Anabolism. Low mechanical signals strengthen long bones

Role of mechanical environment and implant design on bone tissue differentiation: current knowledge and future contexts

OBJECTIVES

To evaluate published evidence related to bone reactions to varying loading regimens and the impact of implant design on bone tissue differentiation.

DATA AND SOURCES

The literature was searched for original research articles relating effect of mechanical environment on bone tissue and effects of implant design on bone biomechanics and marginal bone reactions using MEDLINE and manual tracing of references cited in key papers otherwise not elicited.

STUDY SELECTION

Current literature on biomechanics of bone and dental implants as main focus and pertinent to key aspects of the review.

CONCLUSIONS

Implant design influences force transmission characteristics in peri-implant bone, but not the time-dependent marginal bone reactions. Mechanical signals affect bone tissue differentiation. Therefore, it is essential to control biomechanical loads on implants to maintain osseointegration and/or to promote early bone-implant interface healing.

Mechanotransduction in the cortical bone is most efficient at loading frequencies of 5-10 Hz

A dose-response relationship has been shown between loading frequency and cortical bone adaptation for frequencies of up to 10 Hz, and is presumed to persist with further increases in frequency. Studies herein aimed to investigate cortical bone adaptation to loading frequencies of 1, 5, 10, 20 and 30 Hz. Two studies were performed in adult C57BL/6 mice using the ulna axial compression-loading model. In the first study, the histomorphometric response of the ulna was studied when loaded for 120 cycles day(-1) for 3 days at one of the five frequencies and one of two load magnitudes (1.5 or 2.0 N). In the second study, the changes in ulna geometry and mechanical properties were studied following loading for 5 min day(-1), 3 days week(-1) for 4 weeks at one of the five frequencies and one of two load magnitudes (1.0 or 1.6 N). Preliminary strain gauge measurements showed that frequency had no effect on mechanical strain per unit load. In study 1, loading frequency significantly influenced bone adaptation when loading at 2.0 N, with loading at 10 Hz resulting in significantly greater adaptation than with loading at other frequencies. In study 2, loading frequency significantly influenced the change in geometry when loading at 1.6 N, with loading at 5, 10 or 30 Hz resulting in significantly greater change than with loading at 1 Hz. Loading at 5 Hz also resulted in significantly greater change than with loading at 20 Hz. No frequency effect was found on any of the mechanical properties at either load. Overall, we found cortical bone adaptation to mechanical loading to increase with increasing loading frequency up to 5-10 Hz and to plateau with frequencies beyond 10 Hz. The mechanism for this nonlinear frequency response is not known; however, based on strain gauge measurements, we do not believe it resulted from dampening associated with high frequency loading through the flexed carpal joint. The obtained findings may relate to the mechanism of mechanotransduction within the bone. This requires further investigation.

The aging of Wolff's ?law?: Ontogeny and responses to mechanical loading in cortical bone

The premise that bones grow and remodel throughout life to adapt to their mechanical environment is often called Wolff's law. Wolff's law, however, is not always true, and in fact comprises a variety of different processes that are best considered separately. Here we review the molecular and physiological mechanisms by which bone senses, transduces, and responds to mechanical loads, and the effects of aging processes on the relationship (if any) between cortical bone form and mechanical function. Experimental and comparative evidence suggests that cortical bone is primarily responsive to strain prior to sexual maturity, both in terms of the rate of new bone growth (modeling) as well as rates of turnover (Haversian remodeling). Rates of modeling and Haversian remodeling, however, vary greatly at different skeletal sites. In addition, there is no simple relationship between the orientation of loads in long bone diaphyses and their cross-sectional geometry. In combination, these data caution against assuming without testing adaptationist views about form-function relationships in order to infer adult activity patterns from skeletal features such as cross-sectional geometry, cortical bones density, and musculo-skeletal stress markers. Efforts to infer function from shape in the human skeleton should be based on biomechanical and developmental models that are experimentally tested and validated.

Trabecular bone microarchitecture is deteriorated in men with spinal cord injury

Using magnetic resonance imaging, men with spinal cord injury (n = 10) were found to have fewer trabeculae that were spaced further apart in the knee than able-bodied controls of similar age, height, and weight (n = 8). The deteriorated trabecular bone microarchitecture may contribute to the increased fracture incidence after injury.

INTRODUCTION

Spinal cord injury results in a dramatic decline in areal bone mineral density (aBMD) and a marked increase in lower extremity fracture; however, its effect on trabecular bone microarchitecture is unknown. The purpose of this study was to determine if trabecular bone microarchitecture is deteriorated in the knee of men with long-term, complete spinal cord injury.

MATERIALS AND METHODS

Apparent bone volume to total volume (appBV/TV), trabecular number, (appTb.N), trabecular thickness (appTb.Th), and trabecular separation (appTb.Sp), measures of trabecular bone microarchitecture, were assessed in the distal femur and proximal tibia of men with long-term (>2 years) complete spinal cord injury (SCI; n = 10) and able-bodied controls (CON; n = 8) using high-resolution magnetic resonance imaging. Proximal tibia and arm aBMD were determined using DXA. Independent t-tests were used to assess group differences in anthropometrics and bone parameters. Pearson correlation analysis was used to assess the relationships among trabecular bone microarchitecture, aBMD, and time since injury.

