Skeletal Adaptation to Mechanical Loading

Similarities and Differences in Bone Mineral Density between Multiple Sites in the Same Individual: An Elderly Cadaveric Study

Bone mineral density (BMD) is known to vary based on various factors, and the degree of variation is site-specific. However, few studies have investigated the relationship between bone density at trabecular bone-rich and cortical bone-rich sites in the same individual. In this study, we attempted to measure BMD at multiple sites using whole-body computed tomography images taken immediately after death and to clarify the similarities and differences between skeletal sites. Additionally, we aimed to examine the factors that influence changes in BMD, such as the loading environment, bone microstructure, and the ossification process of each skeletal region. A 3D model containing BMD data of the skull, clavicle, lumbar vertebrae, and femur (neck and diaphysis) was created using computed tomography images taken immediately after the death of 60 individuals (28 men and 32 women, average age: 84.0 years) who consented to participate in the study before death. Arbitrary measurement sites were defined, and bone density was measured at each site. We found that the BMDs of all regions were negatively correlated with age, but this correlation was weaker in the skull than in other regions. The negative correlation was especially pronounced in areas with more trabecular bones in men and in areas with more cortical bones in women. Furthermore, these findings suggest that factors, such as the loading environment, bone microstructure, and the ossification process of the skeletal sites, affect the BMD. Furthermore, our results suggest that it is important to assess the BMD of cortical bone in older women.

Alkaline phosphatase in pediatric patients with genu varum caused by vitamin D-deficient rickets

An elevated serum alkaline phosphatase (ALP) level is one of the markers for the presence of rickets in children, but it is also associated with bone formation. However, its role in diagnosing genu varum in pediatric patients with vitamin D-deficient rickets is still unknown. To clarify the role of the serum ALP level in assessing the severity of genu varum, we retrospectively investigated this issue statistically using data on rickets such as serum intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, ALP, the level of creatinine as the percentage of the median according to age (%Cr), and the metaphyseal diaphyseal angle (MDA) in the lower extremities as an index of the severity of genu varum. A multiple regression analysis revealed that log ALP and %Cr values were negatively associated with MDA values. The former association was also confirmed by a linear mixed model, while iPTH was positively associated with MDA by path model analysis. To elucidate the association of ALP with MDA in the presence of iPTH, we investigated three-dimensional figures by neural network analysis. This indicated the presence of a biphasic association of ALP with MDA: the first phase increases while the second decreases MDA. The latter phenomenon is considered to be associated with the increase in bone formation due to the mechanical stress loaded on the lower extremities. These findings are important and informative for pediatricians to understand the significance of the serum ALP level in pediatric patients with genu varum caused by vitamin D deficiency.

Osteocyte Dysfunction in Joint Homeostasis and Osteoarthritis

Structural disturbances of the subchondral bone are a hallmark of osteoarthritis (OA), including sclerotic changes, cystic lesions, and osteophyte formation. Osteocytes act as mechanosensory units for the micro-cracks in response to mechanical loading. Once stimulated, osteocytes initiate the reparative process by recruiting bone-resorbing cells and bone-forming cells to maintain bone homeostasis. Osteocyte-expressed sclerostin is known as a negative regulator of bone formation through Wnt signaling and the RANKL pathway. In this review, we will summarize current understandings of osteocytes at the crossroad of allometry and mechanobiology to exploit the relationship between osteocyte morphology and function in the context of joint aging and osteoarthritis. We also aimed to summarize the osteocyte dysfunction and its link with structural and functional disturbances of the osteoarthritic subchondral bone at the molecular level. Compared with normal bones, the osteoarthritic subchondral bone is characterized by a higher bone volume fraction, a larger trabecular bone number in the load-bearing region, and an increase in thickness of pre-existing trabeculae. This may relate to the aberrant expressions of sclerostin, periostin, dentin matrix protein 1, matrix extracellular phosphoglycoprotein, insulin-like growth factor 1, and transforming growth factor-beta, among others. The number of osteocyte lacunae embedded in OA bone is also significantly higher, yet the volume of individual lacuna is relatively smaller, which could suggest abnormal metabolism in association with allometry. The remarkably lower percentage of sclerostin-positive osteocytes, together with clustering of Runx-2 positive pre-osteoblasts, may suggest altered regulation of osteoblast differentiation and osteoblast-osteocyte transformation affected by both signaling molecules and the extracellular matrix. Aberrant osteocyte morphology and function, along with anomalies in molecular signaling mechanisms, might explain in part, if not all, the pre-osteoblast clustering and the uncoupled bone remodeling in OA subchondral bone.

