Current methods for assessing skeletal maturity in US children are inadequate both in terms of racial/ethnic representation and outdated samples. The United States is a multi-racial nation, yet skeletal maturity standards are based on white children from many generations ago. The primary goal of the proposed study is to rectify this disparity, and provide up-to-date race-specific modules in the FELS method for skeletal maturity assessment. Children of diverse racial/ethnic groups will be included via multiple existing radiographic collections nationwide. The updated method for skeletal maturity assessment will be accomplished through three specific aims.
Aim 1 will determine differences between races in both the timing and tempo of skeletal maturity and its individual components.
Aim 2 will re-calibrate the FELS method using data from contemporary children.
This aim will also provide a new program for assessment of skeletal maturity with sex- and race- specific modules. The program will be user-friendly and open source, with both stand-alone and web-based capability.
Aim 3 will integrate two new interpretive parameters into the FELS assessment program output: relative contribution of five maturation categories to skeletal age, and prediction of future catch up or slow- down in skeletal maturation for a given child. The combination of these three aims will serve to benefit the treatment and clinical management of children nationwide.

Public Health Relevance

None of the methods of assessing skeletal age available to clinicians and other investigators of pediatric growth and maturation include data from contemporary children, nor do they include data from U.S. black, Hispanic or Asian children. There is a clear and pressing need for an accurate and valid method of assessing skeletal age applicable to the current, multi-ethnic population of U.S. children. This need can be achieved by updating the FELS skeletal age method using recent available data from non-Hispanic white, non-Hispanic black, Hispanic and Asian American children.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
Project #
Application #
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Lester, Gayle E
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Wright State University
Public Health & Prev Medicine
Schools of Medicine
United States
Zip Code
Boeyer, Melanie E; Sherwood, Richard J; Deroche, Chelsea B et al. (2018) Early Maturity as the New Normal: A Century-long Study of Bone Age. Clin Orthop Relat Res 476:2112-2122
Duren, Dana L; Nahhas, Ramzi W; Sherwood, Richard J (2015) Do Secular Trends in Skeletal Maturity Occur Equally in Both Sexes? Clin Orthop Relat Res 473:2559-67
Duren, Dana L; Seselj, Maja; Froehle, Andrew W et al. (2013) Skeletal growth and the changing genetic landscape during childhood and adulthood. Am J Phys Anthropol 150:48-57
Nahhas, Ramzi W; Sherwood, Richard J; Chumlea, Wm Cameron et al. (2013) Predicting the timing of maturational spurts in skeletal age. Am J Phys Anthropol 150:68-75
Nahhas, Ramzi W; Sherwood, Richard J; Chumlea, Wm Cameron et al. (2013) An update of the statistical methods underlying the FELS method of skeletal maturity assessment. Ann Hum Biol 40:505-14
Duren, Dana L; Blangero, John; Sherwood, Richard J et al. (2011) Cortical bone health shows significant linkage to chromosomes 2p, 3p, and 17q in 10-year-old children. Bone 49:1213-8