Osteoporosis International

, Volume 22, Issue 5, pp 1525–1536 | Cite as

Metacarpal thickness, width, length and medullary diameter in children—reference curves from the First Zürich Longitudinal Study

  • D. D. MartinEmail author
  • C. Heckmann
  • O. G. Jenni
  • M. B. Ranke
  • G. Binder
  • H. H. Thodberg
Original Article



Metacarpal thickness (T), width (W), length (L) and medullary diameter (M) were measured in 3,121 X-rays from 231 healthy Caucasian children aged 3 to 19 years and analysed for bone age, age, height, weight and gender-related characteristics, showing highly differentiated growth patterns with prepubertal dips. Reference data for the four metacarpal measures are presented.


The aim of the study was to create and explore a reference database for metacarpal T, W, L and M in children.


Three thousand one hundred twenty-one left-hand X-rays (1,661 from boys) from 231 healthy Caucasian subjects (119 boys) aged 3 to 19 years were analysed by BoneXpert, a programme for automatic analysis of hand X-rays and bone age (BA; in years).


In boys, growth of T, W and L shows a prepubertal decrease from BA 7 to 13 and then accelerates again. In girls, the same is seen only for T starting from BA 8 to 11, whereas W and L grow at a declining rate. M shows steady growth until BA 10.5 in girls and BA 13.5 in boys and then grows smaller in both. W is greater in boys from BA 6 onwards, while L is greater in girls from BA 9 to 13 and T from BA 11 to 14. BA is reflected best by L until start of puberty and by T and L thereafter.


T, W, L and M show highly differentiated growth patterns. These reference data provide a basis for further research into skeletal development and the management of hormone therapies in children.


Child Metacarpal dimensions Radiogrammetry Reference values Skeletal growth 



Julia Neuhof is thanked for her excellent work in scanning the ZLS X-ray films, Novo Nordisk for lending the Scanner, and Elisabeth Kaelin, Jon Caflisch and Luciano Molinari for the data and X-ray management of the ZLS.

Conflicts of interest

Hans Henrik Thodberg is the owner of Visiana, which holds and markets the BoneXpert medical device for automated determination of bone age. The other authors have no conflict of interest.


  1. 1.
    Boettcher J, Pfeil A, Rosholm A, Petrovitch A, Seidl BE, Malich A et al (2005) Digital X-ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: a cross-sectional and longitudinal study. Arthritis Rheum 52:3850–3859CrossRefGoogle Scholar
  2. 2.
    Mentzel HJ, Blume J, Boettcher J, Lehmann G, Tuchscherer D, Pfeil A et al (2006) The potential of digital X-ray radiogrammetry (DXR) in the assessment of osteopenia in children with chronic inflammatory bowel disease. Pediatr Radiol 36:415–420PubMedCrossRefGoogle Scholar
  3. 3.
    van Rijn RR, Boot A, Wittenberg R, van der Sluis IM, van den Heuvel-Eibrink M, Lequin MH et al (2006) Direct X-ray radiogrammetry versus dual-energy X-ray absorptiometry: assessment of bone density in children treated for acute lymphoblastic leukaemia and growth hormone deficiency. Pediatr Radiol 36:227–232PubMedCrossRefGoogle Scholar
  4. 4.
    Thodberg HH, van Rijn RR, Tanaka T, Martin DD, Kreiborg S (2009) A paediatric bone index derived by automated radiogrammetry. Osteoporos Int 21:1391–1400. doi: 10.1007/s00198-009-1085-9 PubMedCrossRefGoogle Scholar
  5. 5.
    Bonnard GD (1968) Cortical thickness and diaphysial diameter of the metacarpal bones from the age of three months to eleven years. Helv Paediatr Acta 23:445–463PubMedGoogle Scholar
  6. 6.
    Prader A, Largo RH, Molinari L, Issler C (1989) Physical growth of Swiss children from birth to 20 years of age. First Zurich Longitudinal Study of growth and development. Helv Paediatr Acta Suppl 52:1–125PubMedGoogle Scholar
  7. 7.
    Gasser T, Kneip A, Binding A, Prader A, Molinari L (1991) The dynamics of linear growth in distance, velocity and acceleration. Ann Hum Biol 18:187–205PubMedCrossRefGoogle Scholar
  8. 8.
    Garn SM (1970) The earlier gain and the later loss of cortical bone in nutritional perspective. Thomas, SpringfieldGoogle Scholar
  9. 9.
    Martin DD, Deusch D, Schweizer R, Binder G, Thodberg HH, Ranke MB (2009) Clinical application of automated Greulich–Pyle bone age determination in children with short stature. Pediatr Radiol 39:598–607PubMedCrossRefGoogle Scholar
  10. 10.
    Thodberg HH, Kreiborg S, Juul A, Pedersen KD (2009) The BoneXpert method for automated determination of skeletal maturity. IEEE Trans Med Imaging 28:52–66PubMedCrossRefGoogle Scholar
  11. 11.
    Thodberg HH (2009) An automated method for determination of bone age. J Clin Endocrinol Metab 94:2239–2244PubMedCrossRefGoogle Scholar
  12. 12.
    van Rijn RR, Lequin MH, Thodberg HH (2009) Automatic determination of Greulich and Pyle bone age in healthy Dutch children. Pediatr Radiol 39:591–597PubMedCrossRefGoogle Scholar
  13. 13.
    Martin DD, Sato K, Sato M, Thodberg HH, Tanaka T (2010) Validation of a new method for automated determination of bone age in Japanese children. Horm Res Paediatr 74:15–22PubMedCrossRefGoogle Scholar
  14. 14.
    Martin DD, Neuhof J, Jenni OG, Ranke MB, Thodberg HH (2010) Automatic determination of left- and right-hand bone age in the First Zurich Longitudinal Study. Horm Res Paediatr 74:50–55PubMedCrossRefGoogle Scholar
  15. 15.
    Thodberg HH, Jenni OG, Ranke MB, Martin DD (2010) Validation of bone age methods through prediction of final adult height. Horm Res Paediatr 73:398–404PubMedCrossRefGoogle Scholar
  16. 16.
    Thodberg HH, Olafsdottir H (2003) Adding curvature to minimum description length shape models. British Machine Vision Conference 5, pp 14–16Google Scholar
  17. 17.
    Rosholm A, Hyldstrup L, Baeksgaard L, Grunkin M, Thodberg HH (2001) Estimation of bone mineral density by digital X-ray radiogrammetry: theoretical background and clinical testing. Osteoporos Int 12:961–969PubMedCrossRefGoogle Scholar
  18. 18.
    Seeman E (2001) Sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab 86:4576–4584PubMedCrossRefGoogle Scholar
  19. 19.
    Frost HM, Schonau E (2000) The“muscle-bone unit” in children and adolescents: a 2000 overview. J Pediatr Endocrinol Metab 13:571–590PubMedGoogle Scholar
  20. 20.
    Martin DD, Heckmann C, Walter C, Ranke MB, Thodberg HH, Binder G (2010) Differentiation of growth hormone effects on metacarpal bone and bone age in children with growth hormone deficiency. Osteoporos Int (in press)Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • D. D. Martin
    • 1
    Email author
  • C. Heckmann
    • 1
  • O. G. Jenni
    • 2
  • M. B. Ranke
    • 1
  • G. Binder
    • 1
  • H. H. Thodberg
    • 3
  1. 1.Pediatric Endocrinology and DiabetologyUniversity Children’s HospitalTübingenGermany
  2. 2.Child Development CentreUniversity Children’s HospitalZurichSwitzerland
  3. 3.VisianaHolteDenmark

Personalised recommendations