Investigation of bone changes in microgravity during long and short duration space flight: comparison of techniques

Bisphosphonate conjugation enhances the bone-specificity of NELL-1-based systemic therapy for spaceflight-induced bone loss in mice

Microgravity-induced bone loss results in a 1% bone mineral density loss monthly and can be a mission critical factor in long-duration spaceflight. Biomolecular therapies with dual osteogenic and anti-resorptive functions are promising for treating extreme osteoporosis. We previously confirmed that NELL-like molecule-1 (NELL-1) is crucial for bone density maintenance. We further PEGylated NELL-1 (NELL-polyethylene glycol, or NELL-PEG) to increase systemic delivery half-life from 5.5 to 15.5 h. In this study, we used a bio-inert bisphosphonate (BP) moiety to chemically engineer NELL-PEG into BP-NELL-PEG and specifically target bone tissues. We found conjugation with BP improved hydroxyapatite (HA) binding and protein stability of NELL-PEG while preserving NELL-1's osteogenicity in vitro. Furthermore, BP-NELL-PEG showed superior in vivo bone specificity without observable pathology in liver, spleen, lungs, brain, heart, muscles, or ovaries of mice. Finally, we tested BP-NELL-PEG through spaceflight exposure onboard the International Space Station (ISS) at maximal animal capacity (n = 40) in a long-term (9 week) osteoporosis therapeutic study and found that BP-NELL-PEG significantly increased bone formation in flight and ground control mice without obvious adverse health effects. Our results highlight BP-NELL-PEG as a promising therapeutic to mitigate extreme bone loss from long-duration microgravity exposure and musculoskeletal degeneration on Earth, especially when resistance training is not possible due to incapacity (e.g., bone fracture, stroke).

Specific host metabolite and gut microbiome alterations are associated with bone loss during spaceflight

Understanding the axis of the human microbiome and physiological homeostasis is an essential task in managing deep-space-travel-associated health risks. The NASA-led Rodent Research 5 mission enabled an ancillary investigation of the gut microbiome, varying exposure to microgravity (flight) relative to ground controls in the context of previously shown bone mineral density (BMD) loss that was observed in these flight groups. We demonstrate elevated abundance of Lactobacillus murinus and Dorea sp. during microgravity exposure relative to ground control through whole-genome sequencing and 16S rRNA analyses. Specific functionally assigned gene clusters of L. murinus and Dorea sp. capable of producing metabolites, lactic acid, leucine/isoleucine, and glutathione are enriched. These metabolites are elevated in the microgravity-exposed host serum as shown by liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomic analysis. Along with BMD loss, ELISA reveals increases in osteocalcin and reductions in tartrate-resistant acid phosphatase 5b signifying additional loss of bone homeostasis in flight.

Neurosurgery and spinal adaptations in spaceflight: A literature review

BACKGROUND

Spaceflight places astronauts in multiple environments capable of inducing pathological changes. Alterations in the spine have a significant impact on astronauts' health during and after spaceflight. Low back pain is an established and common intra-flight complaint. Intervertebral disc herniation occurs at higher rates in this population and poses significant morbidity. Morphological changes within intervertebral discs, vertebral bodies, and spinal postural muscles affect overall spine function and astronaut performance. There remains a paucity of research related to spaceflight-induced pathologies, and currently available reviews concern the central nervous system broadly while lacking emphasis on spinal function.

OBJECTIVE

Our aim was to review and summarize available data regarding changes in spinal health with exposure to spaceflight, especially focusing on effects of microgravity. The authors also present promising diagnostic and treatment approaches wherein the neurosurgeon could positively impact astronauts' health and post-flight outcomes.

MATERIALS AND METHODS

Articles included in this review were identified via search engine using MEDLINE, PubMed, Cochrane Review, Google Scholar, and references within other relevant articles. Search criteria included "spine and spaceflight", "vertebral column and spaceflight", "vertebral disc and spaceflight", and "muscle atrophy and spaceflight", with results limited to articles written in English from 1961 to 2020. References of selected articles were included as appropriate.

RESULTS

Fifty-six articles were included in this review. Compositional changes at the intervertebral discs, vertebral bone, and paraspinal muscles contribute to undesirable effects on astronaut spinal function in space and contribute to post-flight pathologies. Risk of intervertebral disc herniation increases, especially during post-flight recovery. Vertebral bone degeneration in microgravity may increase risk for herniation and fracture. Paraspinal muscle atrophy contributes to low back pain, poorer spine health, and reduced stability.