RESULTS

There were no group differences in age, height, or weight; however, the distal femur and proximal tibia of SCI had 27% and 20% lower appBV/TV, 21% and 20% lower appTb.N, and 44% and 33% higher appTb.Sp, respectively (p < 0.05). The distal femur of SCI also had 8% lower appTb.Th (p < 0.05). Whereas arm aBMD was not different in the two groups, proximal tibia aBMD was 43% lower in SCI. In SCI and CON combined, aBMD was correlated with appBV/TV (r = 0.62), appTb.N (r = 0.78), and appTb.Sp (r = -0.82) in the proximal tibia (p < 0.05). Time since injury was more strongly correlated with appTb.N (r = -0.54) and appTb.Sp (r = 0.56) than aBMD (r = -0.36) in the distal tibia, although none of the relationships were statistically significant (p > 0.05).

CONCLUSION

Men with complete spinal cord injury have markedly deteriorated trabecular bone microarchitecture in the knee, which may contribute to their increased fracture incidence.

High-frequency vibration training increases muscle power in postmenopausal women1,21Stratec Medizintechnik, Novotec, and Unitrem provided the peripheral quantitative computerized tomograph and the forceplates.2No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To test whether training on a high-frequency (28Hz) vibrating platform improves muscle power and bone characteristics in postmenopausal women.

DESIGN

Randomized controlled trial with 6-month follow-up.

SETTING

Outpatient clinic in a general hospital in Italy.

PARTICIPANTS

Twenty-nine postmenopausal women (intervention group, n=14; matched controls, n=15).

INTERVENTION

Participants stood on a ground-based oscillating platform for three 2-minute sessions for a total of 6 minutes per training session, twice weekly for 6 months. The controls did not receive any training. Both groups were evaluated at baseline and after 6 months.

MAIN OUTCOME MEASURES

Muscle power, calculated from ground reaction forces produced by landing after jumping as high as possible on a forceplate, cortical bone density, and biomarkers of bone turnover.

RESULTS

Over 6 months, muscle power improved by about 5% in women who received the intervention, and it remained unchanged in controls (P=.004). Muscle force remained stable in both the intervention and control groups. No significant changes were observed in bone characteristics.

CONCLUSION

Reflex muscular contractions induced by vibration training improve muscle power in postmenopausal women.

At the crossroads of skeletal responses to estrogen and exercise

The recent observation that mice deficient in estrogen receptor alpha (ERalpha) have an impaired response to mechanical strain suggests that ERalpha plays an important role in mediating the response of the skeleton to mechanical loading as well as to estrogen. In view of previous findings that estrogen deficiency leads to a fall in ERalpha numbers, postmenopausal bone loss might result from the impaired response of bone to mechanical strain caused by deficient ERalpha signalling.

Transmissibility of 15-hertz to 35-hertz vibrations to the human hip and lumbar spine: determining the physiologic feasibility of delivering low-level anabolic mechanical stimuli to skeletal regions at greatest risk of fracture because of osteoporosis

STUDY DESIGN

Experiments were undertaken to determine the degree to which high-frequency (15-35 Hz) ground-based, whole-body vibration are transmitted to the proximal femur and lumbar vertebrae of the standing human.

OBJECTIVES

To establish if extremely low-level (<1 g, where 1 g = earth's gravitational field, or 9.8 ms-2) mechanical stimuli can be efficiently delivered to the axial skeleton of a human.

SUMMARY OF BACKGROUND DATA

Vibration is most often considered an etiologic factor in low back pain as well as several other musculoskeletal and neurovestibular complications, but recent in vivo experiments in animals indicates that extremely low-level mechanical signals delivered to bone in the frequency range of 15 to 60 Hz can be strongly anabolic. If these mechanical signals can be effectively and noninvasively transmitted in the standing human to reach those sites of the skeleton at greatest risk of osteoporosis, such as the hip and lumbar spine, then vibration could be used as a unique, nonpharmacologic intervention to prevent or reverse bone loss.

MATERIALS AND METHODS

Under sterile conditions and local anesthesia, transcutaneous pins were placed in the spinous process of L4 and the greater trochanter of the femur of six volunteers. Each subject stood on an oscillating platform and data were collected from accelerometers fixed to the pins while a vibration platform provided sinusoidal loading at discrete frequencies from 15 to 35 Hz, with accelerations ranging up to 1 g(peak-peak).

RESULTS

With the subjects standing erect, transmissibility at the hip exceeded 100% for loading frequencies less than 20 Hz, indicating a resonance. However, at frequencies more than 25 Hz, transmissibility decreased to approximately 80% at the hip and spine. In relaxed stance, transmissibility decreased to 60%. With 20-degree knee flexion, transmissibility was reduced even further to approximately 30%. A phase-lag reached as high as 70 degrees in the hip and spine signals.

CONCLUSIONS

These data indicate that extremely low-level, high-frequency mechanical accelerations are readily transmitted into the lower appendicular and axial skeleton of the standing individual. Considering the anabolic potential of exceedingly low-level mechanical signals in this frequency range, this study represents a key step in the development of a biomechanically based treatment for osteoporosis.

