Until what age is height growth limited?

Height Growth Cessation

Height growth continues until the epiphyseal growth plates close, which occurs when the cartilaginous zones at the ends of long bones become completely obliterated and calcified—after this point, no further lengthening of bones will occur. 1

Timing of Growth Plate Closure

The age at which growth plates close varies significantly by sex and individual factors:

Females

• Peak growth velocity occurs at approximately 10.9-11.5 years of age 2
• Growth typically ceases by age 14-16 years when epiphyseal closure is complete 3
• Bone age of 14.0 years or greater in females indicates near-complete or complete growth potential exhaustion 3
• Growth velocity dropping below 2 cm/year signals imminent growth cessation 4, 3

Males

• Peak growth velocity occurs at approximately 14.0-14.4 years of age 2
• Growth typically ceases by age 16-18 years when epiphyseal closure is complete 3
• The pubertal growth spurt begins later (around 11.9-12.0 years) compared to females 2
• Growth continues for approximately 2 years longer than in females due to later onset of puberty 2

Biological Mechanism of Growth Cessation

Growth plate senescence is the fundamental process limiting height: 5

• Progenitor cells in the resting zone become depleted
• Proliferative chondrocyte numbers progressively decrease
• Hypertrophic chondrocytes are replaced by osteocytes
• The extracellular matrix calcifies and becomes vascularized
• Once this process completes, the growth plate is "closed" and longitudinal bone growth is impossible 1, 5

Clinical Assessment of Remaining Growth Potential

Radiography of the left wrist is the gold standard for determining whether growth potential remains: 1, 3

• Open epiphyses with visible cartilaginous zones indicate ongoing growth potential
• Thin or nearly obliterated cartilaginous zones suggest minimal remaining growth
• Completely closed epiphyses confirm that no further height gain is possible 1

Critical Factors Affecting Final Height Attainment

The timing of puberty is the most critical determinant of final height: 6, 7

• Earlier pubertal onset allows more prepubertal growth, potentially increasing final height
• Rapid-tempo puberty with accelerated testosterone production causes premature skeletal age advancement and shortened final height 7
• Late-onset puberty appears particularly deleterious to spinal growth, resulting in body disproportion and compromised final height 6

Common Pitfall

Constitutional delay of growth is often assumed to result in normal adult height, but this is incorrect in many cases—58% of boys with constitutional delay fail to achieve their genetic height potential, particularly those with slower growth velocity and less body disproportion at presentation 6. Additionally, rapid-tempo puberty can occur even in children previously diagnosed with constitutional delay, leading to unexpectedly short adult stature 7.

Age-Specific Growth Monitoring

Growth velocity calculated over a minimum 6-month period is more sensitive than single height measurements: 1

• Growth velocity below the 25th percentile indicates potential growth failure requiring evaluation 4
• Growth velocity above the 75th percentile indicates catch-up growth 1
• At age 17 with 6 months of growth cessation, bone age assessment is the priority to determine if epiphyseal closure has occurred 3