CONCLUSION

Anatomical changes in microgravity contribute to the development of spinal pathologies. Microgravity impacts sensory neurovestibular function, neuromuscular output, genetic expression, among other systems. Future developments in imaging and therapeutic interventions may better analyze these changes and offer targeted therapeutic interventions to decrease the burden of pain and other diseases of the spine in this population.

Population analysis of space travelers

Although many space missions have been completed in the last 60 years, space exploration is still technologically and medically challenging. While large-scale medical studies are impossible in space travelers, meta-analysis allows combining data from small crews that participated in space missions over several decades. Our primary objective was to examine space-travelers' sociodemographic characteristics and spaceflight activities, and their changes with time from the first spaceflight. Our secondary objective was to evaluate the publication practices to assess data availability for health-related meta-analytic studies. Based on state-funded space agencies used as primary sources, and third-party websites used as secondary sources, 565 humans (501 males/64 females) have currently completed spaceflight. The average age of space-travelers increased from 34±4 in the 1960s to 45±4 in the 2010s. While the duration of space missions has increased consistently, the number of missions per year varied in correlation with technological events. Using papers identified in the systematic review of bone health in astronauts, we examined the changes in reporting practices with time. The reported sample size varied from 1 to 58 people, in total providing data for 148 individuals. Data confidentiality significantly improved with time; however, the corresponding decrease in the availability of individual parameters did not allow stratification even by age, sex, and mission duration. Thus, space travelers represent a diverse population suitable for comparative studies, however, it is important to develop reporting practices that ensure consistent, transparent, and ethical presentation of outcomes to support meta-analyses that are critical for understanding the scope of spaceflight-induced health issues.

Bioinspired Scaffold Action Under the Extreme Physiological Conditions of Simulated Space Flights: Osteogenesis Enhancing Under Microgravity

Prolonged exposure to microgravity (MG) during long-duration space flights is known to induce severe dysregulation of osteoblast functions connected to a significant bone loss, similar to the condition induced by osteoporosis. Hence, we here present MG as a promising model to challenge the effectiveness of new scaffolds designed for bone regeneration in counteracting bone loss. To this end, we carried out an integrative study aimed to evaluate, in the extreme condition of Random Positioning Machine-simulated MG, the osteoinductive potential of nanocrystalline magnesium-doped hydroxyapatite/type I collagen composite scaffold (MHA/Coll), that we previously demonstrated to be an excellent tool for bone tissue engineering. Initially, to test the osteoinductive properties of our bioinspired-scaffold, MHA/Coll structure was fully characterized under MG condition and compared to its static counterpart. Human bone marrow-derived mesenchymal stem cells were used to investigate the scaffold biocompatibility and ability to promote osteogenic differentiation after long-duration exposure to MG (up to 21 days). The results demonstrate that the nanostructure of MHA/Coll scaffold can alleviate MG-induced osteoblast dysfunction, promoting cell differentiation along the osteogenic lineage, with a consequent reduction in the expression of the surface markers CD29, CD44, and CD90. Moreover, these findings were corroborated by the ability of MHA/Coll to induce the expression of genes linked to osteogenesis, including alkaline phosphatase and osteocalcin. This study confirmed MHA/Coll capabilities in promoting osteogenesis even in extreme long-term condition of MG, suggesting MG as an effective challenging model to apply in future studies to validate the ability of advanced scaffolds to counteract bone loss, facilitating their application in translational Regenerative Medicine and Tissue Engineering.

A systematic review and meta-analysis of bone loss in space travelers

Bone loss in space travelers is a major challenge for long-duration space exploration. To quantify microgravity-induced bone loss in humans, we performed a meta-analysis of studies systematically identified from searching Medline, Embase, Web of Science, BIOSIS, NASA Technical reports, and HathiTrust, with the last update in November 2019. From 25 articles selected to minimize the overlap between reported populations, we extracted post-flight bone density values for 148 individuals, and in-flight and post-flight biochemical bone marker values for 124 individuals. A percentage difference in bone density relative to pre-flight was positive in the skull, +2.2% [95% confidence interval: +1.1, +3.3]; neutral in the thorax/upper limbs, −0.7% [−1.3, −0.2]; and negative in the lumbar spine/pelvis, −6.2 [−6.7, −5.6], and lower limbs, −5.4% [−6.0, −4.9]. In the lower limb region, the rate of bone loss was −0.8% [−1.1, −0.5] per month. Bone resorption markers increased hyperbolically with a time to half-max of 11 days [9, 13] and plateaued at 113% [108, 117] above pre-flight levels. Bone formation markers remained unchanged during the first 30 days and increased thereafter at 7% [5, 10] per month. Upon landing, resorption markers decreased to pre-flight levels at an exponential rate that was faster after longer flights, while formation markers increased linearly at 84% [39, 129] per month for 3–5 months post-flight. Microgravity-induced bone changes depend on the skeletal-site position relative to the gravitational vector. Post-flight recovery depends on spaceflight duration and is limited to a short post-flight period during which bone formation exceeds resorption.

