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Role of growth hormone in enchondroplasia and chondral osteogenesis: evaluation by X-ray of the hand

Journal article
Authors L. Even
Björn Andersson
Berit Kriström
Kerstin Albertsson-Wikland
Z. Hochberg
Published in Pediatric Research
Volume 76
Issue 1
Pages 109-114
ISSN 0031-3998
Publication year 2014
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 109-114
Language en
Keywords Age Determination by Skeleton, Bone Development, Bone and Bones, radiography, Child, Female, Growth Disorders, complications, radiography, Hand, radiography, Human Growth Hormone, deficiency, metabolism, Humans, Male, Multivariate Analysis, Osteogenesis, Radiography, X-Rays
Subject categories Pediatrics


BACKGROUND: The process of growth and maturation of long (radius and ulna) and short (metacarpals and phalanges) bones of the hand (enchondroplasia) differs from that of the carpal cuboid bones (chondral osteogenesis). This study aimed to assess the impact of growth hormone (GH) on these two processes of bone maturation. METHODS: Subjects of the study were 95 prepubertal children: 30 children with GH deficiency and 65 children with idiopathic short stature, aged 7.4 +/- 1.9 y (mean +/- SD) (trial registration number 98-0198-033). Bone maturation was assessed by the Greulich and Pyle method from X-rays obtained at the start and at 1 and 2 y of GH treatment, separately for carpals, long bones, and short bones, and was expressed as years of delay relative to chronological age. RESULTS: At GH start, the delay in bone maturation in the GH-deficient group was significantly greater for carpals (3.6 +/- 1.3 y) than for long (3.0 +/- 1.3 y) and short (1.7 +/- 1.1 y) bones. The delay was nonsignificantly greater for carpal bones in GH-deficient subjects than in subjects with idiopathic short stature (3.6 +/- 1.3 vs. 3.1 +/- 1.1 y, respectively) and was normalized after 2 y of GH treatment. CONCLUSION: The dominant effect of GH was on chondral osteogenesis, with milder effect on enchondroplasia. A distinct delay in carpal and long-bone maturation, which normalizes during 2 y of GH treatment, was typical in GH-deficient children. Therefore, separate carpal bone assessment in bone age reading is needed.

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