Advanced skeletal maturity in children and adolescents with myelomeningocele

Abstract

Purpose: Atypical skeletal development is common in youth with myelomeningocele (MM), though the underlying reasons have not been fully elucidated. This study assessed skeletal maturity in children and adolescents with MM and examined the effects of sex, age, sexual development, ethnicity, anthropometrics and shunt status.

Methods: Forty-three males and 35 females with MM, 6-16 years old, underwent hand radiographs for bone age determination. The difference between bone age and chronological age was evaluated using Wilcoxon sign rank tests. Relationships between age discrepancy (skeletal-chronological) and participant characteristics were assessed using multiple linear regression with forward selection.

Results: Overall, forty percent (31/78) of MM participants had an advanced bone age of 1 year or greater (median: 2.5 years), while 47% (37/78) were within 1 year above or below their chronological age (-0.001 years) and 13% (10/78) were delayed by more than 1 year (-1.4 years). Bone age was advanced compared to chronologic age in both males and females (p⩽ 0.024). Advanced bone age was observed in early to late puberty and after maturation (p⩽ 0.07), as well as in Hispanic participants (p= 0.003) and in those with a shunt (p= 0.0004). Advanced bone age was positively correlated with height, weight and body mass index (BMI) percentiles (p= 0.004). In multiple linear regression analysis, advanced bone age was most strongly associated with higher Tanner stage of sexual development, and higher weight, height or BMI percentile.

Conclusions: Advanced skeletal maturity is common in children/adolescents with MM over 8 years of age who have reached puberty (65%), particularly those who are overweight (80%). Hormonal effects associated with adiposity and sexual maturity likely influence skeletal maturation. Clinicians may use Tanner stage and weight or BMI to gain insight into skeletal maturity.

Keywords: Skeletal maturity; bone age; myelomeningocele; pediatrics; spina bifida.

Figure 1:

Difference between skeletal age and chronological age as a function of chronological age in boys and girls.

Figure 2:

Difference between skeletal age and chronological age as a function of Tanner stage of sexual maturity.

Figure 3:

Difference between skeletal age and chronological age for normal/healthy weight (BMI ≤ 85^th percentile), overweight (BMI between 85^th and 95^th percentile), and obese (BMI > 95th percentile) participants.

Figure 4:

Difference between skeletal age and chronological age for participants with height < 20^th percentile and height ≥ 20^th percentile.

Figure 5:

Difference between skeletal age and chronological age for non-Hispanic and Hispanic participants.

Figure 6:

Difference between skeletal age and chronological age for participants without and with a shunt.