone age can change erratically over time. The resulting errors in predicted adult heights based on these bone age determinations are large. Moreover, growth hormone therapy appears to accelerate bone maturation. The radiographic evidence of this acceleration can be delayed. In this setting, improvements in predicted adult heights can be artifactually large. Routine monitoring of bone age during GH therapy is unnecessary. Bayley and Pinneau, bone age determination, Greulich and Pyle, predicted height, radiography, Tanner and Whitehouse.