Evaluation of two methods of bone age assessment in peripubertal children in Zimbabwe

Kowo-Nyakoko, Farirayi; Gregson, Celia; Madanhire, Tafadzwa; Stranix‐Chibanda, Lynda; Rukuni, Ruramayi; Offiah, Amaka C.; Micklesfield, Lisa K.; Cooper, Cyrus; Ferrand, Rashida A; Rehman, Andrea M.; Ward, Kate

doi:10.1016/j.bone.2023.116725

Cited by 7 publications

(15 citation statements)

References 26 publications

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“…The strengths of this study are having a comparator group of HIV negative children, and the study sample was a likely representation of children living in Harare. Another strength is the use of the TW3 method instead of the GP method which was shown to be less valid in our previous work [21]. The cross-sectional nature of our study means causality cannot be implied.…”

Section: Discussionmentioning

confidence: 83%

“…In contrast, there was no relationship found between BMI and skeletal maturation in Iranian and Malawian children aged 6-15 years and 2-28 years respectively [31,40]. The Malawian study used Greulich Pyle to assess BA which we have found to be less biased by age and less precise than Tanner Whitehouse 3 method [21]. In the South African Birth to Twenty Bone Health Study [41], being heavier and taller at age two years in males and having greater lean mass and having entered puberty in females were associated with more advanced development at age 9-10 years, which is in general agreement the current ndings.…”

Section: Discussionmentioning

confidence: 99%

“…Digital hand-wrist radiographs of the non-dominant side were taken by a trained radiographer. Details of the method of obtaining the radiographs have previously been published [21]. BA was assessed using the Tanner Whitehouse 3 Radius, Ulna and Short bones method which has been found to be precise and, in contrast to the Greulich-Pyle method, not biased by age in this population of peripubertal adolescents [21,22].…”

Section: Bone Age Assessmentmentioning

confidence: 99%

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The impact of HIV infection on skeletal maturity in peripubertal children in Zimbabwe: a cross sectional study

Nyakoko,

Gregson,

Westbury

et al. 2023

Preprint

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Introduction HIV infection and its treatment compromises skeletal development (growth and maturation). Skeletal maturity is assessed as bone age (BA) on hand and wrist radiographs. BA younger than chronological age (CA) indicates delayed development. We conducted a cross-sectional study to determine differences between BA and CA (i.e., skeletal maturity deviation [SMD]), and risk factors associated with SMD in peripubertal children with and without HIV established on antiretroviral therapy (ART) including use of tenofovir disoproxil fumarate (TDF). Methods Children with HIV taking ART for at least two years and a comparison group of HIV-negative children, aged 8-16 years and frequency-matched by age and sex, were recruited from HIV clinics and local schools in the same catchment area, in Harare, Zimbabwe. BA was assessed from non-dominant hand-wrist radiographs using the Tanner Whitehouse 3 method. Negative SMD values correspond to delayed development, i.e., BA younger than CA. Multivariable linear regression models determined factors associated with SMD overall, and in children with HIV. Results In total, 504 participants (54% males) were included; by design CA was similar in males and females, whether living with or without HIV. Mean (SD) SMD was more negative in CWH than in HIV-negative children in both males [-1.4(1.4) vs. -0.4(1.1) years] and females [-1.1(1.3) vs. -0.0(1.2) years]. HIV infection and weight-for-age Z-score<-2 were associated with more negative SMD in both males and females after adjusting for socio-economic status, orphanhood, pubertal stage, and calcium intake. Age at ART initiation was associated with SMD in females with those starting ART later more delayed: starting ART aged 4-8 years 1.14 (-1.84, -0.43), or over 8 years 1.47 (-2.30, -0.65) (p-value for trend <0.001). Similar non-significant trends were seen in males. TDF exposure was not associated with delayed development. Conclusion Perinatally-acquired HIV infection and being underweight were independently associated with delayed skeletal maturation in both males and females. Starting ART later was independently associated with skeletal maturation delay in females with HIV. Given the known effects of delayed development on later health, it is important to find interventions to ensure healthy weight gain through early years and in CWH to initiate ART as early as possible.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Bone Age Assessmentmentioning

confidence: 99%

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The impact of HIV infection on skeletal maturity in peripubertal children in Zimbabwe: a cross sectional study

Nyakoko,

Gregson,

Westbury

et al. 2023

Preprint

Self Cite

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“…Additionally, five studies (9.80%) were conducted exclusively in Africa, including two in South Africa [71,72], one in Zimbabwe [73] one in Botswana [74], and one in Ethiopia [75]. Also, a total of five studies (9.80%) were carried out in the region of Oceania.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

Martín Pérez,

Vega González

et al. 2023

Diagnostics

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Aim: The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. Materials and Methods: A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans “AND” and “OR”. NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. Results: A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich–Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner–Whitehouse radius–ulna–short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner–Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. Conclusion: GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.

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“…It reflects the maturity of physiological development 1 . In clinical practice, bone maturity is usually justified by bone age (BA), 2 which is influenced by inherited factors, nutrition, environment conditions, illness 3 and endocrine factors 4 . Increasing evidence supports the prominent impact of sex hormones on BA during the onset of puberty 5 .…”

Section: Introductionmentioning

confidence: 99%

Association between sex hormones and bone age in boys aged 9–18 years from China

Shu,

Niu,

Zhang

et al. 2024

J Cellular Molecular Medi

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This study aimed to analyse the association between sex hormones and bone age (BA) in boys aged 9–18 years, both individually and interactively, and further to explore whether nutritional status may influence this association. A retrospective analysis was performed among 1382 Chinese boys with physical measurements, sexual characteristics, BA radiographs and sex hormone indicators from February 2015 to February 2022. A total of 470 (34.0%) boys had advanced BA. BA was positively associated with estradiol, luteinizing hormone (LH), follicle‐stimulating hormone (FSH) and testosterone in both advanced and normal BA groups after adjusting for age, genetic height and body mass index. Multiple logistic regression showed that after adjusting for covariates, estradiol (odds ratio [OR] = 1.66, 95% confidence interval [CI]: 1.14–2.12), LH (OR = 1.43, 95% CI: 1.04–1.96), and testosterone (OR = 1.58, 95% CI: 1.17–2.13) were significantly associated with the increased risk of advanced BA in boys, and the association was reinforced when these hormones were interactively explored. Stratified by nutritional status, the interaction between estradiol, LH, and testosterone showed a strong association with advanced BA in boys with normal weight.

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Evaluation of two methods of bone age assessment in peripubertal children in Zimbabwe

Cited by 7 publications

References 26 publications

The impact of HIV infection on skeletal maturity in peripubertal children in Zimbabwe: a cross sectional study

The impact of HIV infection on skeletal maturity in peripubertal children in Zimbabwe: a cross sectional study

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review

Association between sex hormones and bone age in boys aged 9–18 years from China

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