Development of a comparative chimpanzee musculoskeletal glenohumeral model: implications for human function

Modern human shoulder function is affected by the evolutionary adaptations that have occurred to ensure survival and prosperity of the species. Robust examination of behavioral shoulder performance and injury risk can be holistically improved through an interdisciplinary approach that integrates anthropology and biomechanics. Coordination of these fields can allow different perspectives to contribute to a more complete interpretation of biomechanics of the modern human shoulder. The purpose of this study was to develop a novel biomechanical and comparative chimpanzee glenohumeral model, designed to parallel an existing human glenohumeral model, and compare predicted musculoskeletal outputs between the two models. The chimpanzee glenohumeral model consists of three modules - an external torque module, a musculoskeletal geometric module and an internal muscle force prediction module. Together, these modules use postural kinematics, subject-specific anthropometrics, a novel shoulder rhythm, glenohumeral stability ratios, hand forces, musculoskeletal geometry and an optimization routine to estimate joint reaction forces and moments, subacromial space dimensions, and muscle and tissue forces. Using static postural data of a horizontal bimanual suspension task, predicted muscle forces and subacromial space were compared between chimpanzees and humans. Compared with chimpanzees, the human model predicted a 2 mm narrower subacromial space, deltoid muscle forces that were often double those of chimpanzees and a strong reliance on infraspinatus and teres minor (60-100% maximal force) over other rotator cuff muscles. These results agree with previous work on inter-species differences that inform basic human rotator cuff function and pathology.

Associations between the serum levels of selected bone turnover markers and biological traits in nursing home women aged 80+ without inflammation. A pilot study

BACKGROUND

Bone turnover markers (BTM) reflect the status of bone remodeling processes responsible for bone mineral density. The existing body of evidence that osseous tissue can interact with many other body tissues and organs suggests that the cross-talks can lead to different relationships. The biological traits associated with BTMs have not been thoroughly studied in the elderly despite bone turnover being known to increase with age.

OBJECTIVE

To determine whether the C-terminal crosslinking telopeptides of type I collagen (CTXI) and the serum levels of total (TAP) and bone-specific (BAP) alkaline phosphatase are associated with the biological traits in nursing home women aged 80-92 years without inflammation and, if so, to indicate the best predictors of these BTM's blood concentrations.

METHODS

A group of 64 female volunteers aged 80 years and older, the residents of nursing homes, were screened for the study. Fifty two women were ineligible as they met the exclusion criteria. As a result, the study group consisted of 12 participants (85.1 ± 3.9 years; 58.1 ± 8.7 kg; 1.52 ± 0.06 m), all having blood C-reactive protein (CRP) levels below 3 mg/l. Also assessed were the participants' morphology, glucose and insulin levels, lipid profiles, CTXI, TAP, and BAP. Other measured parameters included body composition, resting heart rate and arterial blood pressure, isometric knee extension peak torque (IKEPT), and walking capacity (6-min walk test). The statistical analysis was performed using Pearson's correlation coefficients, the Benjamini-Hochberg procedure, and a stepwise multiple regression analysis with backward elimination.

