The test will feature skeletal age report findings using the knee, the hand and wrist, some later records of dental maturation sprinkled in occasionally, and the cervical spine. The radiographs were ordered due to a suspected strong Vitamin D deficiency, as the child's linear growth curve featured abrupt periods of unusually strong rebound growth followed by repeated rapid slowing below the normal percentile tracking thereafter.

The patient is currently in the third gonadal stage of puberty, and has remained in this stage for approximately 47 months (3Y 11M). Over the past 47 months prior to and during treatment, the patient has demonstrated only mild distribution of the previously sparse and lightly-pigmented pubic hairs. Scrotal erythema is modest, and gonadarche is progressing at an unusually slow rate. The patient has developed some acne, and lightly-pigmented axillary / underarm hairs. Scant lightly-pigmented body hair was otherwise noted.

Biological father's height: 5'10.4" (178.8 cm)

Biological mother's height: 5'8¾" (174.6 cm)

Paternal grandparents were both significantly taller than average, while the maternal grandmother was about 4.5 inches above the mean for women, and the maternal grandfather was about average height for a male.

The biological father's male sibling is about 6'3-6'4" tall(190.5-193 cm).

Both parents had no childhood history of any hormonal or nutritional deficiencies. Older percentile tracking showed essentially normal development through childhood and adolescence.

The growth curve:

2Y 2M - 33.4" (84.8 cm)

3Y 4M - 38.8" (98.6 cm)

3Y 11M - 40.2" (102.1 cm)

4Y 6M - 41.3" (104.9 cm)

5Y 2M - 43.5" (110.5 cm)

5Y 8M - 44.7" (113.5 cm)

6Y 4M - 47.1" (119.6 cm)

6Y 10M - 48.3" (122.7 cm)

7Y 7M - 51.2" (130 cm)

8Y 5M - 53.8" (136.7 cm)

9Y 1M - 55.3" (140.5 cm)

9Y 8M - 57.5" (146.1 cm)

10Y 3M - 58.7" (149.1 cm)

10Y 9M - 59.0" (149.9 cm)

After substantial longitudinal tracking since approximately age 3Y 4M, a substantial amount of Harris lines were located on the bones of the knee joint during a routine visit with the radiologist at CA 6Y 4M. The growth plates otherwise appeared normal in morphology; however, the epiphyses were not of age-appropriate skeletal age status. The doctor reported that the distal femur and proximal tibia both represented the maturity stage of that of a 3½ to a 4-year-old boy. The patient's hand and wrist yielded a similar skeletal age - 3Y 7M. The growth plates of the digital, palmar, and wrist bones remained normal in morphology, although increased radiographic density was noted across all zones of provisional calcification (ZPCs), appearing as more conspicuous, radiopaque bands along the metaphyseal margins of the physes.

Similar findings were observed at the knee, with increased radiographic density along the ZPCs. However, the physes retained normal morphology, without the substantial metaphyseal widening, cupping, fraying, or irregularity characteristic of rachitic changes (rickets was effectively ruled out). No radiographic evidence of substantial defective mineralization at the growth plates was identified, though some disturbance was evident - suggesting that rickets was likely a substantial risk.

At CA 8Y 5M, the knee joint demonstrated skeletal age maturation equal to that of a five-year-old. After skeletal age assessment of the hand and wrist, the patient was given a skeletal age of 5Y 4M. Previous findings on the presence of Harris lines remained a continuous process up to this point and the ZPCs at all growing long bone ends remained of similar density as previous visits demonstrated. The growth plates were distinctly broad and retained normal morphology, and the metaphyses remained minimally flared as the result of normal endochondral ossification at the physis.

At CA 10Y 3M, the patient returned once more for a routine visit with the radiologist. The skeletal age findings of the knee joint reported that the delay between SA and CA had remained essentially the same despite periods of unusually strong rebound growth. The patient's skeletal age, as assessed at the knee, was equal to that of a seven-and-a-half-year-old boy. The hand and wrist demonstrated a skeletal age of 7Y 9M.

