The Role of Blood Spot Dehydroepiandrosterone Sulfate Levels in Adjunct to Hand Wrist Radiographs as Skeletal Maturity Indicator

Abstract

Objective: The purpose of this study was to find out whether blood spot Dehydroepiandrosterone Sulfate (DHEAs) levels can be used as Skeletal Maturity Indicators (SMI) by correlating them to hand-wrist maturation stages. Methods:The cross sectional study population consisted of 107 subjects (62 females and 45 males) 5-25 years old. Hand-wrist radiographs were obtained, and the subjects were divided into 5 groups based on the hand-wrist skeletal maturity stages. A blood spot sample was collected and immunoassayed for DHEAs. Analysis of variance was used to compare the mean DHEAs levels corresponding to the hand-wrist maturation stages. Pearson's correlations were performed to determine the DHEAs trends relating to the various hand-wrist maturation stages.Results: DHEAs levels increased continuously from the prepubertal stage to the acceleration, high growth velocity/peak, deceleration, and postpubertal stages (r=0.17), but the total increase was not found to be statistically significant (p=0.08). Conclusion:The blood spot DHEAs level cannot be used as an SMI in individuals. Nevertheless, it can be used in conjunction with hand wrist radiographs to predict and validate the skeletal maturation. The role of DHEAs in the termination of growth and residual growth may be a subject for further research.

Serum biomarkers associated with radiographic skeletal maturity indicators: A systematic review and meta-analysis

“…Two studies- Anusuya et al (2020) and Srinivasan and Premkumar (2012)-assessed the levels of DHEA or DHEA-S and reported the association of highest biomarker levels during SMI 4-5 and CS 4 staging, respectively. This was in stark contrast to the study by Venkatagiriappa et al (2016), who found that DHEA-S levels progressively increased from prepubertal to postpubertal HW stages and were independent of the growth status of the individual. Anusuya et al (2020) reported an earlier peak in female patients compared to Srinivasan and Premkumar (2012), who observed no differences between the sexes.…”

“…Among the studies with a cross-sectional study design, four (Masoud, 2008; Sinha et al, 2014; Srinivasan and Premkumar, 2012; Venkatagiriappa et al, 2016) utilised HW radiographs exclusively as radiographic SMI. Studies by Masoud (2008) and Venkatagiriappa et al (2016) divided the study participants into five groups according to the Fishman Staging (Fishman, 1982).…”

“…Among the studies with a cross-sectional study design, four (Masoud, 2008; Sinha et al, 2014; Srinivasan and Premkumar, 2012; Venkatagiriappa et al, 2016) utilised HW radiographs exclusively as radiographic SMI. Studies by Masoud (2008) and Venkatagiriappa et al (2016) divided the study participants into five groups according to the Fishman Staging (Fishman, 1982). On the other hand, Sinha et al (2014) and Srinivasan and Premkumar (2012) utilised the Björk (1972) and Grave and Brown (1976) method of radiographic skeletal maturational assessment, where the respective study participants were divided into three groups (prepubertal, pubertal and adult/post pubertal).…”

“…The review included 19 studies (published in 25 articles) and consisted of 1555 participants. Among the cross-sectional studies, studies by Masoud (2008) and Venkatagiriappa et al (2016) were conducted on 84 (45 female and 39 male) and 107 (62 female and 45 male) individuals, respectively, with an age range of 5–25 years. On the other hand, the studies by Srinivasan and Premkumar (2012) and Sinha et al (2014) had 60 (30 male and 30 female; mean age = 22.95 years) and 45 (age range = 8–19 years) study participants, respectively, which were further divided into three groups (prepubertal, pubertal and adult/post pubertal).…”

“…The review included 19 studies (published in 25 articles) and consisted of 1555 participants. Among the crosssectional studies, studies by Masoud (2008) and Venkatagiriappa et al (2016) were conducted on 84 (45 female and 39 male) and 107 (62 female and 45 male) individuals, respectively, with an age range of 5-25 years. On the other hand, the studies by Srinivasan and Premkumar The cohort studies by Masoud (2008) and Tripathi (2017) included 25 participants with an age range of 9-18 years and 63 participants with an age range of 13-18 years, respectively.…”