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Even with a healthy diet, most people’s height won’t increase after age 18 to 20.

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Your height is mostly determined by genetics. For most people, height will not increase after age 18 to 20 due to the closure of the growth plates in bones. However, proper nutrition during childhood and adolescence can help you maximize your height.

Many people are unhappy with their height. But can anything be done about it?

If you have asked this question, you are not alone. Some claim good nutrition or special exercises can increase your height as an adult.

This article takes a closer look at whether it's possible to increase your height after the age of 18.

Before discussing whether it's possible to change your height as an adult, it's important to consider what determines your height in the first place.

The easy answer is genetics, but that isn't quite the whole story.

Studying twins is one way scientists determine the extent to which genetics affect body height ().

In general, height in twins is highly correlated. This means that if one twin is tall, the other is likely to be tall as well ().

Based on studies in twins, it's estimated that 60-80% of the difference in height between people is due to genetics (, , ).

The other 20-40% is due to environmental factors like nutrition ().

Trends in height worldwide help demonstrate the importance of nutrition and lifestyle factors.

One enormous study including 18.6 million people reported changes in height over the last century.

The study found that in many countries, the average person was taller in 1996 than in 1896 ().

Improved nutritional intake in these countries may be the cause for this change.

Even with a healthy diet, most people's height won't increase after age 18 to 20.

The graph below shows the rate of growth from birth to age 20. As you can see, the growth lines fall to zero between ages 18 and 20 (, ).

The reason why your height stops increasing is your bones, specifically your growth plates.

The growth plates, or epiphyseal plates, are areas of specialized cartilage near the end of your long bones.

Increases in height are primarily due to the lengthening of your long bones, as the growth plates are still active or "open."

Near the end of puberty, hormonal changes cause the growth plates to harden or "close" and the lengthening of bones to stop ().

Growth plates close around age 16 in women and somewhere between ages 14 and 19 in men ().

Even though true growth of the long bones won't occur in most adults, some slight daily variations in height are typical.

The cause of this variation throughout the day is the slight compression of the discs in your spine (, 12).

Daily activities impact the cartilage and fluid in your spine and cause slight reductions in height as the day progresses (, 12, ).

This loss of height during the day may be up to about half an inch (1.5 cm) (, , ).

Some research has indicated that the height of the discs in your spine may continue to increase through young adulthood, but the impact on overall height is minimal ().

A common height myth is that certain exercises or stretching techniques can make you grow taller.

Many people claim that activities like hanging, climbing, using an inversion table and swimming can increase your height.

Unfortunately, there is no good evidence to support these claims.

It is true that your height varies slightly throughout the day due to the compression and decompression of the cartilage discs in your spine ( 12).

By decompressing your discs, some of these activities could temporarily increase your height to a very small extent ().

However, this isn't a real change in height, as any changes are quickly reversed ( 12, , ).

Many people worry that exercise, especially weight lifting, can be detrimental to your height.

Some of this concern is specific to children and adolescents, whose growth plates haven't closed.

The cartilage of the growth plates is weaker than the mature bone that forms during adulthood and could potentially become damaged more easily.

However, most research shows that weight training is safe and beneficial at all ages, as long as it's appropriately supervised.

Moreover, studies have shown that weight training before adulthood does not decrease growth ().

Most sports medicine doctors and experts also agree that weight training does not need to be avoided in children and adolescents.

One study asked 500 sports medicine experts whether weight lifting should be avoided until a person's growth plates close ().

85% of the experts said that it is not necessary to avoid weight lifting, and only 10% thought that it may be best to avoid weight training.

Additionally, other research shows that the primary concerns for weight training injuries are a lack of supervision or improper use of equipment (, ).

In adults, growth plates have closed and become stronger than during childhood. Because of this, the risk of growth plate damage is not a major concern.

Indeed, weight lifting can lead to minor compression of spinal discs in adults. However, this is reversible and also occurs during normal daily activities (, , , ).

One potential cause for concern is injuries like herniated discs.

In this case, the size and health of the discs in your spine can be compromised, and it is possible that a slight decrease in height could occur ().

Although you may not be able to change your height substantially as an adult, there are things you can do to maximize your height potential in your teenage years.

