Women who have sustained a hip fracture have a 2.4-fold increase in mortality risk. It has been known for some time that fragility fracture is a risk factor for mortality. Therefore, if an individual’s skeletal age is greater than their chronological age, then the individual has a higher risk of fracture. Skeletal age is defined as the age of our skeleton as a consequence of fracture or exposure to risk factors for fracture. In the same way, the idea of ‘ skeletal age‘ is quite relevant in osteoporosis. Knowing his heart age helps the man take preventive measures to mitigate his risk of cardiovascular mortality. For example, a 65-year old man may have a ‘heart age’ of 70 (according to this UK calculator), because the man has a body mass index of 26 kg/m 2 which places him in the ‘overweight’ category. We know that being overweight is a risk factor for cardiovascular mortality, and the heart age of an individual is determined by the presence of excess weight. In medical application, for the sake of illustration, we can start with the idea of ‘heart age’. In engineering, the idea of ‘effective age’ is used to assess the age of a structure based on its current condition rather than its chronological age. However, for practical health purposes, the age of our body is more informative than our chronological age. The number of years that pass from the date of birth (elapsed time) is chronological age. It is easy to determine the chronological age of an individual. In this article, we put forward the new concept of “skeletal age” to quantify the impact of fracture on mortality. In addition, it is important to make sure that puberty does actually occur and progress normally, as delayed puberty and absent puberty are difficult to initially distinguish.In a previous blog, we discussed the implication of communicating mortality risk to patients with a fracture. A child with presumed constitutional delay of growth must continue to be followed, because if puberty comes earlier or occurs at a faster tempo than expected, the child may not achieve the expected adult height. For example, a girl with Turner syndrome could have a delayed bone age due to lack of estrogen production, but her predicted height based on bone age is still likely to be low for the family.Īnother caveat is the timing of puberty. If the predicted height based on the bone age is still below the height expected for the family, further work-up is still indicated. However, there are several caveats to the diagnosis of constitutional delay of growth. If the bone age and pubertal stage are delayed, the child would be expected to have a later puberty than average and catch up in height by growing longer than average. If a child's height is below what is expected for the midparental height, the growth velocity is normal, and there are no signs of other disease, the next step is to assess the child's degree of pubertal development and obtain a bone age. Assessing the child's BMI or weight for height is also important, as insufficient calorie intake or calorie loss from issues such as malabsorption will also cause poor growth. An abnormal growth velocity requires further work-up into endocrine (hypothyroidism, growth hormone deficiency, sex steroid deficiency, cortisol excess, etc.) and non-endocrine causes (cardiac, renal, hepatic, gastroenterologic, hematologic or other disease) of growth delay. If the child has been growing at a normal growth velocity over time, pathologic causes of short stature are less likely. Plotting growth points and BMIĪnother important step is to plot previous growth points. If the child is within the range of their mid-parental height, the child likely has familial short stature (assuming the parents did not have medical issues limiting their growth). The next step is to obtain the parental heights and calculate a mid-parental height (taking the average of the parent's heights in inches and adding on 2.5 inches for a boy and subtracting 2.5 inches for a girl). The first step to take when seeing a short child is to carefully measure them and be certain their height is plotted accurately on the correct age and sex growth chart. While constitutional delay of growth, or being a "late bloomer" is a common cause of short stature, it should be considered a diagnosis of exclusion, first requiring ruling out other causes of short stature. From a healthcare professional: If a child's bone age is delayed, are they always a late bloomer?
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