RESULTS

Inverse correlations were found between CTX-I and hemoglobin concentration (HGB) (r = -0.680; p = .015), red blood cells count (RBC) (r = -0.664; p = .019), fat-free mass (r = -0.633; p = .027), body weight (r = -0.589; p = .044), and total cholesterol (r = -0.581; p = .048). The multiple regression analysis of CTX-I showed that body weight was the only independent variable that was statistically significant (r2 = 0.346; p < .05; SEE = 0.347 ng/ml). BAP was positively correlated with double product (DP) (r = 0.742; p = .006), RBC (r = 0.650; p = .022), HGB (r = 0.637; p = .026), mean arterial pressure (MAP) (r = 0.622; p = .031), diastolic blood pressure (DBP) (r = 0.612; p = .034), body height (r = 0.603; p = .038), IKEPT (r = 0.565; p = .056), and systolic blood pressure (SBP) (r = 0.538; p = .071). BAP, a dependent variable, was the most closely correlated with DP (r² = 0.550; p < .01; SEE = 9.161 U/l). TAP was also significantly associated with DP (r = 0.775; p = .003), with the association being stronger than between BAP and DP (r² = 0.600; p < .01; SEE = 1000.5 beats/min*mm Hg).

CONCLUSIONS

In relatively healthy the oldest-old nursing home women without inflammation, total body weight was the best predictor of bone resorption shown by the CTX-I concentration, whereas the rate pressure product (DP) turned out to best predict osteoblastic activity determinable from serum alkaline phosphatase activity. The results of the study suggest that the activity of serum TAP and BAP can be enhanced by different mechanisms.

Phenomenon of osteocyte lacunar mineralization: indicator of former osteocyte death and a novel marker of impaired bone quality?

An increasing number of patients worldwide suffer from bone fractures that occur after low intensity trauma. Such fragility fractures are usually associated with advanced age and osteoporosis but also with long-term immobilization, corticosteroid therapy, diabetes mellitus, and other endocrine disorders. It is important to understand the skeletal origins of increased bone fragility in these conditions for preventive and therapeutic strategies to combat one of the most common health problems of the aged population. This review summarizes current knowledge pertaining to the phenomenon of micropetrosis (osteocyte lacunar mineralization). As an indicator of former osteocyte death, micropetrosis is more common in aged bone and osteoporotic bone. Considering that the number of mineralized osteocyte lacunae per bone area can distinguish healthy, untreated osteoporotic and bisphosphonate-treated osteoporotic patients, it could be regarded as a novel structural marker of impaired bone quality. Further research is needed to clarify the mechanism of lacunar mineralization and to explore whether it could be an additional target for preventing or treating bone fragility related to aging and various endocrine diseases.

Does the shape of forelimb long bones co-vary with grasping behaviour in strepsirrhine primates?

Fine prehensile activities are often thought to have been associated with the evolution of the human hand. However, there has been no holistic approach establishing the link between the morphology of the forelimb and grasping ability in living primates. The present study investigated the possible relationships between grasping behaviour and the morphology of the forelimb in strepsirrhines in a phylogenetic context. To do so, grasping behaviour during feeding and the shape of the long bones of the forelimb were analysed for 22 species of strepsirrhines. The data obtained show that there is a phylogenetic signal in forelimb morphology in primates in relation to grasping behaviour, but also that there is a marked co-evolution between grasping behaviour and the shape of the humerus and radius. This latter finding suggests a functional association between grasping and forelimb shape, which in turn suggests that bone shape constrains or facilitates behaviour. This result may permit future inferences to be made regarding this behaviour in extinct species and deserves further examination in more detail.

Ontogeny of the hominoid scapula: The influence of locomotion on morphology

Primate shoulder morphology has been linked with locomotor habits, oftentimes irrespective of phylogenetic heritage. Among hominoids, juvenile African apes are known to climb more frequently than adults, while orangutans and gibbons maintain an arboreal lifestyle throughout ontogeny. This study examined if these ontogenetic locomotor differences carry a morphological signal, which should be evident in the scapulae of chimpanzees and gorillas but absent in taxa that do not display ontogenetic behavioral shifts. The scapular morphology of five hominoid primates and one catarrhine outgroup was examined throughout ontogeny to evaluate if scapular traits linked with arboreal activities are modified in response to ontogenetic behavioral shifts away from climbing. Specifically, the following questions were addressed: 1) which scapular characteristics distinguish taxa with different locomotor habits; and 2) do these traits show associated changes during development in taxa known to modify their behavioral patterns? Several traits characterized suspensory taxa from nonsuspensory forms, such as cranially oriented glenohumeral joints, obliquely oriented scapular spines, relatively narrow infraspinous fossae, and inferolaterally expanded subscapularis fossae. The relative shape of the dorsal scapular fossae changed in Pan, Gorilla, and also Macaca in line with predictions based on reported ontogenetic changes in locomotor behavior. These morphological changes were mostly distinct from those seen in Pongo, Hylobates, and Homo and imply a unique developmental pattern, possibly related to ontogenetic locomotor shifts. Accordingly, features that sorted taxa by locomotor habits and changed in concert with ontogenetic behavioral patterns should be particularly useful for reconstructing the locomotor habits of fossil forms.