Overall, you want to be sure you are eating enough and that you aren't deficient in any vitamins or minerals.

While many children eat enough (or even too much), diet quality is often poor ().

Because of this, many individuals in modern society are deficient in important nutrients like vitamin D and calcium ( 26).

These nutrients are very important for bone growth and overall health (, ).

Calcium from the diet alters hormone production in a way that benefits your bones. Vitamin D may also improve bone health (, ).

One great way to combat nutrient deficiencies and promote optimal bone growth is to increase your intake of fruits and vegetables (, 32).

Eating enough protein is also essential for bone health, although some people have questioned whether high protein intake can harm your bones.

However, a large analysis of 36 studies found that higher protein intake is not harmful to your bones. In fact, higher protein intake was beneficial for the bone density of the spine ().

One way to increase your protein intake is to try to consume at least 20 grams of protein each time you eat.

Good sources of protein include eggs, poultry, lean meats and dairy. Soy and other legumes are also high in protein.

While proper nutrition during childhood is essential for reaching your greatest height, there may be differences between men and women.

Some research has shown that environmental factors, such as nutrition, may play a larger role in height in women than men.

This may be partially due to differences in access to food and medical care or the higher rates of osteoporosis in women ( 34).

Other lifestyle choices, such as not smoking, could also benefit your height during development ( 35).

However, it is important to remember that while lifestyle factors during childhood can affect height, a person's final height is still mostly due to genetics.

Summary: Eating enough
and avoiding nutrient deficiencies during childhood and adolescence can help
maximize your growth potential.

Although most adults won't grow taller after age 18 to 20, there are exceptions to this rule.

First, the closure of the growth plates may be delayed in some individuals ( 36, 37).

If the growth plates remain open past age 18 to 20, which is uncommon, height could continue to increase.

Second, some suffer from gigantism. This condition causes excessive growth, often due to too much growth hormone (GH) production ().

However, these individuals typically only increase in height until their growth plates close around age 22 ( 39).

Furthermore, one form of hemochromatosis, a condition in which excessive iron is absorbed in the intestines, may also cause an increase in height ( 40).

In general, these conditions could increase height until the growth plates close.

Summary: Some rare
medical conditions could lead to height increases after age 18, but this
generally only occurs if the growth plates haven't closed.

If you are an adult who is unsatisfied with your height, here are a few things you can try:

Practice good posture: Poor posture can rob anyone of a few inches of height.

Try heels or inserts: Choose shoes with taller heels or place inserts in your shoes to add up to a few inches of
height.

Gain muscle to look and feel stronger: If you feel small in general, lifting weights to gain muscle can make you more muscular and
confident.

While these simple strategies may help, some people resort to more extreme measures, such as medical treatments or procedures.

Several of these procedures involve lengthening the bones of the lower leg ( 41, ).

However, due to the invasive and expensive nature of these operations, many do not choose such drastic measures. These procedures are even banned in some countries.

Others seek out treatment with growth hormone (GH). While GH can improve height in children who are not growing properly, benefits of this treatment in adults are unlikely (, 44).

Ultimately, finding a way to accept your height is recommended over considering more extreme measures.

Although you may not be able to increase your height as much as you would like, there are things you can do to help yourself accept your current height.

It's helpful to realize that height isn't everything.

You can be happy and successful regardless of your stature. In fact, there are many happy successful people throughout history who were short.

Although some people think that being short puts you at a psychological disadvantage, scientists debate whether this is true (, 46).

Researchers have also promoted the idea of using coping strategies and focusing on things other than height ().

Making a list of your best qualities, both physical and non-physical, may help improve your outlook.

Additionally, you could focus on other areas of self-improvement. Losing weight or gaining muscle may give you the extra boost of confidence you are looking for.

Height is largely determined by genetics, and most people will not grow taller after age 18.

However, proper nutrition during childhood and adolescence can help you maximize your height.

If you are unhappy with your height, you may want to consider some simple strategies to look and feel your best.

These may include having a good posture, wearing shoe inserts or heels or lifting weights to gain muscle.

What's more, focusing on your strengths and other areas of self-improvement can move your focus off of your height.

Ultimately, you can't change the hand you were dealt in life, but you can seek to make the most of it.

