Automatic Bone Age Determination in Adult Height Prediction for Girls with Early Variants Puberty and Precocious Puberty

Objective: In cases of precocious puberty, the determination of bone age (BA) is usually performed by clinicians using the Greulich-Pyle (GP) atlas, and there can be significant variation between assessors. The aim of this study was to compare predicted adult height (PAH) calculations based on BA read by the automated BA method “BoneXpert” (BX) with clinician-determined BA-based PAH calculations. Methods: Girls who presented with suspicion of precocious puberty and normal pubertal variants, such as premature thelarche and premature adrenarche, and whose BA determined by both BX and two different clinicians were followed up until reaching near-final height (NFH). Those whose breast development started before the age of 8 years were considered as precocious puberty. Four PAH calculations were performed with two different estimated height calculation methods, the Bayley-Pinneau (BP) and Roche-Wainer-Thissen based on two different BA predictions (Clinician-GP and BX-GP). PAH-standard deviation score (PAH-SDS) and NFH-SDS values of the patients were compared. Results: The median chronological age of the 44 girls included at presentation was 9.3 years, while the median BA was 10.4 years and 10.6 years according to clinician-GP and BX-GP, respectively; mean height-SDS was 0.75 and target height-SDS was -0.28. When they reached NFH, the height-SDS was -0.02. Final analyzes were performed in 26 cases who did not have low birth weight and did not receive puberty-arresting treatment. Delta PAH-SDS-NFH-SDS (Δ-SDS) was compared according to the four different PAH calculations. The closest PAH-SDS value measurement to NFH-SDS was calculated by BP based on BA determined by the BX-GP method (-0.09). Conclusion: PAH calculations using the BP method based on BX-derived GP readings most accurately predict NFH in girls with precocious puberty, and normal pubertal variants.