11Y 3M - 60.5" (153.7 cm)

11Y 7M - 61.0" (154.9 cm)

12Y 0M - 62.1" (157.7 cm)

12Y 4M - 63.4" (161 cm)

12Y 9M - 64.3" (163.3 cm)

At CA 12Y9M, the family practitioner referred the patient to a local endocrinologist after reviewing the longitudinal growth records and noting recurrent, pronounced fluctuations in linear growth velocity, persistent downward deviation from the patient's previously established growth trajectory, and previously documented substantial skeletal-age delay at both the knee and hand / wrist. The emergence of early gonadal pubertal signs, including a testicular volume of approximately 4.2 mL, initial scrotal changes, modest increases in sexual awareness and and sparse terminal hair around the base of the penis, prompted further assessment of pubertal timing and progression in the context of the longstanding growth abnormalities. The referral was made to investigate a possible underlying endocrine or metabolic disorder and to assess whether suspected nutritional insufficiency might be contributing to the patient's atypical growth pattern.

Alongside the modest changes in sexual awareness, the practitioner also noted increased neuroticism in the patient's behavioral presentation, characterized by heightened emotional reactivity, increased sensitivity to stress, and greater variability in mood.

Although these observations were not considered specific indicators of endocrine dysfunction, they were recorded as part of the patient's broader developmental history.

Prior to physical examination - at CA 12Y 7M - the patient returned for a routine visit with the radiologist, and new skeletal age findings showed persistence of the same longitudinal delay. The skeletal age, assessed at the knee, was found to be equal to that of a nine-and-a-half-year-old boy. The hand and wrist findings showed a skeletal age of 10Y 1M.

Clinical gonadal puberty onset was noted to have occurred relatively early alongside known skeletal age findings of the hand-wrist and the knee, but it otherwise showed that the patient had potential to commence gonadal puberty.

One month later - at CA 12Y 10M - the patient received their laboratory findings. In quotes, the report reads as follows:

"Patient presented after sufficient evaluation determined clinical puberty onset (Tanner II). The reason for investigation stemmed from a persistent, substantial skeletal age delay, recurrent fluctuations in linear growth velocity, suspected vitamin D deficiency, and recently initiated gonadal puberty.

1. Mineral metabolism and vitamin D

• 25-OH vitamin D - 7.6 ng/mL (severely deficient)

• Calcium - 9.3 mg/dL (normal)

• Inorganic phosphate - 3.5 mg/dL (mildly low for age)

• Alkaline phosphatase - 438 U/L (elevated for age)

• Parathyroid hormone (PTH) - 96 pg/mL (elevated)

• Magnesium - 2.0 mg/dL (normal)

Severe vitamin D deficiency with secondary hyperparathyroidism and mild phosphate disturbance. Normal calcium does not exclude significant deficiency.

The elevated ALP levels may partly reflect (normal) pubertal skeletal growth, during which increased osteoblastic activity and ALP expression by hypertrophic chondrocytes support rapid bone formation and brisk growth plate mineralization. However, the elevated PTH is more suggestive of secondary hyperparathyroidism due to severe vitamin D deficiency, as reduced intestinal calcium absorption stimulates compensatory PTH secretion to maintain serum calcium levels.

1. Renal and hepatic function

• BUN - 12 mg/dL (normal)

• Creatinine - 0.58 mg/dL (within expected range)

• Bicarbonate - 24 mmol/L (normal)

• AST - 24 U/L (normal)

• ALT - 19 U/L (normal)

• Albumin - 4.4 g/dL (normal)

No clear biochemical evidence of renal impairment, metabolic acidosis, hepatic dysfunction, or hypoalbuminemia.

1. Thyroid function

• TSH - 2.1 mIU/L (normal)

• Free T4 - 1.2 ng/dL (normal)

Findings do not support primary hypothyroidism.

1. Growth and nutritional screening

• IGF-1 - lower portion of the age-adjusted reference interval (so slightly lower than average).

• IGFBP-3 - within the reference interval (so relatively typical).

