Kerem Liya, Tuffaha Marwa, Chovel Sella Aluma, Castellanos Luz Elena, Ramirez Alcantara Jonanlis, Stanley Takara
Division of Pediatric Endocrinology, Department of Pediatrics, Hadassah Hebrew University Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
Division of Pediatric Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Pediatr Res. 2025 Oct 3. doi: 10.1038/s41390-025-04459-2.
Bone age (BA) assessment is an essential tool in pediatric endocrinology, used to assess growth and perturbations in pubertal onset. BA advancement is common in children with premature adrenarche (PA), potentially leading to additional evaluation or intervention. The extent to which BA advancement reflects variation in metabolic and demographic factors, including body mass index (BMI), sex, race, and ethnicity, remains insufficiently characterized.
We conducted a retrospective chart review of 296 children (72% female, mean age 7.3 ± 1.6 years) with isolated PA seen at a tertiary pediatric endocrinology clinic. Absolute and standardized BA advancement were analyzed in relation to BMI, sex, race, and ethnicity. Multivariate linear regression adjusted for age and covariates.
BA advancement was greater in children with obesity (19.2 ± 15.1 months) versus those below the 95th% (11.4 ± 13.5), and in males (19.9 ± 14.3) versus females (12.4 ± 14.3). White race was associated with lower advancement (p = 0.02). BMI (p < 0.0001), male sex (p < 0.0001), and Hispanic vs. White ethnicity (p = 0.023) significantly affected standardized BA advancement.
BMI, sex, and race/ethnicity influence BA advancement in PA, supporting individualized interpretation and further study of clinical implications.
Bone age (BA) advancement is an important consideration in the diagnostic workup of children with premature adrenarche. In this diverse cohort, BMI status, sex, race, and ethnicity were significantly associated with BA advancement, suggesting that both metabolic and demographic factors influence skeletal maturation. While BA advancement in obesity and premature adrenarche is recognized, this study underscores their combined effects and the variability across populations. These findings point to limitations in current BA standards and support the need for individualized interpretation. Further research should explore how BA advancement in obesity and across ethnic groups affects adult height and long-term outcomes.
骨龄（BA）评估是儿科内分泌学中的一项重要工具，用于评估生长情况以及青春期启动的扰动。骨龄提前在性早熟（PA）儿童中很常见，这可能导致进一步的评估或干预。骨龄提前在多大程度上反映了代谢和人口统计学因素（包括体重指数（BMI）、性别、种族和民族）的差异，目前仍未得到充分描述。
我们对一家三级儿科内分泌诊所收治的296例孤立性性早熟儿童（72%为女性，平均年龄7.3±1.6岁）进行了回顾性病历审查。分析了与BMI、性别、种族和民族相关的绝对骨龄提前和标准化骨龄提前情况。采用多变量线性回归对年龄和协变量进行了校正。
肥胖儿童的骨龄提前（19.2±15.1个月）大于BMI低于第95百分位数的儿童（11.4±13.5个月），男性（19.9±14.3个月）大于女性（12.4±14.3个月）。白人种族与较低的骨龄提前相关（p=0.02）。BMI（p<0.0001）、男性性别（p<0.0001）以及西班牙裔与白人种族（p=0.023）显著影响标准化骨龄提前。
BMI、性别和种族/民族影响性早熟儿童的骨龄提前，支持进行个体化解读并进一步研究其临床意义。
骨龄（BA）提前是性早熟儿童诊断检查中的一个重要考虑因素。在这个多样化的队列中，BMI状况、性别、种族和民族与骨龄提前显著相关，这表明代谢和人口统计学因素均影响骨骼成熟。虽然肥胖和性早熟中的骨龄提前是公认的，但本研究强调了它们的综合影响以及不同人群之间的变异性。这些发现指出了当前骨龄标准的局限性，并支持进行个体化解读的必要性。进一步的研究应探讨肥胖和不同种族群体中的骨龄提前如何影响成人身高和长期结局。