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Is It Possible to Increase Your Height After 18?

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Many people are unhappy with their height and wonder if there's anything they can do. Read on to learn whether it is really possible to increase your height.

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Grant Tinsley, Ph. D.

Professor, Reseacher and Consultant

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Hi, I'm Grant Tinsley.

As a professor at Texas Tech University, I perform academic research, mentor student researchers, and teach undergraduate and graduate courses. My peer-reviewed research articles can be found on PubMed or Google Scholar.

As a consultant, I provide services in the areas of data analysis, peer-reviewed manuscript preparation, dietary supplement formulation, and scientific review.

You can read more about me here.

Featured Articles

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Dr. Grant Tinsley is an Associate Professor at Texas Tech University and the Owner of Tinsley Consulting LLC.

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This individual is no longer a medical reviewer in our network. The credentials and contact information reflected here may not be current.
Dr. Grant Tinsley is a tenured associate professor at Texas Tech University and the director of the Energy Balance & Body Composition Laboratory. He has published more than 75 peer-reviewed journal articles in intermittent fasting, body composition assessment, and sports nutrition. He is also a certified strength and conditioning specialist and a certified sports nutritionist.
Education

Oklahoma State University, BS

Colorado State University, MS

Baylor University, PhD

Stanford University, Medical Statistics Certificate

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Certified Strength & Conditioning Specialist, with distinction (CSCS,*D)

Certified Sports Nutritionist (CISSN)

Professional Accomplishments

Principal investigator for 13 externally supported research projects

2021 recipient of the National Strength and Conditioning Association Nutritional Research Achievement Award

2019 recipient of the Texas Tech University Alumni Association New Faculty Award

2018 recipient of the Best Paper Award from the European Journal of Sports Science

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An adult cannot increase their height after the growth plates close.

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Some people dislike their height and wish they could be taller. While leading a healthy lifestyle can support growth, there is not much that a fully grown adult can do to increase their height.

About 80% of a person's height depends on their genetics. After a person has reached adulthood, most tricks to increase height - such as good nutrition - will not work.

However, there are ways to appear taller and prevent loss of height, which is common as people age.

This article looks at what determines height, how to prevent height loss, and more.

Height stems from a range of factors, including:

genetics

sex assigned at birth

certain medical conditions

nutrition

exercise

secretion of growth hormone from the pituitary gland

Genetics plays the most significant role in determining a person's height. on twins have demonstrated the importance of heredity in determining a person's body type.

This means that if a person's parents are tall, it is more likely that they will also be tall. If a person's parents are short, it is much more likely that the person will be short, as well.

Sex is another biological factor that plays a role in determining a person's height. Females tend to have less total height potential than males.

Certain medical conditions can also play a role in determining a person's height. The following conditions can change how a person grows during childhood:

Nutrition also affects a person's height potential. Getting good nutrition that includes dietary sources of vitamins and minerals helps people grow. Conversely, individuals who do not get adequate nutrition may not grow as tall.

Studies have found that as nutrition has improved over time, people have grown taller. This suggests that children who eat a diet rich in calcium, protein, and other nutrients will be able to maximize their potential for growth.

Physical activity also plays a role in childhood growth and height, as being active promotes the release of human growth hormone.

When this hormone activates, a child with open growth plates in their bones may experience more growth than they would if they were not physically active.

However, once the growth plates in the bones close, a person will generally not grow any taller.

Most females reach their full adult height aged 14-16 years. Most males reach their full height by the age of 16-18 years. It is very unusual for a person to grow after the age of 18 years.

Although a person cannot increase their height after the growth plates in the bones have closed, there are ways to look taller. These include the following.

Practice good posture

Not only does standing and sitting with good posture make people look taller, but it also helps prevent the neck and back pain that often accompany slouching.

A person can stand with good posture by:

keeping the shoulders back

pulling the belly toward the spine with the muscles lightly engaged

keeping the head level and in line with the body

placing the feet shoulder-width apart

avoiding locking the knees

keeping the weight primarily on the balls of the feet

letting the arms hang naturally at the sides

A person can practice good sitting posture by:

keeping the feet flat on the floor while sitting

adjusting the chair height so that the thighs stay parallel to the floor and the feet are flat on the floor

avoiding crossing the legs

supporting the back using a small pillow or towel

letting the shoulders rest comfortably

Maintaining good posture helps keep the proper space between the vertebra, and it may make a person look taller.

