THE BIOLOGY OF BONE MATURATION AND AGING

The only indicator of development that is available from birth to matu rity is skeletal age. This short review discusses how standard bone ag es have been developed from assessment of radiographs, and describes t he advantages and disadvantages of the 'atlas' approach as developed b y Greulich and Pyle, and the bone by bone approach, as developed by Ta nner. As the standards currently available are based mainly on histori cal series of radiographs from particular populations, it is stressed that national standards should be established and updated regularly if bone ages are to be used to assess development. The question of the c linical relevance of using bone age assessments of the hand and wrist to determine the state of maturation of the whole skeleton and, partic ularly, the growth potential is also discussed. It is concluded that, despite the difficulties of assessing bone age, and the assumptions on which the Various methods are based, determination of skeletal develo pment is clinically relevant in that it provides the only means of ass essing rates of maturational change throughout the growing period.