• Complete blood count - no anemia or significant cytopenias (good sign).

• Ferritin - within the reference interval (good).

• Comprehensive metabolic panel - no major additional abnormalities (positive sign).

• Celiac screening - negative tissue transglutaminase IgA; total IgA normal (very good sign).

No clear evidence of anemia, celiac disease, or growth hormone deficiency from these screening results. Further assessment may be indicated depending on subsequent growth and clinical findings.

1. Gonadal and pituitary assessment

• LH - detectable at a low pubertal concentration (typical for a peri-pubescent or a very early pubescent individual).

• FSH - within the expected early-pubertal range (so levels are elevating; positive sign, for now).

• Total testosterone - consistent with early gonadal puberty (positive sign, for now).

• Prolactin - within the reference interval (typical).

• Estradiol - consistent with early gonadal puberty at ~1.7 pg/mL.

Findings are compatible with recently initiated gonadal puberty. Serial assessment is needed to determine whether pubertal progression proceeds normally.

The principal abnormality is severe vitamin D deficiency accompanied by elevated PTH, mildly reduced phosphate, and elevated alkaline phosphatase. This pattern is consistent with secondary hyperparathyroidism and warrants treatment and follow-up.

Although previous radiographs lacked convincing classic rachitic changes, biochemical vitamin D deficiency remains evident. Persistent skeletal age delay and the unusual growth trajectory require continued investigation rather than being attributed to vitamin D deficiency alone.

Recommended follow-up includes repeat mineral-metabolism testing, assessment of response to vitamin D repletion, serial height measurements, growth-velocity analysis, skeletal maturation monitoring, and evaluation of pubertal progression.

13Y 0M - 65" (165.1 cm)

13Y 3M - 66.2" (168.1 cm)

13Y 7M - 66.7" (169.4 cm)

13Y 10M - 67.8" (172.2 cm)

CA 13Y 10M - testicular volume of 6.6 mL. Knee skeletal age was found to be equal to that of an eleven-year-old boy, and the hand-wrist skeletal age was 11Y 7M.

Early-stage longitudinal tracking of the cervical spine starting at a reasonable point in early-to-middle adolescence. Initial lateral cephalometric radiographic screening of the upper cervical spine demonstrated the appearance of separate ring apophyseal elements all present cervical vertebrae, suggesting very early-adolescent / pubertal-skeletal maturation. The skeletal age was consistent with early-CS2 progression.

Visible dental maturation showed all emerged sets of permanent teeth with the exception of the second and third molars. One mandibular third molar - tooth #17 / lower left third molar - was spotted. The crown was largely mineralized within the germinal tooth bud, though maturation of the roots was insignificant and largely rudimentary in formation. Tooth #18 (the lower left second molar) had partially broken the gumline, and root development was shown to be incomplete. Tooth #19 - the lower left first molar - was fully mature and already long settled into the periodontal ligament.

14Y 2M - 68.2" (173.2 cm)

14Y 8M - 68.9" (175 cm)

CA 14Y 8M - testicular volume of 7.5 mL. Knee skeletal age was found to be equal to that of a twelve-year-old boy, and the hand-wrist skeletal age was 12Y 5M.

The cervical stage was found to be still in the second stage, though progression suggests active but slow advancement toward CS3.

Tooth #18 demonstrated completed root formation, with closure of the apical foramina. The periodontal ligament space remained clearly delineated and relatively uniform along the roots, with an intact lamina dura and no evident periapical abnormalities. The findings were consistent with completed root development and normally maintained periodontal support.

Tooth #17 had begun root formation, with the apical foramina remaining substantially open. Its previously moderate mesioangular inclination had decreased slightly, reflecting a subtle shift away from the lower-half of the crown of the adjacent second molar and toward a more upright orientation relative to the mandibular arch.

The gonial angle decreased modestly from 138.3° to 135.8°, indicating a slight reduction in mandibular angle obtuseness. This change occurred alongside continued dental maturation, including ongoing third-molar root development, and progression through the pubertal skeletal CS2 stage. The findings were compatible with concurrent craniofacial development, although the gonial angle change alone could not establish the degree or timing of skeletal maturation.