Strengthen the core muscles

A strong midsection can help a person maintain good posture and look taller. The core muscles are the muscles in the abdomen and along the spinal column.

These muscles help support the spine. When these muscles are too weak, the spine is not properly supported and may compress. This can also lead to slouching.

To get stronger core muscles, a person can try the following exercises:

Plank: Keeping abdominal muscles engaged, hold the position at the top of a pushup.

Superman: Lying on the stomach, extend the arms, legs, and head off the floor and hold.

Abdominal crunch: Lying on the back with the knees bent and the feet on the floor, raise the head and shoulders using the core muscles.

Take supplements

Some vitamins and minerals can supplement a healthy diet. Certain supplements can help strengthen bone, the support system of the body that helps an individual maintain good posture.

Supplementing with calcium and vitamin D can improve bone density and prevent the bone loss that can lead to osteoporosis, arthritis, fractures, and stooped posture.

A person should avoid supplements that manufacturers claim can lead to growth in adulthood. Once the growth plates close, which happens after puberty, there is no way to add height, regardless of what appears on the label of the supplement bottle.

Eat a nutritious diet

According to a 2016 literature review, average adult height has increased in high income countries in a short period. The study authors note that previous research shows that improvements in diet, as well as overall improved living standards and decreased disease exposure, are responsible for the height increase.

Eating a nutritious, balanced diet provides the body with the nutrients it needs to maintain strong bones and prevent osteoporosis and bone loss. Bone loss can lead to height loss as the spine and joints compress.

A balanced diet includes a variety of colorful vegetables alongside leafy greens, fruits, whole grains, and lean meats.

Wear higher shoes

Wearing heeled or platform shoes is a simple and convenient way to add temporary height. However, a showed that wearing shoes with taller heels and walking at a higher speed can impair a person's balance, which could lead to injury.

Another found that wearing high heels puts strain on the cervical and lumbar muscles in healthy women. The authors state that this could lead to muscle fatigue, swelling, and decreased movement.

Therefore, a person may wish to wear heeled shoes only occasionally. A person should also walk carefully when wearing these shoes to avoid injury.

Do yoga

Doing yoga may help loosen the muscles and lead to increased body flexibility and better posture, providing the appearance of more height.

A found that yoga increased the bone density of postmenopausal women with osteoporosis. The authors suggest that yoga allows the bones to retain calcium, which may strengthen them and allow a person to gain better posture.

As bone loss is one of the leading causes of height loss with age, yoga may prevent the loss of height in adulthood.

Although adults cannot do much to increase their height, they can take steps to avoid the age-related loss of height.

After a person reaches the age of 30 years, they may lose as much as half an inch of height per decade due to osteoporosis, compression of the spine, and other reasons. This can add up to a significant loss of height over time.

People can take steps to combat age-related shrinking. These include:

maintaining adequate nutrition, including getting plenty of calcium

doing weight-bearing exercises regularly to combat muscle loss

staying properly hydrated

quitting smoking, if applicable

getting plenty of rest

This section answers some common questions about increasing height as an adult.

How long does it take to improve posture to seem taller?

According to a 2017 study in the Journal of Physical Therapy Science, it may take about 8 weeks for better posture to make a person appear taller.

In the study, researchers randomly assigned 28 participants to one of three exercise protocols to improve their posture. The team took posture measurements before the exercise program and after 8 weeks.

All of the protocols led to significant improvements in posture after the 8-week period. Although each body is different, it will generally take about this length of time for the body posture to improve enough to give the appearance of more height.

In addition to performing posture-improving exercises, a person should reduce activities that cause posture to decline, such as continually looking down at a phone or slouching in a chair.

How much height increase can you expect from enhancing your posture?

A person's posture can make them appear shorter if they slump their shoulders or neck or round their spine. This can take several inches away from their true height.

Although there is not much research on how much height can increase with improved posture, there are anecdotal reports of up to 2 inches.

