What is the Most Effective Method for Predicting Adult Height in Boys with Constitutional Delay of Growth and Puberty?

Abstract

Background: Predicted adult height (PAH) can be calculated using methods such as Bayley-Pinneau (BP), Roche-Wainer-Thissen (RWT), and BoneXpert based on bone age (BA) assessment. Since these methods were developed for healthy children, varying results have been reported regarding their efficacy across different patient groups.

Objective: This study aimed to determine the most effective method for PAH by comparing the BP, RWT, and BoneXpert methods in boys with constitutional delay of growth and puberty (CDGP).

Subjects and methods: Sixty-two male patients with CDGP who had reached their final height (FH) were included in the study. Two experienced clinicians reassessed left-hand and wrist radiographs taken at the time of diagnosis using the Greulich-Pyle (GP) atlas to manually determine BA. Among the methods used for PAH, the GP atlas was used for BP and RWT, while we used its GP-based electronic software for the BoneXpert method.

Results: The mean age at diagnosis of the patients was 14.2 ± 0.8 years, with 58.1% (n=36) having a similar family history. The mean height standard deviation (SD) score was -2.1 ± 0.9, and 24.2% (n=15) of patients received low-dose testosterone induction therapy. The median BAs of the patients were 12.5 (11.5-13.0) years using the GP atlas and 12.6 (11.8-13.4) years with BoneXpert (p<0.001). Boys who were treated with or not treated with testosterone therapy had similar mean height SD scores, median testicular volumes, and median BAs assessed by both methods. The mean target height and FH SD scores were -0.6 ± 0.6 and -0.6 ± 0.9, respectively (p=0.8). Almost all patients (n=60, 97%) achieved adult height within the target range, with no significant difference in the FH SD score between boys who received testosterone and those who did not (p=0.1). There was no significant difference between the FH and PAH when estimated by the BP and RWT methods (p=0.2 and p=0.6, respectively), while the BoneXpert method underestimated the FH (p<0.001). The BP and RWT methods provided better predictions in patients with BA ≤ 2 years compared to BoneXpert (p=0.3 and p=0.4 vs. p<0.001, respectively). Conversely, RWT and BoneXpert methods were more accurate in PAH in boys with delayed BA >2 years (p=0.1 and p=0.1, respectively), while the BP method resulted in overestimation (p=0.003).

Conclusion: The RWT method was found to be a better predictor of FH compared to the BP or BoneXpert methods in boys with delayed BA ≤ 2 years and >2 years.