Repetitive, negligible force reaching in rats induces pathological overloading of upper extremity bones

Work-related repetitive motion disorders are costly. Immunohistochemical changes in bones resulting from repetitive reaching and grasping in 17 rats were examined. After 3-6 weeks, numbers of ED1+ macrophages and osteoclasts increased at periosteal surfaces of sites of muscle and interosseous membrane attachment and metaphyses of reach and nonreach forelimbs. These findings indicate pathological overloading leading to inflammation and subsequent bone resorption.

INTRODUCTION

Sixty-five percent of all occupational illnesses in U.S. private industry are attributed to musculoskeletal disorders arising from the performance of repeated motion, yet the precise mechanisms of tissue pathophysiology have yet to be determined for work-related musculoskeletal disorders. This study investigates changes in upper extremity bone tissues resulting from performance of a voluntary highly repetitive, negligible force reaching and grasping task in rats.

MATERIALS AND METHODS

Seventeen rats reached an average of 8.3 times/minute for 45-mg food pellets for 2 h/day, 3 days/week for up to 12 weeks. Seven rats served as normal or trained controls. Radius, ulna, humerus, and scapula were collected bilaterally as follows: radius and ulna at 0, 3, 4, 5, 6, and 12 weeks and humerus and scapula at 0, 4, and 6 weeks. Bones were examined for ED1-immunoreactive mononuclear cells and osteoclasts. Double-labeling immunohistochemistry was performed for ED1 (monocyte/macrophage lineage cell marker) and TRACP (osteoclast marker) to confirm that ED1+ multinucleated cells were osteoclasts. Differences in the number of ED1+ cells over time were analyzed by ANOVA.

RESULTS

Between 3 and 6 weeks of task performance, the number of ED1+ mononuclear cells and osteoclasts increased significantly at the periosteal surfaces of the distal radius and ulna of the reach and nonreach limbs compared with control rats. These cells also increased at periosteal surfaces of humerus and scapula of both forelimbs by 4-6 weeks. These cellular increases were greatest at muscle attachments and metaphyseal regions, but they were also present at some interosseous membrane attachments. The number of ED1+ cells decreased to control levels in radius and ulna by 12 weeks.

CONCLUSIONS

Increases in ED1+ mononuclear cells and osteoclasts indicate that highly repetitive, negligible force reaching causes pathological overloading of bone leading to inflammation and osteolysis of periosteal bone tissues.

On bone adaptation due to venous stasis

This paper addresses the question of whether or not interstitial fluid flow due to the blood circulation accounts for the observed periosteal bone formation associated with comprised venous return (venous stasis). Increased interstitial fluid flow induced by increased intramedullary pressure has been proposed to account for the periosteal response in venous stasis. To investigate the shear stresses acting on bone cell processes due to the blood circulation-driven interstitial fluid flow, a poroelastic model is extended to the situation in which the interstitial fluid flow in an osteon is driven by the pulsatile extravascular pressure in the osteonal canal as well as by the applied cyclic mechanical loading. Our results show that under normal conditions, the pulsatile extravascular pressure in the osteonal canal due to cardiac contraction (10mm Hg at 2Hz) and skeletal muscle contraction (30mm Hg at 1Hz) induce peak shear stresses on the osteocyte cell processes that are two orders of magnitude lower than those induced by physiological mechanical loading (100 microstrain at 1Hz). In venous stasis the induced peak shear stress is reduced further compared to the normal conditions because, although the mean intramedullary pressure is increased, the amplitude of its pulsatile component is decreased. These results suggest that the interstitial fluid flow is unlikely to cause the periosteal bone formation in venous stasis. However, the mean interstitial fluid pressure is found to increase in venous stasis, which may pressurize the periosteum and thus play a role in periosteal bone formation.

Developmental Biology and Human Evolution

▪ Abstract  Our understanding of developmental biology burgeoned during the last decade. This review summarizes recent advances, provides definitions and explanations of some basic principles, and does so in a way that will aid anthropologists in understanding their profound implications. Crucial concepts, such as developmental fields, selector and realizator genes, cell signaling mechanisms, and gene regulatory elements are briefly described and then integrated with the emergence of skeletal morphology. For the postcranium, a summary of events from limb bud formation, the appearance of anlagen, the expression of Hox genes, and the fundamentals of growth plate dynamics are briefly summarized. Of particular importance are revelations that bony morphology is largely determined by pattern formation, that growth foci such as physes and synovial joints appear to be regulated principally by positional information, and that variation in these fields is most likely determined by cis-regulatory elements acting on restricted numbers of anabolic genes downstream of selectors (such as Hox). The implications of these discoveries for the interpretation of both contemporary and ancient human skeletal morphology are profound. One of the most salient is that strain transduction now appears to play a much reduced role in shaping the human skeleton. Indeed, the entirety of “Wolff's Law” must now be reassessed in light of new knowledge about pattern formation. The review concludes with a brief discussion of some implications of these findings, including their impact on cladistics and homology, as well as on biomechanical and morphometric analyses of both ancient and modern human skeletal material.

