Inaccuracy and bias in adult skeletal age estimation: Assessing the reliability of eight methods on individuals of varying body sizes

- Skeletal age estimations are affected by body size.
- Underweight and short individuals have less reliable age estimates.
- Obese and tall individual are over-aged.
- Lovejoy et al. and Suchey-Brooks are the most reliable when size cannot be estimated.

Accurate age estimations are essential for identifying human skeletal remains and narrowing missing persons searches. This study examines how BMI, body mass, and stature influence inaccuracy and bias in adult skeletal age estimations obtained using eight methods. 746 skeletons from the Hamann-Todd and William Bass Collections were used. Underweight BMI, light body mass, and short-stature individuals have the most error associated with their age estimates and are consistently under-aged between 3 to 13 years. Obese BMI, heavy body mass, and tall-stature individuals are consistently over-aged between 3 to 8.5 years. The most reliable methods for smaller-bodied individuals are Kunos et al. (first rib) and Buckberry-Chamberlain (auricular surface); for individuals in the average range, İşcan et al. (fourth ribs) and Passalacqua (sacrum); and for larger-bodied individuals, İşcan et al., Passalacqua, and Rougé-Maillart et al. (auricular surface and acetabulum). Lovejoy et al. (auricular surface) and Suchey-Brooks (pubic symphysis) produce consistent inaccuracy and bias scores across all body size groups. The least reliable method for smaller-bodied individuals is İşcan et al.; for larger-bodied individuals, Buckberry-Chamberlain; and across all body size groups, DiGangi et al. (first rib).