After the age of 30 years, people begin to lose height gradually. On average, individuals lose about half an inch in height every 10 years. This loss may accelerate after the age of 70 years. Slouching and similar posture habits can exacerbate this loss, making an individual appear shorter.

An adult cannot increase their height after the growth plates close. However, there are plenty of ways a person can improve their posture to look taller.

A person can also take preventive measures against height loss as they age. These include eating a balanced, nutritious diet, exercising, using supplements, and practicing good posture.

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Is there any way to get taller as an adult?

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Several factors determine how tall a person will grow. Is it possible to increase your height as an adult? Learn more here.

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The reason why your height stops increasing is your bones, specifically your growth plates.

The growth plates, or epiphyseal plates, are areas of specialized cartilage near the end of your long bones.

Increases in height are primarily due to the lengthening of your long bones, as the growth plates are still active or “open.”

Near the end of puberty, hormonal changes cause the growth plates to harden or “close” and the lengthening of bones to stop.

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Abstract

The complex networks of nutritional, cellular, paracrine, and endocrine factors are closely related with pubertal growth and epiphyseal fusion. Important influencing factors include chondrocyte differentiation capacity, multiple molecular pathways active in the growth plate, and growth hormone-insulin-like growth factor-I axis activation and epiphyseal fusion through estrogen and its receptors. However, the exact mechanisms of these phenomena are still unclear. A better understanding of the detailed processes involved in the pubertal growth spurt and growth plate closure in longitudinal bone growth will help us develop methods to efficiently promote pubertal growth and delay epiphyseal fusion with fewer adverse effects.

Keywords: Growth, Puberty, Growth plate

Introduction

Growth in height is driven by elongation of long bones due to chondrogenesis at the epiphyseal plates, also known as the growth plate. This process results from chondrocyte proliferation, hypertrophy, and extracellular matrix secretion. It is organized by complex networks of nutritional, cellular, paracrine, and endocrine factors 1).

Puberty can be defined as the transitional period from childhood through the development of secondary sexual characteristics to the achievement of final height in adulthood 2).

Growth velocity is increased in early or midpuberty and is known as the pubertal growth spurt. The growth velocity decreases and may even be zero after epiphyseal fusion, that is, after growth plate closure in late puberty. Therefore, the pubertal growth spurt and growth plate closure have opposite effects on bone elongation. However, the exact mechanisms behind these contrary phenomena during puberty are still unknown 2).

Precocious puberty (PP) is a known cause of short stature after earlier puberty due to premature closure of growth plates in long bones. PP is divided into two categories, central and peripheral types, according to pathological lesions. The etiology of most cases of central PP is idiopathic. In industrialized countries, the number of patients with idiopathic central PP is increasing 3).

Gonadotropin-releasing hormone agonist is used as a major therapeutic modality in idiopathic central PP. Several aromatase inhibitors have also been studied as new treatment options. These drugs decrease the secretion of estrogen and delay growth plate closure 3).

The elucidation of the detailed mechanisms of pubertal growth and epiphyseal fusion may help in developing new strategies for the treatment of short stature or PP.

In this article, the processes of bone formation, histology and physiology of the growth plate, and cellular, paracrine, and endocrine factors for bone growth will be reviewed.

Bone formation

The mechanisms of bone formation are divided into two processes, intramembranous and endochondral ossification. The former is involved in the growth of the craniofacial skeleton and the latter is critical for the growth of the axial and appendicular skeleton. Therefore, endochondral ossification is more important for the increase in human height. It requires several processes, including condensation of mesenchymal cells and differentiation into chondrocytes, osteoblasts, and osteocytes 4).

Histology and physiology of the growth plate

The growth plate is located between the epiphysis and metaphysis and composed of three zones (resting, proliferative, and hypertrophic zone). Each zone contains various chondrocytes in different stages of differentiation. The resting zone contains small chondrocytes that act as stem-like cells with a slow replication rate. The proliferative zone is composed of flat chondrocytes that line up along the long axis of the bone and have high replication rates. The hypertrophic zone is the layer of chondrocytes undergoing terminal differentiation and has an increased thickness, surrounding calcified matrix, and attracted factors for bone and vessel formation 5).