Quantifying trabecular orientation in the pelvic cancellous bone of modern humans, chimpanzees, and the Kebara 2 Neanderthal

The adaptive nature of bone lies in its ability to respond to the environment by conforming and reshaping itself constantly to accommodate life-time stresses experienced throughout daily activities. In order to keep strains within the bone as uniform and isotropic as possible, the trabecular orientation is determined by forces acting on the bone through adaptive remodeling. Hence, the preserved structure of bones may contain direct information about the forces they may have undergone. Some authors (Correnti [1952], Atti Acc Naz Lincei 12:518-523, [1955] Riv Antrop 42:289-336; Macchiarelli et al. [1999] J Hum Evol 36:211-232, [2001] Cambridge, UK: Cambridge University Press) have described in detail the trabecular systems of the hip bone in different primate species and have identified a gait-related system above the acetabulum with substantial differences across species (Macchiarelli et al. [1999]; Rook et al. [1999] Proc Natl Acad Sci USA 96:8875-8879). The aim of this study was to quantify trabecular orientation above the acetabulum to test the hypothesis that hominoid biomechanical behavior is recorded in the cancellous bone. The pelvic bones of 23 archaeological adult modern humans (12 females, 11 males), 20 adult Pan troglodytes (10 females, 10 males), and one adult male Neanderthal were radiographed and digitized. Fast Fourier transforms (FFTs) of the regions of interest in the corpus of the ilium were performed, with the angular distribution of the trabeculae quantified. All species displayed a constant and periodic orthogonal arrangement in the trabeculae with differences in the pattern of dominance between the arcades oriented along the 0 degrees or the 90 degrees axes. The variation in the FFT spectrum between species is discussed in the light of distinctive biomechanical features.

Effects of implant healing time on crestal bone loss of a controlled-load dental implant

The universally accepted concept of delay-loaded dental implants has recently been challenged. This study hypothesizes that early loading (decreased implant healing time) leads to increased bone formation and decreased crestal bone loss. We used 17 minipigs to study implants under a controlled load, with non-loaded implants for comparison. Radiographic and histological assessments were made of the osseointegrated bone changes for 3 healing times (between implant insertion and loading), following 5 months of loading. The effect of loading on crestal bone loss depended on the healing time. Early loading preserved the most crestal bone. Delayed loading had significantly more crestal bone loss compared with the non-loaded controls (2.4 mm vs. 0.64 mm; P < 0.05). The histological assessment and biomechanical analyses of the healing bone suggested that loading and bioactivities of osteoblasts exert a synergistic effect on osseointegration that is likely to support the hypothesis that early loading produces more favorable osseointegration.

A new direction for ultrasound therapy in sports medicine

Ultrasound therapy is a widely available and frequently used electrophysical agent in sports medicine. However, systematic reviews and meta-analyses have repeatedly concluded that there is insufficient evidence to support a beneficial effect of ultrasound at dosages currently being introduced clinically. Consequently, the role of ultrasound in sports medicine is in question. This does not mean that ultrasound should be discarded as a therapeutic modality. However, it does mean that we may need to look in a new direction to explore potential benefits. A new direction for ultrasound therapy has been revealed by recent research demonstrating a beneficial effect of ultrasound on injured bone. During fresh fracture repair, ultrasound reduced healing times by between 30 and 38%. When applied to non-united fractures, it stimulated union in 86% of cases. These benefits were generated using low-intensity (<0.1 W/cm(2)) pulsed ultrasound (LIPUS), a dose alternative to that traditionally used in sports medicine. Although currently developed for the intervention of bone injuries, LIPUS has the potential to be used on tissues and conditions more commonly encountered in sports medicine. These include injuries to ligament, tendon, muscle and cartilage. This review discusses the effect of LIPUS on bone fractures, the dosages introduced and the postulated mechanisms of action. It concludes by discussing the relevance of these latest findings to sports medicine and how this evidence of a beneficial clinical effect may be implemented to intervene in sporting injuries to bone and other tissues. The aim of the paper is to highlight this latest direction in ultrasound therapy and stimulate new lines of research into the efficacy of ultrasound in sports medicine. In time this may lead to accelerated recovery from injury and subsequent earlier return to activity.

Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: a randomized controlled study

Recent animal studies have given evidence that vibration loading may be an efficient and safe way to improve mass and mechanical competence of bone, thus providing great potential for preventing and treating osteoporosis. Randomized controlled trials on the safety and efficacy of the vibration on human skeleton are, however, lacking. This randomized controlled intervention trial was designed to assess the effects of an 8-month whole body vibration intervention on bone, muscular performance, and body balance in young and healthy adults. Fifty-six volunteers (21 men and 35 women; age, 19-38 years) were randomly assigned to the vibration group or control group. The vibration intervention consisted of an 8-month whole body vibration (4 min/day, 3-5 times per week). During the 4-minute vibration program, the platform oscillated in an ascending order from 25 to 45 Hz, corresponding to estimated maximum vertical accelerations from 2 g to 8 g. Mass, structure, and estimated strength of bone at the distal tibia and tibial shaft were assessed by peripheral quantitative computed tomography (pQCT) at baseline and at 8 months. Bone mineral content was measured at the lumbar spine, femoral neck, trochanter, calcaneus, and distal radius using DXA at baseline and after the 8-month intervention. Serum markers of bone turnover were determined at baseline and 3, 6, and 8 months. Five performance tests (vertical jump, isometric extension strength of the lower extremities, grip strength, shuttle run, and postural sway) were performed at baseline and after the 8-month intervention. The 8-month vibration intervention succeeded well and was safe to perform but had no effect on mass, structure, or estimated strength of bone at any skeletal site. Serum markers of bone turnover did not change during the vibration intervention. However, at 8 months, a 7.8% net benefit in the vertical jump height was observed in the vibration group (95% CI, 2.8-13.1%; p = 0.003). On the other performance and balance tests, the vibration intervention had no effect. In conclusion, the studied whole body vibration program had no effect on bones of young, healthy adults, but instead, increased vertical jump height. Future human studies are needed before clinical recommendations for vibration exercise.

