Surprising Evidence of Pelvic Growth (Widening) after SkeletalMaturity
Alexander A. Berger,
Jordan B. Renner,
Laurence E. Dahners
Department of Orthopaedics, University of North Carolina, CB #7055, Bioinformatics Building, Chapel Hill, North Carolina 27599-7055,
Department of Biostatistics, University of North Carolina, CB #7420, 3101 McGavran-Greenberg Hall, Chapel Hill, North Carolina 27599-7055,
Department of Radiology, University of North Carolina, CB #7510, 2006 Old Clinic Chapel Hill, North Carolina 27599-7055
Received 22 December 2010; accepted 5 May 2011 Published online 23 May 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/jor.21469
Following an increase in length and width during childhood and adolescence, skeletal growth is generally assumed tostop. This study investigates the inﬂuence of aging on the dimensions of the pelvis and the L4 lumbar vertebra during adulthood. Thedimensions of the pelvis, L4 vertebra, and femoral heads were calculated for 246 patients who had received pelvic and abdominalComputed Tomography scans from the UNC Health Care System. Linear regression analysis determined the signiﬁcance of relation-ships between age and width of the pelvis. There was a strong correlation between increasing patient age and increasing width of thepelvis at the trochanters, (0.333 mm/year of age p
0.0001), at the iliac wings, (0.371 mm/year of age p
0.0002), and between thefemoral heads, indicating that the bony pelvis widens over 20 mm between the ages of 20 and 80. The pelvic inlet did not enlarge overtime while the distance between the hips and the femoral head diameter did signiﬁcantly increase. The height of L4 did not increaseover time, but the L4 width did increase. These correlations were seen in both genders. Surprisingly, our results suggest that the pelvisand L4 vertebra increase in width after skeletal maturity and cessation of longitudinal growth.
2011 Orthopaedic Research Society.Published by Wiley Periodicals, Inc. J Orthop Res 29:1719–1723, 2011.
bone growth; pelvic widening; bone maturation; longitudinal growth; computed tomography
During childhood and young adulthood our bones growin both length and width. Bone widens by periostealapposition, a process which slows during aging.
Bonewidening also occurs in later years and this is thoughtto be an adaptive response to compensate for the lossof strength produced by endocortical bone loss. In a 7- year prospective study of over 600 women, Szulc et al.
reported that rates of endocortical resorption increasedwith age, while the rate of periosteal apposition de-creased with age, resulting in a decrease in the massof the bone. Other research also supports an increasein skeletal bone width in postmenopausal women as aresult of periosteal apposition.
In a previous radiographic study of trochantericbursitis, we noted that the width of the entire pelvisincreased with age after skeletal maturity (unpub-lished data). We were surprised by this apparent indi-cation of growth in width of the skeleton postmaturity. We searched for previous studies indicating such pelvic enlargement and were unable to ﬁnd infor-mation in the literature regarding post maturitychanges in the actual width of the skeleton (as opposedto simply the dimensions of the bones themselves). Incritical discussions of these ﬁndings, there were anumber of serious questions advanced. We developedseveral hypotheses that might explain this unexpectedﬁnding. The ﬁrst was that, as patients became moreobese with age, the greater distance between the pelvisand plain radiographic plates would increase, inducing greater magniﬁcation on X-rays and apparentincreases in pelvic dimensions. Therefore, weembarked on this present study in which we usedcomputed tomography data (not subject to magniﬁca-tion) to more carefully investigate the dimensionalchanges in the pelvic bones. Another hypothesis wasforwarded that, because our data represented a crosssection of the population rather than a longitudinalfollow-up of individuals, we might have an inadvertentselection bias wherein somehow we had selected largerindividuals in our older age groups. Thus in this studywe elected to also measure the height of the L4 verte-bral body as some indication of whether our olderpatients were also taller (larger overall). The thirdhypothesis assumed that the pelvis was truly enlarg-ing and that any such widening of the pelvis would bedue to periosteal appositional bone formation ratherthan true enlargement or ‘‘growth.’’ Therefore, we alsomeasured the width of the pelvic inlet which weexpected would diminish or narrow from the additionof periosteal new bone. We also measured the distancebetween the femoral heads which we assumed wouldnot be changed by periosteal apposition. Finally wemeasured the diameters of the femoral heads as theydo not have a periosteum with which to produce appo-sitional growth.
This study was approved by the ethics committee of the Uni-versity of North Carolina. We included patients age 20–79.Diagnostic exclusion criteria included the presence of eitherpelvic/vertebral column implants or noticeable abnormalitiesin the normal anatomy of the pelvis/vertebral column suchas scoliosis, osteophytosis, or leg length inequality.
The researchers used picture archiving and communicationSystem (PACS) to ﬁnd patients receiving abdominal/pelvicComputed Tomography (CT) scans at the University of NorthCarolina Health Care System (UNC HCS) between January
: Laurence E. Dahners (T: 1-919-966-3340;F: 1-919-966-6730; E-mail: email@example.com)
2011 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.
JOURNAL OF ORTHOPAEDIC RESEARCH NOVEMBER 2011