Can I still grow taller if my growth plates are "almost closed"? Doctors reveal 3 common misunderstandings

Liang Shengbin, a doctor at Xinzhuang Youyou Pediatric Clinic, said on the Facebook fan page "Dahua Doctor-Liang Shengbin Stimulates Children's Growth Momentum" and the official website that sometimes when children in the growth clinic are measured for bone age, they find that the growth plate is "almost closed." Parents always ask me: "Does this mean that the child will not be able to grow taller?" As a pediatric genetics and metabolism physician, I would like to say, "Most likely, the child will grow a little longer, but the space is usually not large."

Liang Shengbin said that "almost closed" and "completely closed" should be looked at separately. After complete ossification, long bones will no longer grow on their own, even if they take supplements or take growth hormones. Almost closed means it hasn’t reached that point yet. There are three common misunderstandings in this question.

Misunderstanding 1: Think of closure as happening all over the body at the same time on a certain day

Liang Shengbin said that a Swedish team used MRI to scan the wrists, knees and ankles of 958 healthy young people aged 14 to 21 years old. The growth plates were closed sequentially from bottom to top. The heels are the earliest and the wrists are the last. For 17-year-old girls, 75% of wrists are completely closed; for 19-year-old boys, 90% of them have completely closed wrists. Girls have to be 19 years old and boys to 21 years old. These parts have just been closed. The bone age film takes the hand, so when the hand film is about to close, the growth plate on the leg has usually closed first. Then why is the seam still there but not much space?

Misunderstanding 2: Thinking that height growth is blocked by closure

Liang Shengbin said that because the growth plate will age.

The side of the growth plate near the end of the bone is called the quiescent zone, which contains a group of cells responsible for supplying dividing cartilage cells. Two mouse studies in Nature in 2018 and 2019 confirmed that they are stem cells that can self-renew. The older you get and the later puberty progresses, the more the division ability of this group of stem cells is used, and the number of cartilage cells decreases. The growth rate slows down first, and finally the entire piece of cartilage is replaced by bone. Closure of the growth plates is the final step; height has almost stopped before then. So there are still seams visible on the film, which just means it hasn’t been closed yet. How much your child can grow depends on how many centimeters they actually grow this year.

What factors determine whether growth plates age quickly or slowly? Liang Shengbin said that it is mainly estrogen, which is the same for boys and girls. Boys' testosterone will be converted into estrogen in the body, and then estrogen will push the growth plate to age and close. Puberty is early, and estrogen is also early. This is why precocious puberty reduces adult height.

A 2025 PNAS mouse study also found that growth hormone directly promotes the downward differentiation of this group of stem cells. This results in a smaller stem cell pool, which the study authors speculate may explain why growth hormone treatment is less effective over time; however, there is no direct evidence of this mechanism in humans. Is there any medicine that can slow down the growth plates that are quickly shutting down, or reopen the ones that are shutting down?

Misunderstanding 3: Thinking that the growth plate can reopen

Existing drugs, from injections to inhibit precocious puberty to CNP analogs for achondroplasia, only act on growth plates that are still open. The older the growth plate is, the less space the drug can gain. After complete closure, the only thing that can make the bones longer is limb lengthening surgery.

Liang Shengbin cited a systematic review in 2025, which compiled 12 studies and 760 people who underwent this kind of surgery for height. The average age was about 25 years old, and the average increase was 6.7 centimeters; the satisfaction rate was between 88.8% and 98%. But the same article also lists the costs. The most common ones are joint and tendon problems: such as the inability to lift the ankle upwards, and contractures of the knees and ankles. Then there are pinhole infections and poor bone healing, and some require additional surgery to repair the bones.

Liang Shengbin said that if the growth plate is almost closed, will the child not grow taller? My answer is this: Children whose growth plates are almost closed will probably grow a little longer. Space is limited and medicine can’t help much. Once completely closed, the bone will no longer lengthen on its own, and there is no medicine that can reopen the growth plate.

In the end, Liang Shengbin concluded that surgery was the only way to increase bone length. The only time medicine can help is before closure. Therefore, evaluation should be done as early as possible, before the growth rate drops and puberty is advanced. The earlier you look at it, the more you can do. Remember to pay attention to how many centimeters your child has grown recently and where his or her bone age has progressed. Don't wait until it's really closed, then there's really nothing you can do to help.