During the pubertal growth spurt, proliferation and differentiation of chondrocytes, secretion of extracellular matrix, calcification of the hypertrophic zone, invasion and differentiation of osteoblast, and formation of blood vessel repeat continuously in the growth plate 5, 6).

At the end of the pubertal stage, these processes stop and longitudinal growth completes due to still unknown mechanisms 5, 6).

Cellular factors

In early puberty, chondrocytes have the potential to proliferate and differentiate continuously. However, in late puberty, this potential decreases with age. When proliferation completely stops, longitudinal growth also stops and the final adult height is reached. This process is known as senescence of the growth plate. The cellular mechanism of epiphyseal senescence is still unknown. There are four theories on the cellular mechanism of epiphyseal fusion after the pubertal growth spurt. Apoptosis, autophagy, hypoxia, and transdifferentiation have been considered the causes of epiphyseal fusion 7).

1. Apoptosis

This theory is the most widely held hypothesis. Hypertrophic chondrocytes of the growth plate undergo death by apoptosis, leaving behind a frame of cartilage matrix for osteoblasts that invade and lay down bone. Some supporting and opposing results for this hypothesis have been reported in several studies 8). Apoptosis-regulating proteins (such as caspases) were expressed in the growth plate and typical histologic changes in cell during apoptosis were shown in several studies in rat 9). However, another study found no signs of classical apoptosis in fusing human growth plates 10).

2. Autophagy

Autophagy is another method of programmed cell death that involves a catabolic process in which the cell degrades its own components through autophagosomes. Signs of autophagy (autophagosomes, double-membrane structures, and condensed chromatin) were observed in avian hypertrophic chondrocytes and chondrocytes of newborn mice 11, 12). However, there were no autophagosomes or signs of autophagy in the growth plate in a study in humans 7).

3. Hypoxia

Emons et al. 10) reported a dense border of thick bone surrounding growth plate remnants in a human growth plate tissue specimen undergoing epiphyseal fusion. They postulated that the dense border might act as a physical barrier preventing oxygen and nutrients from reaching the fusing growth plate, resulting in hypoxia and eventually cell death in a nonclassical apoptotic manner.

Stewart et al. 13) also observed increased expression of hypoxiainducible factor 2α mRNA during chick and murine chondrocyte differentiation in vitro.

4. Transdifferentiation

This is the oldest hypothesis, in which terminal hypertrophic chondrocytes transdifferentiate into osteoblasts at the chondroosseous junction of the growth plate 14). This theory is mostly based on organ and cell culture models and there is a lack of direct evidence in human studies 7).

Paracrine factors

1. Proliferation and differentiation of chondrocytes

The conversion of progenitor cells in the mesenchymal condensation into chondrocyte lineage is controlled by the expression of the transcription factors Sox9, 5, and 6 8). Parathyroid hormone-related peptide (PTHrP) signaling, Indian hedgehog (IHH) pathway, and runt-related transcription factor 2 (Runx2) are required for further differentiation and hypertrophy of chondrocytes. In addition to those factors, fibroblast growth factor (FGF) pathway and bone morphogenic proteins (BMP) are necessary for the development of the perichondrium, periosteum, chondrocytes, and osteoblasts 7, 15).

Of these paracrine factors, the best studied one is PTHrP that is known as secreted by periarticular chondrocytes of long bones 16, 17, 18). Hirai et al. 19) reported that PTHrP diffuses across the growth plate cartilage maintaining chondrocytes in the proliferative state.

IHH is secreted by prehypertrophic and hypertrophic chondrocytes and positively regulates PTHrP production. And it also has independent effects on chondrocyte differentiation 18). BMP signaling across the growth plate is considered to contribute to the progressive differentiation of resting to proliferative to hypertrophic chondrocytes 20, 21, 22). FGF and its receptor (FGFR) system are also important for growth plate development. Results from various in vivo studies indicate that FGFR1 and FGFR3 are growth-inhibiting, while FGFR-2 is growth-promoting 23, 24).

2. Blood vessel formation

Vascular invasion is a prerequisite for the replacement of avascular cartilage by vascular bone and marrow. The most important stimulating factor for vessel invasion is hypoxia. Vessel formation is mediated by transcription factors, including hypoxia-inducible factor-1 and vascular endothelial growth factor (VEGF) 25, 26).