Multiscale effects of spaceflight on murine tendon and bone

Despite a wealth of data on the effects of spaceflight on tendons and bones, little is known about its effects on the interfacial tissue between these two structures, the enthesis. Mice were sent to space on three separate missions: STS-131, STS-135, and Bion-M1 to determine how spaceflight affects the composition, structure, mechanics, and gene expression of the humerus-supraspinatus and calcaneus-Achilles entheses. At the nanoscale, spaceflight resulted in decreased carbonate levels in the bone, likely due to increased remodeling, as suggested by increased expression of genes related to osteoclastogenesis (CatK, Tnfsf11) and mature osteoblasts (Col1, Osc). Tendons showed a shift in collagen fibril size towards smaller diameters that may have resulted from increased expression of genes related to collagen degradation (Mmp3, Mmp13). These nanoscale changes did not result in micro- and milliscale changes to the structure and mechanics of the enthesis. There were no changes in bone volume, trabecular structure, failure load, or stiffness with spaceflight. This lack of tissue-level change may be anatomy based, as extremities may be less sensitive to spaceflight than central locations such as vertebrae, yet results highlight that the tendon enthesis may be robust against negative effects of spaceflight.

Spaceflight-Induced Bone Tissue Changes that Affect Bone Quality and Increase Fracture Risk

PURPOSE OF REVIEW

Bone mineral density and systemic factors are used to assess skeletal health in astronauts. Yet, even in a general population, these measures fail to accurately predict when any individual will fracture. This review considers how long-duration human spaceflight requires evaluation of additional bone structural and material quality measures that contribute to microgravity-induced skeletal fragility.

RECENT FINDINGS

In both humans and small animal models following spaceflight, bone mass is compromised via reduced bone formation and elevated resorption levels. Concurrently, bone structural quality (e.g., trabecular microarchitecture) is diminished and the quality of bone material is reduced via impaired tissue mineralization, maturation, and maintenance (e.g., mediated by osteocytes). Bone structural and material quality are both affected by microgravity and may, together, jeopardize astronaut operational readiness and lead to increased fracture risk upon return to gravitational loading. Future studies need to directly evaluate how bone quality combines with diminished bone mass to influence bone strength and toughness (e.g., resistance to fracture). Bone quality assessment promises to identify novel biomarkers and therapeutic targets.

Rapid Cellular Perception of Gravitational Forces in Human Jurkat T Cells and Transduction into Gene Expression Regulation

Cellular processes are influenced in many ways by changes in gravitational force. In previous studies, we were able to demonstrate, in various cellular systems and research platforms that reactions and adaptation processes occur very rapidly after the onset of altered gravity. In this study we systematically compared differentially expressed gene transcript clusters (TCs) in human Jurkat T cells in microgravity provided by a suborbital ballistic rocket with vector-averaged gravity (vag) provided by a 2D clinostat. Additionally, we included 9× g centrifuge experiments and rigorous controls for excluding other factors of influence than gravity. We found that 11 TCs were significantly altered in 5 min of flight-induced and vector-averaged gravity. Among the annotated clusters were G3BP1, KPNB1, NUDT3, SFT2D2, and POMK. Our results revealed that less than 1% of all examined TCs show the same response in vag and flight-induced microgravity, while 38% of differentially regulated TCs identified during the hypergravity phase of the suborbital ballistic rocket flight could be verified with a 9× g ground centrifuge. In the 2D clinostat system, doing one full rotation per second, vector effects of the gravitational force are only nullified if the sensing mechanism requires 1 s or longer. Due to the fact that vag with an integration period of 1 s was not able to reproduce the results obtained in flight-induced microgravity, we conclude that the initial trigger of gene expression response to microgravity requires less than 1 s reaction time. Additionally, we discovered extensive gene expression differences caused by simple handling of the cell suspension in control experiments, which underlines the need for rigorous standardization regarding mechanical forces during cell culture experiments in general.