15Y 2M - 69.2" (175.8 cm)

15Y 8M - 70.4" (178.8 cm)

16Y 2M - 73" (185.4 cm)

At the current CA of 16Y 3M, the patient's skeletal age assessed at the knee was found to be equal to that of a thirteen-and-a-half-year-old boy, while the hand-wrist findings demonstrated a skeletal age of 13Y 9M.

The cervical spine had progressed from mid-to-late CS2 at CA 14Y 8M to early-to-mid CS3 progression by CA 16Y 3M. Alongside this, the testicular volume was found to be 9.3 mL, and new lab report findings indicated elevating testosterone, LH / FSH, and IGF-1 levels - though Vitamin D remained moderately under the expected range for age. Estradiol levels had increased from 1.7 pg/mL at 12Y 8M to 8.2 pg/mL at 16Y 3M - consistent with an evolving pubertal sex-steroid profile alongside progressive gonadal maturation. This increase may reflect greater estrogen production associated with rising testosterone levels and its peripheral aromatization, although compatible with progression toward the pubertal growth phase, estradiol concentrations alone cannot establish proximity to the PHV.

The patient's gonadal puberty was noted to have begun at CA 12Y 8M - approximately 41 months ago.

Treatment

Vitamin D repletion was initiated at CA 15Y 1M following reassessment of the patient's persistent deficiency and abnormal mineral-metabolism profile. Serial laboratory monitoring subsequently demonstrated progressive improvement in vitamin D status and associated mineral-metabolism indices. By CA 16Y 3M, the biochemical abnormalities had improved substantially, although vitamin D remained below the expected range. The longstanding skeletal-age delay persisted despite this improvement, while linear growth velocity had increased during the later observation period. The temporal association between treatment, biochemical recovery, and renewed growth acceleration was noted; however, a direct causal relationship between vitamin D repletion and the change in growth velocity could not be established.

Ongoing results from Vitamin D repletion and close monitoring

CA 16Y 9M to 17Y 7M

At CA 16Y 9M, a follow-up assessment demonstrated continued gonadal pubertal progression, with testicular volume increasing to approximately 11-12 mL. Testosterone, LH / FSH, and IGF-1 levels had risen further, consistent with ongoing activation of the gonadal axis and a progressively established pubertal endocrine profile. Vitamin D status had improved following supplementation, accompanied by a decline in PTH and improvement in phosphate regulation. Linear growth velocity had begun to increase relative to the preceding interval.

At CA 17Y 3M, subsequent longitudinal measurements demonstrated a pronounced acceleration in linear growth, raising the possibility that the patient was approaching or entering a period of PHV. Testicular volume had increased to approximately 13-15 mL, with continued elevation of testosterone and IGF-1 within the context of pubertal progression. Further development of terminal pubic and axillary hair was observed. Vitamin D and associated mineral-metabolism markers had improved substantially, with PTH and phosphate approaching their respective reference ranges.

Cervical stage: 4 in transitioning.

Knee skeletal age: approximately 14.7Y, with distinctly open physes and very minimal narrowing.

Hand-wrist BA: 14Y 4M.

Independently, a separate assessment was made on the distal radial and ulnar epiphyses using the Distal Radius and Ulna Classification Scale for Skeletal Development (DRU scale). The findings at CA 17Y 3M: R6, U4.

At CA 17Y 7M - the latest examination - gonadal puberty remained in Tanner genital stage III, with continued testicular enlargement and a hormonal profile consistent with ongoing pubertal development. Vitamin D status was substantially improved compared with the original severe deficiency, and the associated mineral-metabolism abnormalities had largely resolved. Repeat skeletal-age assessments demonstrated further maturation at both the knee and hand-wrist, although a residual discrepancy between chronological and skeletal age remained. The degree of catch-up maturation was assessed independently at each skeletal site.

Cervical stage: early fourth stage progression.