Runx2, FGFs, BMPs, transforming growth factor (TGF), insulin-like growth factor (IGF), and platelet-derived growth factor (PDGF) are also required for VEGF expression and vessel formation 27).

3. Osteoblast differentiation and ossification

There are five steps in differentiation of the osteoblastic lineage. These steps are the preosteoblast, mature osteoblast, osteoid osteocyte, early osteocyte, and mature osteocyte 28). Wingless-type mouse mammary tumor virus integration site (Wnts)/β-catenin signaling, Runx2, Osterix, Ihh, BMPs, and IGFs are required for these processes. During these steps, bone can deposit minerals from the extracellular matrix rich in type I collagen, completing ossification 4).

Endocrine factors

1. Growth hormone-insulin-like growth factor-I axis

Growth hormone (GH) and insulin-like growth factor-I (IGF-I) are the main stimulators of longitudinal bone growth. They are also important for the acquisition of bone mass during the prepubertal period and maintenance of bone homeostasis throughout life. GH stimulates the synthesis and secretion of IGF-I in the liver and growth plate. Longitudinal bone growth is mediated by GH, circulating IGF-I, and more importantly, local IGF-I in the growth plate. For differentiation, proliferation, and hypertrophy of chondrocytes; the production of extracellular matrix; and ossification in the growth plate, IGF-I produced from chondrocytes of the epiphyseal plate is important 29). There is a close interplay between estrogen and GH in the regulation of growth and development in puberty. During puberty, there can be a 1.5- to 3-fold increase in the pulsatile secretion of GH and a more than 3-fold increase in the concentration of serum IGF-I. However, the interactions between estrogen and GH at the growth plate remain unclear because there is a lack of evidence of the independent roles of these two hormones at the cellular level in the growth plate 30, 31).

2. Estrogen

During puberty, estrogen induces the stimulation of the GH-IGF-I axis and a pubertal growth spurt. In the classical pathway, estrogen acts after binding with its receptor (estrogen receptor, ER). There are two subtypes of ER, ERα, and ERβ. Both subtypes seem to be involved in the augmentation of GH secretion and are expressed in the resting, proliferative, and hypertrophic zones of the growth plate. Indirect evidence suggests that epiphyseal fusion occurs when the proliferative capacity of growth plate chondrocytes is exhausted and estrogen acts by advancing growth plate senescence. Therefore, the binding of estrogen with each subtype of ER is thought to be related to the pubertal growth spurt and epiphyseal fusion 32, 33, 34, 35).

In mice studies, ERα looks like the dominant mediator of estrogen actions in bone. ERβ has some repressive functions in bone of females. Evidence for a role of ERβ in males is lacking. A definite role for ERβ in humans remains unclear 36).

Borjesson et al. 37) studied the mechanisms of the pubertal growth spurt and epiphyseal fusion with cartilage-specific ERα knockout mice and reported that the effects of estrogen and ERα on growth plate thickness were unremarkable in early puberty, but obvious in late puberty. They suspected that activation of the GH-IGF-I axis with low doses of estrogen is important for the pubertal growth spurt in early puberty, while high doses of estrogen binding to its receptors in growth plate cartilage are essential for epiphyseal fusion in late puberty.

The effects of estrogen on the growth plate have been studied in many rodent models. However, there are some differences in growth plate physiology between rodents and humans. In rats or mice, the pubertal growth spurt is unremarkable and longitudinal bone growth continues even after sexual maturation, as epiphyseal fusion does not occur at the time of sexual maturation. Therefore, there are difficulties in the direct application of growth plate studies in rodents to humans 5).

Further molecular studies are needed to elucidate the consequences of estrogen and the ER in growth plates. Estrogen is known to promote bone formation by stimulating osteoblastogenesis and inhibiting apoptosis of mature osteoblasts. It is also known to decrease the osteoclast production by inhibiting the reaction with receptor activator of nuclear factor-κB ligand or production of interleukin-1, -6, -7, and tumor necrosis factor-α. Estrogen may also increase osteoclast apoptosis by stimulating the Fas/FasL pathway 4).

