How to know if epiphyseal plates are closed?

The average growth plate closure age is around 14-17 for boys and 13-15 for girls, but this timing can vary significantly from person to person. Understanding how to know if epiphyseal plates are closed is a vital part of monitoring a person's growth and assessing long-term skeletal health, from adolescence through the senior years.

Quick Summary

The most reliable and definitive way to determine if epiphyseal plates are closed is through a medical bone age assessment, which uses X-rays to visualize the bone structure and remaining growth potential. This is a standard diagnostic tool used by healthcare providers, as there are no outward physical signs that can confirm closure with certainty.

Key Points

• X-rays provide the definitive answer: A bone age X-ray is the only reliable method to confirm if epiphyseal plates are closed, as they are not visible or palpable externally [1, 3].

• Puberty is the primary trigger: The closure of growth plates is initiated and completed by hormonal changes during adolescence [1, 3].

• No growth after closure: Once the epiphyseal plates have fully fused, an individual's long bones can no longer increase in length [1, 3].

• Peak bone mass is reached early: The mass of bone accumulated by young adulthood is critical for preventing age-related bone diseases [1].

• Closure timing varies: The exact timing of growth plate closure is influenced by genetics, nutrition, and hormones [1].

• Understand the long-term impact: Epiphyseal plate closure marks a shift from growth to bone density maintenance, important for senior care [1].

What are Epiphyseal Plates?

Epiphyseal plates, also known as growth plates, are cartilage areas at the ends of long bones responsible for bone lengthening during childhood and adolescence [1, 3]. Cartilage cells multiply and are replaced by bone in a process called ossification, which adds length to the bones [1, 3].

The Role of Puberty in Growth Plate Closure

Puberty and the surge in sex hormones like estrogen and testosterone are the main triggers for growth plate fusion [1, 3]. These hormones cause the remaining cartilage to ossify, fusing the bone's ends with the shaft and stopping longitudinal growth [1, 3]. This fusion typically finishes in the mid-to-late teens, leading to the achievement of maximum adult height [1, 3]. Closure happens gradually and at different times in various bones [1, 3].

The Only Definitive Method: Medical Imaging

The only accurate way to determine if epiphyseal plates are closed is through medical imaging [1, 3].

The X-ray Assessment

A bone age X-ray, usually of the hand and wrist, is the most common method [1, 3]. On an X-ray, open growth plates appear as dark lines [1, 3]. Once fused, these lines disappear, and the bone looks solid [1, 3]. Radiologists use standardized atlases, like the Greulich and Pyle atlas, to compare the X-ray to age-matched images and estimate remaining growth potential [1].

Advanced Imaging

In some complex situations, MRI or CT scans may be used for a more detailed view of the cartilage or bone structure [1].

Factors Influencing the Timing of Closure

Several factors can affect when epiphyseal plates close:

• Genetics: Family history is a key predictor of growth patterns and adult height [1].
• Hormonal Health: Balanced growth and sex hormones are vital [1]. Endocrine issues can cause early or delayed closure [1].
• Nutrition: Proper diet with calcium, vitamin D, and protein supports bone development [1].
• Medical Conditions: Some chronic illnesses can impact bone growth [1].

Common Misconceptions and How to Spot Them

• Myth: Stretching or exercise reopens closed plates. Fact: Closed growth plates cannot be reopened [1]. Exercise helps bone density but not length [1].
• Myth: Pain indicates plate closure. Fact: Closure is painless [1]. Joint pain in teens is likely from growth spurts or injury [1].
• Myth: A physical exam confirms closure. Fact: Only an X-ray can confirm closure by visualizing the plates [1].

The Lifelong Impact of Epiphyseal Closure

Epiphyseal closure signifies the end of height growth and the period where peak bone mass is typically reached [1]. This peak bone mass is a major factor in the risk of osteoporosis later in life [1]. After closure, bones still remodel, making lifelong bone health through diet, exercise, and care crucial for seniors [1].

Epiphyseal Plate Status: Open vs. Closed

Feature	Open (Growing) Epiphyseal Plate	Closed (Fused) Epiphyseal Plate
Appearance on X-ray	Appears as a dark, distinct line or gap at the ends of long bones [1, 3].	The line is gone, and the bone's ends and shaft have fused into one continuous structure [1, 3].
Growth Stage	Indicates an active growth phase [1, 3].	Marks the end of longitudinal growth [1, 3].
Age Range	Typically visible from infancy through mid-to-late teens [1, 3].	Generally occurs in the late teens, earlier for females and later for males [1, 3].
Hormonal Influence	Stimulated by growth hormone [1].	Triggered by sex hormones during puberty [1].
Risk of Injury	More vulnerable to fractures [2].	Bone is more uniformly strong [2].

Conclusion: The Importance of Professional Confirmation

While growth patterns provide clues, an X-ray is the only way to answer how to know if epiphyseal plates are closed [1, 3]. Consulting a healthcare provider is essential for concerns about skeletal maturity and long-term bone health, including osteoporosis risk [1].

For more information on bone health and aging, you can visit the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a reliable source for comprehensive health information. Visit the NIAMS website for more bone health information

Frequently Asked Questions

Can epiphyseal plates close at different ages?

Yes, the timing of growth plate closure can vary from person to person based on genetics and other factors [1]. They generally close earlier in females than in males [1]. Different bones in the same person also close at different rates [1, 3].

Is it possible to grow taller after my epiphyseal plates have closed?

No, once your epiphyseal plates have fully fused, longitudinal bone growth ceases [1, 3]. Any slight height changes during the day are temporary and due to spinal disc compression [1].

Does pain indicate that my growth plates are closing?

No, the process of epiphyseal plates closing is not associated with pain [1]. Joint pain in adolescents is more likely due to a growth spurt, injury, or other medical condition [1].

Can exercise influence the timing of growth plate closure?

Regular weight-bearing exercise is good for bone density but doesn't influence the timing of growth plate closure [1]. However, severe growth plate injuries in children could potentially cause premature closure in that bone [2].

What is a 'bone age' and how is it used?

A 'bone age' is assessed using a hand and wrist X-ray and compared to standard images to estimate skeletal development and remaining growth potential in children [1].

Do epiphyseal plates close uniformly across all bones?

No, epiphyseal plates close at different times for different bones [1, 3]. Plates in the hands and feet typically close before those in the long bones of the legs [1, 3].

Is it necessary to have an X-ray to know if my plates are closed?

Yes, an X-ray is the only definitive method [1, 3]. While age and pubertal stage offer clues, only imaging can confirm if the cartilage lines are still present [1, 3].