Measuring strain using digital image correlation of second harmonic generation images

The micromechanical environment of bone is crucial to understanding both bone fracture and mechanobiological responses of osteocytes, yet few techniques exist that are capable of measuring strains on the micrometer scale. A method for measuring micrometer level strains has been developed based on digital image correlation (DIC) of second harmonic generation microscopy (SHGM) images. Bovine tibias milled into thin sections were imaged using SHGM under loads of 0 and 15 MPa. Strains were measured using DIC and compared to applied strain values. First and second principal strains decreased in magnitude as the analysis region area increased from 1750 µm(2) to 60,920 µm(2), converging to 1.23 ± 0.74 and -0.745 ± 0.9816 times the applied strain respectively. A representative sample histogram revealed regions of pure tensile and compressive strain, and that strains were highly heterogeneous ranging from 8410 to -8840 microstrain for an applied 2870 microstrain. Comparison with applied strain measures suggested that analysis sizes of 1750 µm(2) and greater were measuring strains on the tissue scale, and higher resolution is required for collagen fibrillar strains. Regions of low SHGM intensity ("dark" regions) were seen which are believed to be lacunar and perilacunar regions of low collagen density. However, no significant differences in strain magnitude were present in dark regions versus regions of high signal intensity. The proposed technique is effective for strains on the size order of bone microarchitecture, and would be useful for studies into the mechanical microenvironment during loading. The technique also has potential for in vivo studies in small animal models.

Mouse shoulder morphology responds to locomotor activity and the kinematic differences of climbing and running

Mechanical loads play a significant role in determining long bone shape and strength, but less work has explored how these loads influence flat bones like the scapula, which has been shown to vary with locomotor preference among primate taxa. Here, we tested the effects of voluntary running and climbing exercise in mice to examine how the mechanical loads borne from different locomotor patterns influence shoulder morphological development. Ninety-nine female wild-type mice were distributed equally among sedentary control, activity-wheel running, and vertical climbing experimental conditions. Running mice had the lowest body masses, larger intrinsic shoulder muscles, and the most pronounced differences in scapular size and shape relative to the other groups. Climbing mouse scapular morphology also differed significantly from the control individuals, but these differences were not as marked as those between the running and control mice. This might be attributable in part to greater levels of activity in the wheel-runners relative to the climbers. Additionally, climbing mice held their bodies closer to the substrate and maintained more flexed limbs and posterior hand positions compared with the kinematics of running. As a result, climbers differed significantly from both the running and control mice in developing a relatively broader infraspinous region, which is likely related to preferential recruitment of the infraspinatus and teres minor muscles to maintain flexed shoulder postures. The results of this study demonstrate that variation in activity level and type of locomotor regime over a significant portion of the life history influences muscle and bone development in the shoulder.

Effects of resistance training on biomarkers of bone formation and association with red blood cell variables