3. Androgen

Androgen itself also contributes to bone formation and the pubertal growth spurt, perhaps through a direct interaction with growth plate chondrocytes 38). Dihydrotestosterone can stimulate proliferation and proteoglycan synthesis in growth plate chondrocytes in vitro and testosterone stimulates chondrocyte proliferation in an organ culture model study with increased local IGF-I production 5).

In epiphyseal fusion, the activity of androgen is due to the aromatization of androgens to estrogens in various peripheral tissues, including growth plate cartilage 36).

Conclusions

Many factors are related with the stimulation of bone formation and growth, the pubertal growth spurt, epiphyseal senescence, and fusion, including nutritional, cellular, paracrine, and endocrine factors.

An important cellular factor in these processes is the differentiation and aging of chondrocytes in the growth plate. Important paracrine factors include the many molecular pathways involved in chondrocyte differentiation, vascularization, and ossification. Estrogen and the GH-IGF-I axis are important endocrine factors.

But, hitherto, the exact processes of interactions between paracrine and endocrine systems in growth plate, and the cellular mechanisms of the decreasing capacity of proliferation of chondrocytes and growth of organ with age are unknown.

Elucidation of the detailed mechanisms of the pubertal growth spurt and growth plate fusion will allow a better understanding of the molecular mechanisms responsible for short stature, PP, and skeletal disorders. It will also contribute to the development of new therapeutic modalities with fewer side effects and better efficacy.

Footnotes

Conflict of interest: No potential conflict of interest relevant to this article was reported.

References

3. Styne DM, Grumbach MM. Puberty : ontogeny, neuroendocrinology, physiology, and disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, editors. Williams textbook of endocrinology. 12th ed. Philadelphia: Saunders; 2011. pp. 1054-1202. [ Google Scholar]

4. Maes C, Kronenberg HM. Postnatal bone growth: growth plate biology, bone formation, and remodeling. In: Glorieux FH, Pettifor JM, Juppner H, editors. Pediatric bone. 2nd ed. San Diego: Elsevier Co.; 2012. pp. 55-82. [ Google Scholar]

Articles from Annals of Pediatric Endocrinology & Metabolism are provided here courtesy of Korean Society of Pediatric Endocrinology

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The complex networks of nutritional, cellular, paracrine, and endocrine factors are closely related with pubertal growth and epiphyseal fusion. Important influencing factors include chondrocyte differentiation capacity, multiple molecular pathways active ...

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Growth plates close around age 16 in women and somewhere between ages 14 and 19 in men.

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doi: 10.1007/s40279-015-0444-2.

Affiliations

¹ Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. belavy@gmail.com.

² Institute of Biomechanics and Orthopedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.

³ Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University Hospital of Cologne, 50924, Cologne, Germany.

⁴ Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.

⁵ Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.

doi: 10.1007/s40279-015-0444-2.

Affiliations

¹ Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. belavy@gmail.com.

² Institute of Biomechanics and Orthopedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.

³ Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University Hospital of Cologne, 50924, Cologne, Germany.

⁴ Department of Human Movement Sciences, MOVE Research Institute Amsterdam, Vrije Universiteit Amsterdam, van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.

⁵ Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, De Boelelaan 1117, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.

Abstract

To better understand what kinds of sports and exercise could be beneficial for the intervertebral disc (IVD), we performed a review to synthesise the literature on IVD adaptation with loading and exercise. The state of the literature did not permit a systematic review; therefore, we performed a narrative review. The majority of the available data come from cell or whole-disc loading models and animal exercise models. However, some studies have examined the impact of specific sports on IVD degeneration in humans and acute exercise on disc size. Based on the data available in the literature, loading types that are likely beneficial to the IVD are dynamic, axial, at slow to moderate movement speeds, and of a magnitude experienced in walking and jogging. Static loading, torsional loading, flexion with compression, rapid loading, high-impact loading and explosive tasks are likely detrimental for the IVD. Reduced physical activity and disuse appear to be detrimental for the IVD. We also consider the impact of genetics and the likelihood of a 'critical period' for the effect of exercise in IVD development. The current review summarises the literature to increase awareness amongst exercise, rehabilitation and ergonomic professionals regarding IVD health and provides recommendations on future directions in research.

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