Evidence of the non-linear nature of skeletal maturation.

Objective: The aim of this study was to assess longitudinal trajectories of skeletal maturation to determine if children exhibit periods of rapid maturation during normal childhood and adolescence.

Design: Retrospective longitudinal study.

Patients: 345 participants, with an average of 25 assessments per participant, between 3 and 20 years of age from the Fels Longitudinal Study.

Main Outcome Measure: : Chronological age (ie, timing) and rate (ie, tempo) of skeletal maturation, as assessed by the Fels Method, at each maturational milestone, as well as the duration of time spent between any two milestones, were calculated for each participant-specific maturational trajectory and compared between three unique, non-linear maturational trajectory types.

Results: More than 81% of participants exhibited a rapid period of skeletal maturation during childhood and/or adolescence, most of whom were characterised by a single maturational spurt during adolescence. Participants with only a single adolescent spurt in skeletal maturation reach adolescent onset and peak approximately 2.8 and 4.2 years earlier, respectively, in boys (p<0.001) and girls (p<0.001), than when compared with participants with both childhood and adolescent spurts. Differences in the timing and tempo of maturational milestones were driven primarily by trajectory type.

Conclusions: Rapid changes in skeletal maturation occur during normal childhood and/or adolescence, indicating the presence of a maturational spurt: a developmental phenomenon that has remained largely uncharacterised. This work highlights patterned changes in the timing, tempo and duration of longitudinal skeletal maturation while simultaneously shifting the paradigm that skeletal maturation progresses linearly.