Increased bone mineral density in the femora of GDF8 knockout mice

GDF8 (myostatin), a member of the transforming growth factor (TGF)-beta superfamily of secreted growth and differentiation factors, is a negative regulator of skeletal muscle growth. GDF8 knockout mice have approximately twice the skeletal muscle mass of normal mice. The effects of increased muscle mass on bone modeling were investigated by examining bone mineral content (BMC) and bone mineral density (BMD) in the femora of female GDF8 knockout mice. Dual-energy X-ray absorptiometry (DEXA) densitometry was used to measure whole-femur BMC and BMD, and pQCT densitometry was used to calculate BMC and BMD from cross-sections taken at two different locations: the midshaft and the distal metaphysis. The DEXA results show that the knockout mice have significantly greater femoral BMD than normal mice. The peripheral quantitative computed tomography (pQCT) data indicate that the GDF8 knockout mice have approximately 10% greater cortical BMC (P =.01) at the midshaft and over 20% greater cortical BMC at the metaphysis (P <.001). Likewise, knockouts show approximately 10% greater cortical thickness (P <.001) and significantly greater cortical BMD (P <.001) at both locations. These results suggest that inhibitors of GDF8 function may be useful pharmacological agents for increasing both muscle mass and BMD.

Acute changes in neuromuscular excitability after exhaustive whole body vibration exercise as compared to exhaustion by squatting exercise

The effects of hard squatting exercise with (VbX+) and without (VbX-) vibration on neuromuscular function were tested in 19 healthy young volunteers. Before and after the exercise, three different tests were performed: maximum serial jumping for 30 s, electromyography during isometric knee extension at 70% of the maximum voluntary torque, and the quantitative analysis of the patellar tendon reflex. Between VbX+ and VbX- values, there was no difference found under baseline conditions. Time to exhaustion was significantly shorter in VbX+ than in VbX- (349 +/- 338 s versus 515 +/- 338 s), but blood lactate (5.49 +/- 2.73 mmol l-1 versus 5.00 +/- 2.26 mmol l-1) and subjectively perceived exertion (rate of perceived exertion values 18.1 +/- 1.2 versus 18.6 +/- 1.6) at the termination of exercise indicate comparable levels of fatigue. After the exercise, comparable effects were observed on jump height, ground contact time, and isometric torque. The vastus lateralis mean frequency during isometric torque, however, was higher after VbX+ than after VbX-. Likewise, the tendon reflex amplitude was significantly greater after VbX+ than after VbX- (4.34 +/- 3.63 Nm versus 1.68 +/- 1.32 Nm). It is followed that in exercise unto comparable degrees of exhaustion and muscular fatigue, superimposed 26 Hz vibration appears to elicit an alteration in neuromuscular recruitment patterns, which apparently enhance neuromuscular excitability. Possibly, this effect may be exploited for the design of future training regimes.

Stochastic resonance in osteogenic response to mechanical loading

Stochastic resonance, in which noise enhances the response of a nonlinear system to a weak signal, has been observed in various biological sensory systems. We speculated that bone formation in response to mechanical loading could be enhanced by adding noise (vibration) to a standard exercise regimen. To test this hypothesis, three different loading regimens were applied to the ulnae of mice: (1) high amplitude, low frequency sinusoidal loading at 2 Hz with an amplitude of 3 N to simulate exercise; (2) low amplitude, broad frequency vibration with frequency components 0-50 Hz and 0.3 N of mean amplitude; (3) the sinusoidal wave combined with vibration (S+V) to invoke stochastic resonance. The simulated exercise regimen induced new bone formation on the periosteal surface of the ulna, however the addition of vibration noise with exercise enhanced the osteogenic response by almost 4-fold. Vibration by itself had no effect on bone formation. It was concluded that adding low magnitude vibration greatly enhanced bone formation in response to loading, suggesting a contribution of stochastic resonance in the osteogenic response.

Designing exercise regimens to increase bone strength

Exercise is a very effective way to strengthen bones, particularly during childhood and adolescence. A collection of studies from the clinic and laboratory have provided new insights into how bone building effects of exercise can be maximized. From the available data we have calculated an "osteogenic index" for exercises.

