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Is It Advisable To Administer Anastrozole To A Teenager To Regulate Bone Growth?

Posted on Wed, 27 Jul 2022

Question: My son just turned 14. His endocrinologist says he has a bone age of 14.5. The radiologist says 14.0.

His height is 5'3.6". His weight is 130 pounds. My wife and I are taller than average. My wife is 5'8" and I am 5'10.5". How tall do you think my son will be?

The endocrinologist is recommending that my son take Anastrozole for three years to make sure his growth plates do not close. Does that make any sense to you?

All his blood tests all came back normal.

Answered by Dr. Elona (8 hours later)

Brief Answer:
It make sense but I don't agree.

Detailed Answer:

Hello,

Anastazole is an aromataze inhibitor drug.

The function of aromatase inhibitors is to block the enzyme which promotes the conversion of androgens to estrogens.

Estrogen also plays an important role in regulating longitudinal growth during puberty by promoting the closure of epiphyses.

If the production of estrogen is blocked, the fusion of the epiphyses may be delayed, potentially leading to a prolonged period of longitudinal growth and increased final adult height.

The Aromataze inhibitors(AIs) are currently being used as an off-label treatment for short stature in adolescent males.
According to some studies, the use of AIs can lead to a significant increase in predicted adult height as well as an increased height standard deviation score for bone age.

So, to answer to your question: Yes, Anastazole can be used to make sure that your son's epiphyseal plate do not close but personally i don't recommend this treatment because there are serious side effect that should be taken in consideration.
My concern is the limited safety profile of AI usage in the pediatric population.

At the other side your son is only 14 and he is in puberty.
Boys go through a growth spurt during puberty and they continue growing gradually until their late late teens (at the average age of 18 years).
A few of them may grow taller into their early 20s from leading well-balance lifestyles.

So ,there is no need to worry! Your son with his genetics, a healthy diet and the right activities level will reach his right adult stature.
I Don't think Anastazole is a good treatment.

Anyway I suggest to discuss carefully with your son's treating endocrinologist about the benefits and the risks of anastazole for your child.

Hope this is helpful.
Regards

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Elona (39 hours later)

Thank you doctor.

Have you ever heard of the Khamis Roche height calculator? Is it accurate? We are caucasians with European roots.

Answered by Dr. Elona (9 hours later)

Brief Answer:
Yes, it can be considered "accurate" but there is always a margin of error.

Detailed Answer:

Hi,

Khamis-Roche Method is used for kids from four to 17 years.

Five parameters (Gender, Mid-parent height, Child's current height, Child's current weight, Skeletal age) helped to predict the height the child would reach as an adult.

Khamis Roche method can be applied only to healthy Caucasian children (kids born to Caucasian parents) and you should know that there is still a margin of error of 2.1 inches for boys in predicting the height of your child at 18 years.

So, to resume me answer: As the name suggests, the calculators only predict the height.

Height prediction may not be accurate, but these scientific methods can give you a fair idea of your child's future height

Your child's actual height could depend on his overall health, the food he takes, his lifestyle, habits, and even the part of the world he lives in.

Hope I have clarified your doubts. Wish you good health.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Elona (6 days later)

Hi doctor. I know this sounds crazy, but I've been measuring XXXXXXX every week for the past 6 weeks and am very happy that he was been growing fast. 6 weeks ago he was 5' 2.75" and he kept growing steadily and last week he was 5' 3.6". However when we measured him yesterday he was still the same as last week, at 5'3.6". Do you think he is done growing? Do you think his bones may be closing? We are getting nervous because there has been no growth in the past week.

Thank you!

Answered by Dr. Elona (3 hours later)

Brief Answer:
I don't think he is done growing.

Detailed Answer:

Hi,

Don't stress! Your son is only 14 and he is in puberty. It is sure that he will grow until he's 18s or even 20s if he has a well balance lifestyle.

After teens hit their peak growth spurt, their growth will slow steadily until they reach their full adult height, about 4 to 5 years after their peak growth spurt.

A left wrist, hand, and fingers X-ray will clarify if his growth plates are closed or not.

Anyway, as I said several time you should not be worried because your son will reach gradually his normal adult height.

The measurement should be done every year because it is impossible to see height growth every week in this age.

Hope I have answered to all your questions. Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Elona (6 hours later)

Thank you doctor. He had a wrist x-ray last month and they said his bones were still open. How often should we do the x-ray? If we see the bones are starting to close, would it then be a good time for him to take anastroloze?

Thank you!

Answered by Dr. Elona (16 hours later)

Brief Answer:
X-ray every year.

Detailed Answer:

Hello

All the elements are Ok.
Age, puberty and open growth plates.
So, there is no reason to be anxious and impatient.
The kid will certainly reach his optimal stature.

