Skeletal Age Assessment
BonAge is the ideal tool for skeletal age evaluation for children and adolescents with growth abnormalities. Radiation-free, accurate, and objective, BonAge is designed to provide on-the-spot results without the need for interpretation by a physician, are correlate highly with conventional readings using the Greulich and Pyle method.

 A Window on Skeletal Development
BonAge assesses skeletal age, sometimes known as bone age, by measuring the ossifying cartilage structures of the wrist, which provide an excellent window on the development of the skeleton. The unique technology utilized by BonAge measures the velocity of an ultrasound wave transmitted through the wrist, using a proprietary algorithm and gender- and ethnicity-based reference curves to produce a skeletal age result in years and months.

The device also incorporates additional features related to development, including a growth module that includes gender- and ethnicity-based growth follow-up, and adult height prediction. An optional bone strength assessment package is offered to provide a complete paediatric evaluation tool for convenience and ease of use for the physician.

Skeletal Age Measurement
Skeletal age testing is the key to identifying growth patterns and deficiencies for children and adolescents. This test, sometimes known as bone age, is generally carried out by physicians once or twice a year for those individuals with short stature or growth abnormalities - estimated to be at least 5% of children and adolescents.

The score is then used by the physician to reveal information about the patient's skeletal maturity and rate of development.

Uses of Skeletal Age Assessment
Skeletal age provides more accurate information about the developmental status of a child than can be inferred from his/her height, weight, and age alone. For children and adolescents with short stature, this test may be used to determine how much growth potential a short child really has.

If the patient's bone age is reduced compared to his chronological age, within a normal range, he has additional growth potential and is likely to reach a taller adult height than his current height would indicate. Skeletal age assessment helps the physician predict adult height of children and adolescents more accurately.

For patients for whom growth abnormalities are suspected, bone age tests are used to help determine if endocrine (glandular) abnormalities are present or should be investigated. For children who are using growth hormone therapy, bone age testing is used for monitoring the effects of therapy. 

Sunlight BonAge Technology

The Basis for Skeletal Age Assessment
Skeletal age assessment is based on the fact that the cartilage structures of the wrist undergo a process of ossification (that is, hardening into bone) during growth. As in other long bones, the development process begins with the appearance of a center of ossification in the diaphysis, followed by ossification centres in the epiphyses and the formation of epiphyseal growth plates. The fusion of the epiphyseal growth plates marks the end of the child's growth. These changes in the cartilage and bone structure of the wrist have been documented in the widely used Greulich and Pyle Atlas, which records the appearance of the bone structure at the left hand and wrist of male and female children and adolescents at 3-12-month intervals, depending on the child's age.

One way of measuring skeletal age, or bone age, is to take an X-ray picture of the left hand and wrist of a child or adolescent patient and compare it to the pictures in the Greulich and Pyle Atlas to find a match between the appearance of the wrist in the X-ray and one of the photos in the Atlas. The age indicated under the matching photo will be the patient's bone age score. 

Using BonAge for Skeletal Age Assessment
BonAge, a novel skeletal maturity assessment device, instead assesses skeletal age with a unique technology that measures the velocity of an ultrasound wave transmitted through the wrist, and uses a proprietary gender- and ethnicity-based algorithm to produce a numeric result in years and months. The device includes a main unit and a measurement unit with an ultrasound probe. The measure-ment unit is made up of a base that supports an ultrasound probe with two ultrasound transducers, and an an armrest between the transducers for the patient’s hand and wrist.  

Calculation of Adult Height
Current height, menarche state, biological parents' height, bone age, and other factors all play a role in determining a patient's expected final adult height. The device uses the bone age determined by BonAge's ultrasound measurement for adult height calculation for both methods; other data relevant to adult height prediction is inputted in the device by the physician during the patient intake process. 

What the Future Holds
The adult height prediction gives physicians and patients a concrete estimate of adult height that csan be used to help determine the next step in treatment of children with suspected or proven growth hormone deficiencies. Some patients may be best served with continued monitoring of bone age and adult height prediction; others can be reassured that adult height will be normal once pubertal growth is complete; and others will need growth hormone treatment.

1. Bayley, N., Pinneau, S.R., Tables for Predicting Adult Height from Skeletal Age: Revised for Use with the Greulich-Pyle Hand Standards, Journal of Pediatrics, 14, 423-441, 1952
2. Tanner, J.M., Landt, K.W., Cameron, N., Carter B.S., and Patel, J., “Prediction

BonAge Growth Module
Sunlight BonAge is designed to permit the physician to track the growth and development of the pediatric patient as well as to measure his bone age. For this purpose, the physician may input various growth information data in the fields of the patient information form. Various growth information inputted by the physician is displayed on-screen and in measurement reports, and percentile data is calculated according to gender- and ethnic-based reference curves1,2, in order to facilitate tracking of growth and development.

A bone strength measurement module is also available with the BonAge device, in order to track the bone strength parameter as part of the growth and development of the patient.

Information about a number of growth parameters inputted by the physician is provided in graphical format on-screen and in measurement reports. This example shows the patient's weight and age, superimposed on a series of curves that show normal values for weight at different ages, at different percentile ranks.

 1. The “Growth reference curves: 2000 CDC Growth Charts: United States,” from the National Center for Health Statistics, published in Advance Data, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, No. 314, December 4, 2000 (Revised)
2. Li, H., Leung. S.S.F., Lam, P.K.W., Zhang, X., Chen, X.X., Wang, S.L., “Height and Weight percentile of Beijing children and adolescents 0-18 years, 1995,” Annals of Human Biology, 1999, vol. 26, no. 5, 457-471

The BonAge Growth Information Measurement Report
The BonAge growth information measurement report, which appears below, provides detailed result information for the patient to help the physician track his growth and development.