Low-intensity, high-frequency vibration appears to prevent the decrease in strength of the femur and tibia associated with ovariectomy of adult rats

The effect of low-intensity, high-frequency vibration on bone mass, bone strength, and skeletal muscle mass was studied in an adult ovariectomized (OVX) rat model. One-year-old female rats were allocated randomly to the following groups: start control, sham OVX, OVX without vibration, OVX with vibration at 17 Hz (0.5g), OVX with vibration at 30 Hz (1.5g), OVX with vibration at 45 Hz (3.0g). Vibrations were given 30 min/day for 90 days. During vibration each group of rats was placed in a box on top of the vibration motor. The amplitude of the vibration motor was 1.0 mm. The animals were labeled with calcein at day 63 and with tetracycline at day 84. The tibia middiaphysis was studied by mechanical testing and dynamic histomorphometry and the femur distal metaphysis by mechanical compression. OVX without vibration increased the periosteal bone formation rate and increased the medullary cross-sectional area, i.e., increased the endocortical resorption and outward anteromedial and lateral drifts of cortical bone at the tibia middiaphysis. OVX also resulted in a reduced maximum bending stress of the tibia diaphysis and a reduced compressive stress of the femur distal metaphysis. Vibration at the highest intensity, i.e., 45 Hz, of OVX rats induced a further increase in periosteal bone formation rate and inhibited the endocortical resorption seen in OVX rats. Furthermore, vibration at 45 Hz inhibited the decline in maximum bending stress and compressive stress induced by OVX. Neither OVX nor OVX with vibration influenced skeletal muscle mass. In conclusion, the results support the idea of a possible beneficial effect of passive physical loading on the preservation of bone in OVX animals.

Microgravity as a model of ageing

PURPOSE OF REVIEW

Longevity with good health and long-term survival in space are two of the many challenges that scientists face in the twenty-first century. Ageing and life in space are both associated with undesirable effects on normal physiological processes. This review will outline how the endocrine, metabolic, immune and musculoskeletal systems are affected by microgravity and ageing, drawing analogies between the observed changes in an attempt to highlight common mechanisms.

RECENT FINDINGS

Mild hypothyroidism, increased stress hormones (mainly catecholamines), decreased sex steroids, insulin resistance, impaired anabolic response to food intake, anorexia, altered mitochondrial function and systemic inflammatory response are common features of both ageing and microgravity. Both conditions lead to progressive bone and muscle atrophy, compromising mobility and the ability to perform essential daily tasks. In skeletal muscle, both ageing and space flight lead to weakness from whole muscle to single fibre level, accompanied by marked alterations in muscle architecture and in tendon mechanical properties.

SUMMARY

What makes microgravity an interesting and unique tool for gerontologists is that many space-related physiological changes resemble those observed during ageing, but are more or less quickly restored after re-entry, thus allowing the biology of ageing to be investigated both ways, not only during its development but also during recovery.

The Maka femur and its bearing on the antiquity of human walking: applying contemporary concepts of morphogenesis to the human fossil record

MAK-VP-1/1, a proximal femur recovered from the Maka Sands (ca. 3.4 mya) of the Middle Awash, Ethiopia, and attributed to Australopithecus afarensis, is described in detail. It represents the oldest skeletal evidence of locomotion in this species, and is analyzed from a morphogenetic perspective. X-ray, CT, and metric data are evaluated, using a variety of methods including discriminant function. The specimen indicates that the hip joint of A. afarensis was remarkably like that of modern humans, and that the dramatic muscle allocation shifts which distinguish living humans and African apes were already present in a highly derived form in this species. Its anatomy provides no indication of any form of locomotion save habitual terrestrial bipedality, which very probably differed only trivially from that of modern humans.

Low-magnitude mechanical loading becomes osteogenic when rest is inserted between each load cycle

Strategies to counteract bone loss with exercise have had fairly limited success, particularly those regimens subjecting the skeleton to mild activity such as walking. In contrast, here we show that it is possible to induce substantial bone formation with low-magnitude loading. In two distinct in vivo models of bone adaptation, we found that insertion of a 10-s rest interval between each load cycle transformed a locomotion-like loading regime that minimally influenced osteoblast activity into a potent anabolic stimulus. In the avian ulna model, the minimal mean (+SE) periosteal labeled surface (Ps.LS) observed in the intact contralateral bones (1.6 +/- 1.5%) was doubled after 3 consecutive days of low-magnitude loading (3.8 +/- 1.5%; p = 0.03). However, modifying the regimen by inserting 10 s of rest between each load cycle significantly enhanced the periosteal response (21.9 +/- 4.5%; p = 0.03). In the murine tibia model, 5 consecutive days of 100 low-magnitude loading cycles did not significantly alter mean periosteal bone formation rate (BFR) compared with contralateral bones (0.011 +/- 0.005 microm3/microm2 per day vs. 0.021 +/- 0.013 microm3/microm2 per day). In contrast, separating each of 10 of the same loading cycles with 10 s of rest significantly elevated periosteal BFR (0.167 +/- 0.049 microm3/microm2 per day; p = 0.01). Endocortical bone formation parameters were not altered by any loading regimen in either model. We conclude that 10 s of rest between each load cycle of a low-magnitude loading protocol greatly enhances the osteogenic potential of the regimen.

Effect of four-month vertical whole body vibration on performance and balance

PURPOSE

This randomized controlled study was designed to investigate the effects of a 4-month whole body vibration-intervention on muscle performance and body balance in young, healthy, nonathletic adults.

METHODS

Fifty-six volunteers (21 men and 35 women, aged 19-38 yr) were randomized to either the vibration group or control group. The vibration-intervention consisted of a 4-month whole body vibration training (4 min.d(-1), 3-5 times a week) employed by standing on a vertically vibrating platform. Five performance tests (vertical jump, isometric extension strength of the lower extremities, grip strength, shuttle run, and postural sway on a stability platform) were performed initially and at 2 and 4 months.