All you can do is to assure he has the right nutrition, have good sleep every night and have more physical activities.
The nature will do the rest.

X ray can be done every year.
I don't recommend anastazole for a kid that has good possibilities that will naturally grow.

Let me know if you have other doubts.
Wish you good health.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Elona (6 hours later)

Thank you doctor. My child's pediatrician agreed with you. He did not think anastroloze was a good idea. And he did not think he was almost done with puberty. However, Noah's pediatric endocrinologist thought he might almost be done with puberty. If he is almost done with puberty, should he then take the anastroloze?

Thank you!

Answered by Dr. Elona (32 hours later)

Brief Answer:
Anastazole side effects.

Detailed Answer:

Hello,

I don't recommend Anastazole in a child because I don t think this drug is safe for the pediatric population.

Several studies show his effectiveness in short children with growth hormone deficiency but they don t guarantee the safety usage in this population and conclude that there are serious side effects that should be taken in consideration.

Your son has not Growth hormone deficiency and it is still in puberty.
So, I don t think you have reason to stress.

Hope this is helpful.
Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Elona (4 hours later)

Thank you so much for all your reassurance doctor. If there is anything else you think of that will reassure us, please keep us in mind.

Answered by Dr. Elona (28 hours later)

Brief Answer:
You can be re-assured that he is growing fine

Detailed Answer:

Hi,

I do not see any reason to worry about your child's growth.

In general, I have seen many boys grow when they enter college. So its every child different pattern of growth. Children grow up at least to their parents height in general. If diet and exercise are taken care of, then they may grow even more.

So nothing to worry in your case.

If you don't have more questions, you can close thread and rate the answer.

Regards,
Dr. Elona

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Elona (2 days later)

Hi Doctor,

We had an appointment with the pediatrician today. He is not concerned that the child is only in the 35th percentile for height. The pediatrician is concerned that he will soon be done with puberty (he just turned 14) and will stop growing before he reaches his full height.

The good news is that Noah’s testicles are at about stage 3 of the five Tanner stages. The bad news is that Noah’s pubic hair is at stage 5. We were told those were the two most important markers of puberty.

Do you think we should now consider anastrozole because the child may soon stop growing?

Thank you so much.

Answered by Dr. Elona (6 hours later)

Brief Answer:
The X-ray markers are very important.

Detailed Answer:

Hi,

You mention that your son's pediatrician has been monitoring your child’s height and weight on growth charts. You can estimate remaining growth based on these charts and this is very important.

But personally (apart the growth charts) I prefer to use x-ray markers to better estimate the amount of growth a child has remaining.

So, To resume, apart height and weight percentile and Tanner stages of child physical and sexual development ,it is very important to evaluate the child hand X-ray.

A good rule of thumb is that once a child has reached the end stages of puberty, the growth plates are essentially closed.

I have not changed my opinion about anastazole.
It can be beneficial but at the other side it can be dangerous and for this reason I recommend to discuss with your son's treating endocrinologist about the risk benefits balance.
If you think that you have more benefits than risks for anastazole treatment and your son's growth plates are closing soon; than you can consider starting this therapy.

Hope this is helpful.
Take care.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Elona (31 minutes later)

Thank you doctor.

His growth plates are still open. How often should we have his hand x-rayed? His bone age is very close to his chronological age. His bone age was measured at 14 or 14.5. His chronological age is about 14.1.

Even though his bone age is not too old, the doctor still thinks he could end puberty soon.

Besides x-rays, are there any signs we can watch for to see if his bones are starting to close?

Answered by Dr. Elona (9 hours later)

Brief Answer:
Hand X-Ray every 6 months - 1 year.

Detailed Answer:

Hi,

Your son's growth plates are still open, his bone age is correct and his growth rate is Ok.

Hand X-ray is the only test that determines the skeletal age or bone age of estimating children's development and this test can be done every 6 months or every year.

Hope I have answered your questions.
Wish you good health.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Elona (29 minutes later)

Thank you doctor. Even if bones are still open, and his bone age is close to his chronological age, should we still be nervous about his pubic hair being at stage 5 on the tanner scale?

What's more important - that his bone age is close to his real age, or that his pubic hair is at tanner stage 5. (And please keep in mind the good news that his testicles are only at tanner stage 3.)

Thank you so much.

Answered by Dr. Elona (35 hours later)

Brief Answer:
No, you have no reason to be nervous.

Detailed Answer:

Hi,

Even with the last information, I did not change my opinion about your son development.

The progression of height, weight and sexual characteristics are specific for every child in puberty.

Your son s secondary sexual characteristics are in normal progressive development and this is normal for a 14 years old boy.

This fact is the evidence that his puberty is not in the end.

So ..don't worry because your boy is normally growing and becoming mature.

Hope this helps. Wish you all the best.

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Remy Koshy