Abstract
Objective Delays in skeletal maturity are related to bone mass and fracture risk in children, but the factors that determine it are unknown. We aimed to identify the association between insulin-like growth factor-1 (IGF-1) and skeletal maturation before and after growth hormone (GH) treatment. Methods In this retrospective cohort study, we observed 783 short children and adolescents, 229 of whom received GH therapy. Skeletal maturation was assessed based on the difference between bone age (BA) and chronological age (CA) (noted as BA-CA). Anthropometric data and laboratory values were measured, and BA was evaluated using the Greulich and Pyle method. Results The delayed BA group was defined as BA‐CA < −2 SD (n = 457), and the occurrence rate of BA delay was 58.37%. A nonlinear relationship was observed between the IGF-1 standard deviation score (IGF-1 SDS) and BA-CA before and after GH therapy. Before GH therapy, there was a significant positive association between the IGF-1 SDS and BA-CA when the IGF-1 level was greater than -2 SDS (β 0.17, 95% CI 0.08, 027; P < 0.001). However, we did not observe a significant relationship between the IGF-1 SDS and BA-CA when the IGF-1 level was lower than -2 SDS (β 0.07, 95% CI -0.12, 0.26; P = 0.454). After GH therapy, there was a significant positive association between the IGF-1 SDS and BA-CA when the IGF-1 level was lower than 2 SDS (β 0.20, 95% CI 0.12, 028; P < 0.001). However, we did not observe a significant relationship between the IGF-1 SDS and BA-CA when the IGF-1 level was greater than 2 SDS (β -0.03, 95% CI -0.33, 0.27; P = 0.866). Conclusion BA is more delayed in short children and adolescents. There is a nonlinear relationship between IGF-1 and BA maturation in short children before and after GH treatment. These findings suggest that a low level of IGF-1 may contribute to BA delay in short children and adolescents.
Highlights
Bone age (BA) is an indicator of physical maturation in childhood and adolescence and is helpful in the clinical workup of children with growth delays [1]
There was a positive association between bone age-chronological age (BA-chronological age (CA)) and growth hormone (GH) treatment duration (β 0.30; 95% CI: 0.21, 0.39; P < 0:001). This retrospective cohort study revealed that children and adolescents with short stature were prone to BA delay (58.37%)
There was a nonlinear relationship between IGF1 and BA maturation in children before and after GH treatment
Summary
Bone age (BA) is an indicator of physical maturation in childhood and adolescence and is helpful in the clinical workup of children with growth delays [1]. 41 patients excluded: Insulin-like growth factor-1 or bone age data missing. 783 patients with short stature, of whom 229 received growth hormone therapy mineral density and increased fracture risk [4], and BA delay is common in children with short stature and adolescents [5]. The skeletal development and maturity of children and adolescents mainly depends on the growth hormone/insulin growth factor-1 (GH/IGF-1) axis. A clinical study reported that type 1 diabetic children with abnormalities of the GH/IGF-1 axis fail to achieve normal peak bone mass and had an increased likelihood of developing osteoporosis and fractures later in life [12]
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