RESULTS

Four-month vibration intervention induced an 8.5% (95% CI, 3.7-13.5%, P=0.001) net improvement in the jump height. Lower-limb extension strength increased after the 2-month vibration-intervention resulting in a 3.7% (95% CI, 0.3-7.2%, P=0.034) net benefit for the vibration. This benefit, however, diminished by the end of the 4-month intervention. In the grip strength, shuttle run, or balance tests, the vibration-intervention showed no effect.

CONCLUSION

The 4-month whole body vibration-intervention enhanced jumping power in young adults, suggesting neuromuscular adaptation to the vibration stimulus. On the other hand, the vibration-intervention showed no effect on dynamic or static balance of the subjects. Future studies should focus on comparing the performance-enhancing effects of a whole body vibration to those of conventional resistance training and, as a broader objective, on investigating the possible effects of vibration on structure and strength of bones, and perhaps, incidence of falls of elderly people.

Genetic predisposition to low bone mass is paralleled by an enhanced sensitivity to signals anabolic to the skeleton

The structure of the adult skeleton is determined, in large part, by its genome. Whether genetic variations may influence the effectiveness of interventions to combat skeletal diseases remains unknown. The differential response of trabecular bone to an anabolic (low-level mechanical vibration) and a catabolic (disuse) mechanical stimulus were evaluated in three strains of adult mice. In low bone-mineral-density C57BL/6J mice, the low-level mechanical signal caused significantly larger bone formation rates (BFR) in the proximal tibia, but the removal of functional weight bearing did not significantly alter BFR. In mid-density BALB/cByJ mice, mechanical stimulation also increased BFR, whereas disuse significantly decreased BFR. In contrast, neither anabolic nor catabolic mechanical signals influenced any index of bone formation in high-density C3H/HeJ mice. Together, data from this study indicate that the sensitivity of trabecular tissue to both anabolic and catabolic stimuli is influenced by the genome. Extrapolated to humans, these results may explain in part why prophylaxes for low bone mass are not universally effective, yet also indicate that there may be a genotypic indication of people who are at reduced risk of suffering from bone loss.

Activation of extracellular signal-regulated kinase is involved in mechanical strain inhibition of RANKL expression in bone stromal cells

Mechanical input is known to regulate skeletal mass. In vitro, application of strain inhibits osteoclast formation by decreasing expression of the ligand RANKL in bone stromal cells, but the mechanism responsible for this down-regulation is unknown. In experiments here, application of 1.8% equibiaxial strain for 6 h reduced vitamin D-stimulated RANKL mRNA expression by nearly one-half in primary bone stromal cells. Application of strain caused a rapid activation of ERK1/2, which returned to baseline by 60 minutes. Adding the ERK1/2 inhibitor PD98059 30 minutes before strain delivery prevented the strain effect on RANKL mRNA expression, suggesting that activation of ERK1/2 was required for transduction of the mechanical force. Mechanical strain also activated N-terminal Jun kinase (JNK) that, in contrast, did not return to baseline during 24 h of continuous strain. This suggests that JNK may represent an accessory pathway for mechanical transduction in bone cells. Our data indicate that strain modulation of RANKL expression involves activation of MAPK pathways.

The bone-specific transcriptional regulator Cbfa1 is a target of mechanical signals in osteoblastic cells

A primary goal of bone research is to understand the mechanism(s) by which mechanical forces dictate the cellular and metabolic activities of osteoblasts, the bone-forming cells. Several studies indicate that osteblastic cells respond to physical loading by transducing signals that alter gene expression patterns. Accumulated data have documented the fundamental role of the osteoblast-specific transcription factor Cbfa1 (core-binding factor) in osteoblast differentiation and function. Here, we demonstrate that low level mechanical deformation (stretching) of human osteoblastic cells directly up-regulates the expression and DNA binding activity of Cbfa1. This effect seems to be fine tuned by stretch-triggered induction of distinct mitogen-activated protein kinase cascades. Our novel finding that activated extracellular signal-regulated kinase mitogen-activated protein kinase physically interacts and phosphorylates endogenous Cbfa1 in vivo (ultimately potentiating this transcription factor) provides a molecular link between mechanostressing and stimulation of osteoblast differentiation. Elucidation of the specific modifiers and cofactors that operate in this mechanotranscription circuitry will contribute to a better understanding of mechanical load-induced bone formation which may set the basis for nonpharmacological intervention in bone loss pathologies.

Effect of a vibration exposure on muscular performance and body balance. Randomized cross-over study

This randomized cross-over study was designed to investigate the effects of a 4-min vibration bout on muscle performance and body balance in young, healthy subjects. Sixteen volunteers (eight men, eight women, age 24-33 years) underwent both the 4-min vibration- and sham-interventions in a randomized order on different days. Six performance tests (stability platform, grip strength, isometric extension strength of lower extremities, tandem-walk, vertical jump and shuttle run) were performed 10 min before (baseline), and 2 and 60 min after the intervention. The effect of vibration on the surface electromyography (EMG) of soleus, gastrocnemius and vastus lateralis muscles was also investigated. The vibration-loading, based on a tilting platform, induced a transient (significant at the 2-min test) 2.5% net benefit in the jump height (P = 0.019), 3.2% benefit in the isometric extension strength of lower extremities (P=0.020) and 15.7% improvement in the body balance (P = 0.049). In the other 2-min or in the 60-min tests, there were no statistically significant differences between the vibration- and sham-interventions. Decreased mean power frequency in EMG of all muscles during the vibration indicated evolving muscle fatigue, while the root mean square voltage of EMG signal increased in calf muscles. We have shown in this study that a single bout of whole body vibration transiently improves muscle performance of lower extremities and body balance in young healthy adults.

