Bone tissue, like all other tissues and organs in the human body, is a tissue that is constantly renewed and has a very high activity especially before puberty. As a parent, knowing this tissue well is very important in the healthy development of our children's bone structure.
When Does Bone Development Start in Children?
The development of the skeletal system and bone tissue in children includes a process that begins in the early stages of the intrauterine period in the mother's womb and continues after birth until the end of adolescence. In the healthy development of a child's bone structure, environmental factors such as diet and habits, regular sleep, age-appropriate physical activity, as well as genetic structure characteristics, are also important. For this reason, one of the most important duties for us as parents is to closely monitor the bone development of our children.
How Does Bone Development Happen in the Womb?
The skeletal system is the notochord, which is located on the back of the embryo in the third week of intrauterine life. It begins to take shape with the maturation of the structure called the spine, spinal cord and brain tissue. In the fourth week, the limb buds from which the arms and legs will develop become evident. Between the fifth and eighth weeks, first the upper extremity with the arms, hands and fingers, and then the lower extremities with the legs, feet and toes are formed. At the end of the fifth week, the embryo reaches about twice its size and the spinal skeleton, including the coccyx, is fully formed. In the seventh week, the embryo reaches a size of about 2 cm.
At this stage, 206 bone structures are formed in the embryo, similar to the adult. However, since the bone development, called osteogenesis, is not completed, the bones are mostly cartilage. It can be examined in four main groups as small bones in the wrist and ankle), flat bones (skull bones and ribs) and irregular bones (spine bones). kernels are available. Primarily primary growth nuclei, long bone in the intrauterine period They become prominent in the middle of the clarification. Near birth, the primary nuclei divide towards the upper and lower ends of the bone to form secondary ossification nuclei. These secondary growth nuclei (epiphysis nuclei), which continue their activity after birth until the end of adolescence, and are located at the ends of long bones, are also called ossification nuclei and provide bone elongation. At the end of adolescence, they complete this task by fusing with the parts of the bone called metaphysis and diaphysis. Many hormones in the body affect this process. Excess and deficiencies may cause some problems related to bone growth.
How to Determine Bone Age?
Since many ossification nuclei in the body are not mineralized after birth, they cannot be detected radiographically. This is the reason why there are spaces at the upper and lower ends of the long bones in the radiographs taken in children. The mineralization ages of the ossification nuclei are different for each bone and for each region of the bone. By using this feature, bone age can be determined and information about the development of the skeletal system can be obtained. In this evaluation, serial radiographs of certain skeletal regions are taken and compared with standard radiographs. It is an informative method about physical development.
It is especially useful in the evaluation of some endocrine disorders such as malnutrition, malabsorption, hypothyroidism or growth hormone deficiencies in children. In addition, the determination of bone age gives very reliable information in forensic medicine applications. In summary, bone age determination is a very useful diagnostic method used in cases where it is necessary to determine the chronological age (for example, in forensic reports), in calculating the height that the child will reach in adulthood, and in the diagnosis of growth-development disorders.
Bone age in a child with normal bone maturation, equal to chronological age. Bone age assessment is made by radiographic examination of the knee and foot bones in the first three months, and the hand and wrist bones in older children. There are a number of atlases (such as Greulich-Pyle atlas, Tanner-Whitehouse atlas) used for this purpose as standard. Chronology by bone age There may be a difference of 10 percent between the ages. For example, a child with a chronological age of 12 may have a bone age of 10 or 14. Differences not exceeding two years are considered to be within normal limits.
How Genetic Differences Affect Bone Development?
Skeletal system and bone development in children differ according to gender. There are also genetic and ethnic-geographical differences. Maturation in the skeletal system occurs earlier in girls than in boys. Lengthening occurs faster and is completed in a shorter time. Therefore, their skeletal length is usually 7 percent shorter than boys. In addition, the bones in girls are thinner than in boys. The degree of maturity of the bones may also differ among healthy children of various ages. For this reason, standard deviation (SD) tables and percentile norm curves are used for bone development as in weight and height measurements.
The degree of bone maturation also shows racial differences. For example, bone maturation, bone lengths and thicknesses are higher in the black race than in the white race. A number of nutritional, congenital or genetic factors and diseases may affect skeletal and bone development in children. In addition, the use of certain drugs, such as cortisone, can change the development and differentiation of bone tissue. Progression of bone age compared to chronological age almost always occurs as a result of hormonal disorders (such as idiopathic pubertas precox, adrenogenital syndrome, ovarian tumors, hypothalamus tumors, Mc-Cune-Albright syndrome). Delayed bone age is a much more common condition.
If the bone development is retarded, thyroid hormone deficiency should be considered first. In addition, conditions that prevent bone maturation can be listed as growth hormone deficiency (pituitary dwarfism), chronic infections, mucopolysaccharidoses, chondrodystrophy, achondroplasia, Turner syndrome and gonadal dysgenesis. In the healthy development of a child's bone structure after birth, environmental factors are also important in addition to genetic structure characteristics. Diet and habits (especially adequate intake of calcium and vitamin D), regular sleep, age-appropriate physical activity and a healthy psychosocial environment It is one of the factors that are absolutely necessary for healthy bone development in the genitals.
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