ABSTRACT
BACKGROUND: In China, three bone age assessment methods have been widely used in the medical and sports fields, including the Greulich-Pyle atlas method (GP method), CHN scoring method (CHN method), and China 05 method. A large-sample empirical study is required to determine which method is more suitable for assessing bone age of children and adolescents. OBJECTIVE: To provide a scientific evidence for appropriate bone age evaluation standards for children and adolescents in the eastern developed areas, by comparing the GGP method, CHN method and China 05 method based on samples of healthy children from Shanghai. METHODS: A total of 4 152 healthy children and adolescents (2 185 boys and 1 967 girls) from the urban area of Shanghai were selected for the study. Their digital X-ray of the left hand and wrist were collected and evaluated by the GGP method, CHN method and China 05 method. The difference between the bone age and the chronological age was used to assess the applicability of different bone age standards. The study was approved by the Ethics Committee of Shanghai Research Institute of Sports Science, and informed consent was given by all parents of the enrolled students. RESULTS AND CONCLUSION: For the GP method, the difference between bone age and chronological age in both genders at the age of ≥ 8 years was-0.12 to-0.65 year with significant difference, except for 8-year-old girls. The significant age difference at the age of ≥ 9 years was 0.18 to 1.62 year, except for the 9-year-old age group. For the CHN method, the difference between bone age and chronological age among 6-17-year-old boys and 6-16-year-old girls was 0.42 to 1.56 years (P 0.05), and-0.60 in 18-year-old boys (P < 0.01); the age difference among 6-17-year-old girls was-0.01 to 0.56 year, and the difference was not significant in most age groups. Among the three methods, the result of China 05 method is relatively better, which is the best method that matches the current development of teenagers in Shanghai, suggesting that the China 05 method is more suitable for the eastern developed areas with economic level similar to Shanghai. All the three methods have some limitations. Considering the long-term growth trend of adolescents, it is necessary to revise the current bone age evaluation standards.