Mechanical strain, induced noninvasively in the high-frequency domain, is anabolic to cancellous bone, but not cortical bone

Departing from the premise that it is the large-amplitude signals inherent to intense functional activity that define bone morphology, we propose that it is the far lower magnitude, high-frequency mechanical signals that continually barrage the skeleton during longer term activities such as standing, which regulate skeletal architecture. To examine this hypothesis, we proposed that brief exposure to slight elevations in these endogenous mechanical signals would suffice to increase bone mass in those bones subject to the stimulus. This was tested by exposing the hind limbs of adult female sheep (n = 9) to 20 min/day of low-level (0.3g), high-frequency (30 Hz) mechanical signals, sufficient to induce a peak of approximately 5 microstrain (micro epsilon) in the tibia. Following euthanasia, peripheral quantitative computed tomography (pQCT) was used to segregate the cortical shell from the trabecular envelope of the proximal femur, revealing a 34.2% increase in bone density in the experimental animals as compared with controls (p = 0.01). Histomorphometric examination of the femur supported these density measurements, with bone volume per total volume increasing by 32% (p = 0.04). This density increase was achieved by two separate strategies: trabecular spacing decreased by 36.1% (p = 0.02), whereas trabecular number increased by 45.6% (p = 0.01), indicating the formation of cancellous bone de novo. There were no significant differences in the radii of animals subject to the stimulus, indicating that the adaptive response was local rather than systemic. The anabolic potential of the signal was evident only in trabecular bone, and there were no differences, as measured by any assay, in the cortical bone. These data suggest that subtle mechanical signals generated during predominant activities such as posture may be potent determinants of skeletal morphology. Given that these strain levels are three orders of magnitude below strains that can damage bone tissue, we believe that a noninvasive stimulus based on this sensitivity has potential for treating skeletal complications such as osteoporosis.

Quantity and quality of trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechanical intervention

The skeleton's sensitivity to mechanical stimuli represents a critical determinant of bone mass and morphology. We have proposed that the extremely low level (< 10 microstrain), high frequency (20-50 Hz) mechanical strains, continually present during even subtle activities such as standing are as important to defining the skeleton as the larger strains typically associated with vigorous activity (>2000 microstrain). If these low-level strains are indeed anabolic, then this sensitivity could serve as the basis for a biomechanically based intervention for osteoporosis. To evaluate this hypothesis, the hindlimbs of adult female sheep were stimulated for 20 minutes/day using a noninvasive 0.3g vertical oscillation sufficient to induce approximately 5 microstrain on the cortex of the tibia. After 1 year of stimulation, the physical properties of 10-mm cubes of trabecular bone from the distal femoral condyle of experimental animals (n = 8) were compared with controls (n = 9), as evaluated using microcomputed tomography (microCT) scanning and materials testing. Bone mineral content (BMC) was 10.6% greater (p < 0.05), and the trabecular number (Tb.N) was 8.3% higher in the experimental animals (p < 0.01), and trabecular spacing decreased by 11.3% (p < 0.01), indicating that bone quantity was increased both by the creation of new trabeculae and the thickening of existing trabeculae. The trabecular bone pattern factor (TBPf) decreased 24.2% (p < 0.03), indicating trabecular morphology adapting from rod shape to plate shape. Significant increases in stiffness and strength were observed in the longitudinal direction (12.1% and 26.7%, respectively; both, p < 0.05), indicating that the adaptation occurred primarily in the plane of weightbearing. These results show that extremely low level mechanical stimuli improve both the quantity and the quality of trabecular bone. That these deformations are several orders of magnitude below those peak strains which arise during vigorous activity indicates that this biomechanically based signal may serve as an effective intervention for osteoporosis.

The anabolic activity of bone tissue, suppressed by disuse, is normalized by brief exposure to extremely low-magnitude mechanical stimuli

It is generally believed that mechanical signals must be large in order to be anabolic to bone tissue. Recent evidence indicates, however, that extremely low-magnitude (<10 microstrain) mechanical signals readily stimulate bone formation if induced at a high frequency. We examined the ability of extremely low-magnitude, high-frequency mechanical signals to restore anabolic bone cell activity inhibited by disuse. Adult female rats were randomly assigned to six groups: baseline control, age-matched control, mechanically stimulated for 10 min/day, disuse (hind limb suspension), disuse interrupted by 10 min/day of weight bearing, and disuse interrupted by 10 min/day of mechanical stimulation. After a 28 day protocol, bone formation rates (BFR) in the proximal tibia of mechanically stimulated rats increased compared with age-matched control (+97%). Disuse alone reduced BFR (-92%), a suppression only slightly curbed when disuse was interrupted by 10 min of weight bearing (-61%). In contrast, disuse interrupted by 10 min per day of low-level mechanical intervention normalized BFR to values seen in age-matched controls. This work indicates that this noninvasive, extremely low-level stimulus may provide an effective biomechanical intervention for the bone loss that plagues long-term space flight, bed rest, or immobilization caused by paralysis.