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



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.

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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.

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Correspondence to D. D. Martin.

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Martin, D.D., Heckmann, C., Jenni, O.G. et al. Metacarpal thickness, width, length and medullary diameter in children—reference curves from the First Zürich Longitudinal Study. Osteoporos Int 22, 1525–1536 (2011).

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  • Child
  • Metacarpal dimensions
  • Radiogrammetry
  • Reference values
  • Skeletal growth