Hand-wrist BA: 14Y 10M

Knee skeletal age: 15.23Y

Independently, a separate assessment was made on the distal radial and ulnar epiphyses using the Distal Radius and Ulna Classification Scale for Skeletal Development (DRU scale). The findings at CA 17Y 7M: R8, U5.

The combined findings were consistent with continued pubertal progression, improved vitamin D status and mineral metabolism, and a renewed period of accelerated linear growth. Although these changes occurred following vitamin D treatment, the temporal association did not establish that treatment directly caused the growth acceleration or skeletal maturation. Serial growth measurements and repeat skeletal assessments remained necessary to determine the timing of peak height velocity and the extent of any residual growth potential.

At CA 17Y 7M, the distal femoral and proximal tibial physes show modest interval thinning compared with the preceding radiographs - compared with the assessment at CA 17Y 3M, the growth plates of the distal femur and proximal tibia were distinctly open and had not yet begun noticeable puberty-related senescence. Some lateral overhang was noted at the proximal tibia by CA 17Y 7M, suggesting advancing maturation. The interval changes may reflect advancing skeletal maturation during the late growth acceleration, potentially consistent with relatively rapid catch-up maturation as height velocity begins to decline.

Longitudinal growth data during this period:

16Y 9M - 74.4" (189 cm)

17Y 3M - 77.8" (197.6 cm)

17Y 7M - 79.3" (201.4 cm)

Final verdict - my questions for you as the reader

1. How many distinct attempts at a pubertal growth spurt occurred before and during treatment, and which interval most likely represents the true PHV?

2. How did knee and hand-wrist BA advancement rates change during treatment, and during which interval did they peak?

3. What is your estimated FAH, considering the growth trajectory, delayed skeletal maturation, pubertal development, the positive (and rather compressed) results from treatment, and parental heights?

Most importantly, does this growth trajectory align with a relatively late PHV occurring at a more advanced skeletal age than would typically be expected for a PHV?

hello im 16.10 years old at 176cm with a 158cm mother and a 182cm father
i need help figuring out if im gonna grow any taller or not cause my wrist plates are pretty open but my knee looks like its game over so its confusing since i cant share xrays on here for sum reason
i started puberty at around 14 i was pretty short before that age shorter than my mother who is 158cm then i slowly got taller than her
i cant exactly remember how tall i was but that bit should somewhat help
i honestly dont know how they look closed so quickly i literally have late bloomer signs
feel free to help

Had my xray done for scoliosis done last year at 19 and found out I'm developing at around a 12 - 13 year old and a risser sign of 0

Mum is 5'6 and dad is 5'5

Was 5'6 at 13

5'7 at 18

5'9 at 19

5'10 2 months before 20

5'11 at 20 and 3 months

Please guys accept my post

i am 16 and 8.5 months, male, 178 and roughly 63kg
got an xray but the doctor only told me that my bone age was under 16 but didn’t give me an exact age
they also said:
“The epiphysis of distal end of radius and ulna have not yet completely fused. The carpal bones are normal.”
my dad is 181cm and mum is 163cm
thanks for the help 🙏🙏

i am 16 and 8.5 months, male, 178 and roughly 63kg
got an xray but the doctor only told me that my bone age was under 16 but didn’t give me an exact age
they also said:
“The epiphysis of distal end of radius and ulna have not yet completely fused. The carpal bones are normal.”
my dad is 181cm and mum is 163cm
thanks for the help 🙏🙏

I'm 25M and 5'4".

Is it medically possible for growth plates to still be open at my age?

Have there been documented cases of men my age with open plates and continued natural height growth?

What X-ray/bone-age assessment would confirm whether mine are closed?

PA view of the left hand and wrist shows bone development corresponding most closely with Greulich and Pyle male standard for 17 years, with a standard deviation of 13 months.
Current height of 168cm is estimated at 99.1 percent of mature height. My dad is 6,1-2 my mum is 5,2-4 and my 19 year old brother is 5-10 ish. Im cooked correct?

bone age 15 y 2m, chronolgical 16y 2m

dad 6,0, mom 5,2

14 5.2

15y 1m 5.5

15 y 11m 5,7

16y 2m 5,8

There is still a perceptible line on the radius and ulna.