We previously showed that resistance training significantly increased the red blood cell count (RBC) and hematocrit (Hct) and decreased the mean cell hemoglobin concentration (MCHC) in physically inactive men. Since the enhanced hematopoiesis may result, at least partly, from bone metabolism, the purpose of this study was to further investigate the effect of resistance training on serum bone-specific alkaline phosphatase activity (B-ALP), a biomarker of bone formation, and focus on the relationship between the change in B-ALP from baseline to 20-week follow-up and the corresponding changes in RBC, Hct and MCHC. Seventy-four men aged 20-45 years were randomly assigned to training and control groups. The training group underwent a 20-week progressive resistance training. Fasting blood samples were analyzed for serum B-ALP at baseline, and at 10-week and 20-week follow-up. B-ALP in the control group exhibited no significant change. In contrast, the training group increased its B-ALP from baseline at 10-week and 20-week follow-up (both P<0.01 compared to control group). Within the training group, B-ALP was elevated at 10-week and 20-week follow-up when compared to baseline (both P<0.001). A significant correlation was found between change in B-ALP from baseline to 20-week follow-up and the corresponding changes in RBC, Hct and MCHC in the training group (r=0.49, P<0.01; r=0.56, P<0.01, and r = -0.38, P<0.05, respectively). We concluded that resistance training increased biomarkers of bone formation, which had association with RBC turnover. Adaptive changes of bone metabolism induced by resistance training might facilitate erythropoiesis.

The effects of hypermuscularity on shoulder morphology in myostatin-deficient mice

Mechanical loads, particularly those generated by skeletal muscle, play a significant role in determining long-bone shape and strength, but it is less clear how these loads influence the morphology of flat bones like the scapula. While scapular morphology has been shown to vary with locomotor mode in mammals, this study seeks to better understand whether genetically modified muscle size can influence scapular shape in the absence of significant locomotor differences. The soft- and hard-tissue morphological characteristics were examined in 11 hypermuscular, mutant (myostatin-deficient), 20 heterozygote, and 15 wild-type mouse shoulders. Body mass did not significantly differ among the genotype groups, but homozygous mutant and heterozygote mice had significantly larger shoulder muscles than wild-type mice. Mutant mice also differed significantly from the wild-type controls in several aspects of scapular size and shape, including glenohumeral joint orientation, total scapular length, superior border length, and supraspinous and infraspinous fossa length. Conversely, several traits describing superoinferior scapular breadth measures (e.g. total breadth and dorsal scapular fossa breadth) did not significantly differ between mutant and wild-type mice. Since the intrinsic musculature of the scapula is oriented in a mediolateral fashion, it follows that mediolaterally configured hard-tissue features like scapular length were most distinct among genotype groups. As had been noted previously with long bones, this study demonstrates that genetically enhanced muscle size has marked effects on the morphological characteristics of the shoulder.

Increased sclerostin serum levels associated with bone formation and resorption markers in patients with immobilization-induced bone loss

CONTEXT

Sclerostin, a Wnt signaling antagonist on the osteoblasts produced by osteocytes, is regulated by mechanical strain and is implicated in the pathogenesis of disuse bone loss. There are no data on sclerostin in humans.

OBJECTIVE

The aim of the study was to evaluate sclerostin in patients immobilized after stroke, compared with control subjects, and to analyze its relationship with markers of bone formation and resorption.

DESIGN

This was a cross-sectional study.

SETTING AND PATIENTS

We studied 40 postmenopausal women immobilized after a single episode of stroke 6 months or longer after onset, and 40 postmenopausal women from the general community. Bone status was assessed by quantitative ultrasound measurements at the calcaneus. Bone alkaline phosphatase (b-AP), carboxy-terminal telopeptide of type I collagen (CrossLaps), and sclerostin were evaluated by ELISA. We also used ELISA to measure serum levels of Dickkopf-1, another soluble inhibitor of Wnt/beta-catenin signaling, highly expressed by osteocytes.

RESULTS

Immobilized patients had higher sclerostin serum levels (median 0.975 ng/ml; 25th to 75th percentiles 0.662-1.490) than controls (median 0.300 ng/ml; 25th to 75th percentiles 0.165-0.400: P < 0.0001) and an increased bone turnover with a more significant rise in bone resorption (CrossLaps) than formation (b-AP) markers. Sclerostin correlated negatively with b-AP (r = -0.911; P < 0.0001) and positively with CrossLaps (r = 0.391; P = 0.012). Dickkopf-1 did not significantly differ between the groups. Patients also had quantitative ultrasound measurements index lower than controls (P < 0.001).

CONCLUSIONS

This study shows for the first time that long-term immobilized patients present hypersclerostinemia associated with reduced bone formation, and suggests that sclerostin could be a link between mechanical unloading and disuse osteoporosis in humans.