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Forum Name: Endocrinology Topics

Question: Growth plates "closing"


 okiegirl1972 - Tue Nov 03, 2009 3:23 pm

I have a question concerning growth plates. I am 4'9 and my husband is 6'2. I have a 13 (almost 14) year old son whom I have taken to two different endocrologist. He is very short his current height is 5'. Both endocrologist said there is no hormone defiency so they will not do GH therapy. I recently took him to a bone & joint clinic for knee and elbow problems the dr. said his growth plates are "closing" I asked if that means he is finished growing he said not nessecilary. Well this news comes as a great concern to me! I know that when they close no further growth is possible. I aslo understand he is going to be short, but the endocronoligist said between 5'2 & 5'9. My question is how much more potential growth is possible once the plates satrt "closing"? Is it now too late for GH therapy? Isn't 13/14 a little early for this process to be staring? He is going thru puberty hair under arms, voice change ect. I have an appt with the endocrologist in 3 weeks, thats the soonest I can get him in. I feel like every day is time passing that we may need! Please advise a very worried mother what to do. Thanks!
 Dr.M.Aroon kamath - Fri Nov 13, 2009 6:30 am

User avatar Hi,
You say - (recently took him to a bone & joint clinic for knee and elbow problems the dr. said his growth plates are "closing").I presume that X-Rays of the elbow and knee were obtained and the doctor based his observation from these films.
It would have been very helpful if you had given the reason for his joint problem.

Hand bone age measurements are a commonly utilized modality for assessing skeletal maturity in children.

In the evaluation of the risk of curve progression in idiopathic
scoliosis however(Because spine films are not sensitive enough to measure the progression of skeletal maturity during the rapid growth phase of adolescence),many orthopedic surgeons use radiographs of the elbow (method of Sauvegrain1).

Bone growth occurs at the epiphysial plate.Growth in height of an individual is a sum of the growth of the long bones in the lower limb,the bones of the vertebral column and the skull.

How much an individual is expected to grow in height per year can not be unfortunately predicted accurately by dividing the known 'average' increase in the height of a group of individuals at (say,25 years of age) by number of years.

This is because bone growth (velocity of growth) is neither uniform, nor linear.Bones grow more rapidly during adolescence and thereafter, the velocity declines.

The examples sited below(observations from some studies) may be more informative...

"Overall, approximately 70% of growth in the femur occurs at the distal growth plate. The proportion of growth occurring in the distal femoral growth plate in girls varies from 60% at seven years of age to 90% at age 14. Similarly, the contribution of the distal femoral growth plate in boys varies from 55% at seven years of age to 90% at age 16. Overall, the contribution of the proximal tibial growth plate is approximately 57%. In girls, this varies from 50% at seven years of age to 80% at age 14. In boys it varies from 50% at seven years of age to 80% at age 16".

From the age of seven to skeletal maturity, the distal femur contributes approximately 1.3 cm per year to femoral growth, except in the last two years, when it contributes half that amount.

Another example:
"The long bones displayed decelerating growth through time, with greater velocities for the larger lower limb (vs. smaller upper limb) bones and the larger proximal (vs. smaller distal) elements within limbs. Coordination for bone size and growth velocity is good both within and between limbs, suggesting a common growth control mechanism that should make growth prediction possible. Adjusted for size, the tibia appears to be the most variable of these four long bones, which may be due to a combination of environmental effects and flexible growth potential". Am. J. Hum. Biol. 16:648-657, 2004. © 2004

The aforesaid observations hopefully make it abundantly clear that growth in height of an individual is complex,various bones contributing varying proportions at varying times to the overall growth.

To conclude,it appears that in a given 'individual',it may be extremely difficult to accurately predict the final height he/she may achieve!
Good day!
 okiegirl1972 - Fri Nov 13, 2009 8:58 pm

You are right, very difficult to understand! The reason for the elbow xray is he has OCD Discenes? in both elbows, why? I do not understand that either. The knees are a family problem that causes subluxation of the knee cap, which he also has in both knees. Thanks for the reply.
 Dr.M.Aroon kamath - Tue Aug 17, 2010 9:57 pm

User avatar Hi,
Osteochondritis dissecans of the elbow is also is known to occur as a familial condition. Several generations have been seen to be affected.I am not certain if bilateral cases have been reported.
Best wishes!

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