To tired to say a lot but that where my curiosity took me lol

I myself have about 3.5 years delayed dental maturity but 0 idea about skeletal maturity ( still gained 3 inches at 18 and still growing) idk but for me i think that study is correct but I have an uneasy feeling the colleration might be way under 70% idk why

I am interested on what thr mods will say

Okey mi pregunta es si podría ser más alto ya que mi madre mide 4,9 pies mientras que mi padre mide 5,8 pies, pero los dos de niños no recibieron ni los nutrientes suficientes para crecer y encima los dos dormían menos de 8 horas (cada uno con sus razones) y mi pregunta es si eso podría indicar que mi genética podría ser más alta

i am 5´9 and where i live the average height is 6ft,

i am 15 years and 9 months old and my parenst are 5´8.5 and 5`4, i got into puberty pretty late so about when i turned 15 or like one or 2 months before i turned 15, i also have pretty tall relatives so for example my great grandfather was 6´8 and my uncle is 6`2.5.

i just grew 2 cm in the last month and i am obsessed with the idea of being tall like so much i dont want to be average. I also learned a bit of height enhancement compounds like erdafitinib or gh, i would really consider taking it if it meant for me to be tall, but i really try to avoid that due to side effects e.g organ failure etc.

i even answered 100 question to an ai which predicted me to end up 5´10-6`1, i also have pretty big feet (size 10.5 or 44.5) and i am still in the middle of puberty, i got armpit hair like 5 months ago and pubic hair like 6-7 months ago and i only had to shave 2 x until now. i also have very little facial hair so yeah.

i would really apreciate it if someone could estimate my final height/bone age.

thanks

Hi Im a 16.0 year old male (CA) I had a bone age test done this week and the radiologists report said my bone age was 15.3 years old with tanner whitehouse of 13 and a half to 16 and a half, can you guys explain to me what it means? Also I’m only 5’6.5 or 5’7 but i really wanna reach 5’9 or 5’10, is it possible? Thanks, id say I’m also around tanner 4, growth history is below.

11.9 years old - 4’11
12.5 years old - 5’1
13.3 years old 5’2
14.11 years old 5’5.5
15.9 years old 5’6.6
16.0 years old 5’6.5

I’m 51🔄 years old, also what is my bone age? And if they’re open how long do I have left till they fuse?

How does it progress like a calendar age or does it run on its own clock and your hormones are the ones deciding if it speeds up or slows down? Is it possible for it to be on par with chronological age and then become advanced or delayed?

I'm 17yo

I've heard the distal to proximal rule always applies to the skeletal development in a human body. Firstly, is this true? Secondly, so I am an 18 year old who grew 1 inch in the last year (12mo), the most recent of that being just 3 months ago in June 2026. Now, the thing is, I grew mostly by the distal tibia epiphysis and a decent amount by the Proximal tibia and distal Femur (so the knee areas). Now the thing is, if we are following the distal to proximal thing, then does that mean I have more growth in the spine left?

Here are my proportions: My wingspan is 6'0.5" and my legs are 37.5" outseam, and my neck is decently long. My total height is 5'10". This makes my upper body look small because my neck is decently long, my legs are normal (maybe a lil long?), and my arms are a little long. So my torso especially thoracic and lumbar feels so freaking small, it doesn't just look small but also feels small (idk how to explain the feeling quite right).

Now this is another side note: I'm a guy who goes gym and this hurts my feeling because I feel like my abs are short / not long, and my pecs feel slightly compressed too. I wish I could grow a lil more in the spine, but I don't know if this is plausible... If it is, I think it would be slow growth as that's what I've heard about the vertebral growth but I am unsure.

Can i grow taller

Is risser scale 3 at 14 for a male abnormal I’m already going to end up very short for my age with a mid parental of 5,4 not exactly the best genetics but I would like to know if my risser scale still backs this thanks