Quantitative ultrasound imaging monitoring progressive disuse osteopenia and mechanical stimulation mitigation in calcaneus region through a 90-day bed rest human study

Background

Osteoporosis parallels aging and functional mechanical unloading (e.g., space flight and bed rest), jeopardizing mineral density, microstructure, and integrity of bone and leading to an increased risk of fracture. A way to combat this deterioration is to harness the sensitivity of bone to mechanical signals.

Objective

This study evaluates the longitudinal effect of a dynamic mechanical loading through the heel on human bone in vivo during 90-day bed rest, monitored by quantitative ultrasound (QUS) imaging and dual-energy X-ray absorptiometry (DXA) in localized regions of interests, i.e., calcaneus.

Methods

A total of 29 bed rest individuals were evaluated (11 control and 18 treatment) with a brief (10-minute) daily low-intensity (0.3g), high-frequency (30Hz) dynamic mechanical stimulation countermeasure through vibrational inhibition bone erosion (VIBE). Both QUS and DXA detected longitudinal bone density and quality changes.

Results

Ultrasound velocity (UV) decreased in the control group and increased in the group treated with low-intensity loading. The UV increased by 1.9% and 1.6% at 60- and 90-day bed rest (p=0.01) in VIBE over control groups. A trend was found in broadband ultrasound attenuation (BUA), with a VIBE benefit of 1.8% at day 60 and 0.5% at day 90 in comparison with control (p=0.5). Bone mineral density (BMD) assessed by DXA decreased -4.50% for control individuals and -2.18% for VIBE individuals, showing a moderate effect of the mechanical intervention (p=0.19). Significant correlations between QUS and DXA were observed, with a combined BUA and UV vs. BMD: r²=0.70.

Conclusion

These results indicated that low-intensity, high-frequency loading has the potential to mitigate regional bone loss induced by long-term bed rest and that QUS imaging may be able to assess the subtle changes in bone alteration.

Translational potential of this article

Quantitative ultrasound has shown the efficacy of noninvasively assessing bone mass and structural properties in cadaver and isolated trabecular bone samples. While its ability in measuring in vivo bone quality and density is still unclear, a scanning confocal ultrasound imaging is developed and can perform an instant assessment for the subtle changes of such bone loss. This ultrasound imaging modality can potentially be used in the clinical assessment of bone mass. Moreover, physical stimulation has shown the ability to prevent bone loss induced by functional disuse and estrogen deficiency in animal models. However, its treatment capability is unclear. This study has shown that low-magnitude mechanical signals, introduced using low-intensity vibration (LIV), can mitigate regional bone loss caused by functional disuse. Thus localized mechanical treatment, and the quantitative ultrasound imaging have shown translational potential to noninvasively attenuate bone loss, and assess bone mass in the clinic, e.g., in an extreme condition such as long-term space mission, and long-term bedrest such as in case of spinal cord injury.

Lumbopelvic Muscle Changes Following Long-Duration Spaceflight

Long-duration spaceflight has been shown to negatively affect the lumbopelvic muscles of crewmembers. Through analysis of computed tomography scans of crewmembers on 4- to 6-month missions equipped with the interim resistive exercise device, the structural deterioration of the psoas, quadratus lumborum, and paraspinal muscles was assessed. Computed tomography scans of 16 crewmembers were collected before and after long-duration spaceflight. The volume and attenuation of lumbar musculature at the L2 vertebral level were measured. Percent changes in the lumbopelvic muscle volume and attenuation (indicative of myosteatosis, or intermuscular fat infiltration) following spaceflight were calculated. Due to historical studies demonstrating only decreases in the muscles assessed, a one-sample t test was performed to determine if these decreases persist in more recent flight conditions. Crewmembers on interim resistive exercise device-equipped missions experienced an average 9.5% (2.0% SE) decrease in volume and 6.0% (1.5% SE) decrease in attenuation in the quadratus lumborum muscles and an average 5.3% (1.0% SE) decrease in volume and 5.3% (1.6% SE) decrease in attenuation in the paraspinal muscles. Crewmembers experienced no significant changes in psoas muscle volume or attenuation. No significant changes in intermuscular adipose tissue volume or attenuation were found in any muscles. Long-duration spaceflight was associated with preservation of psoas muscle volume and attenuation and significant decreases in quadratus lumborum and paraspinal muscle volume and attenuation.

Bone fragility after spinal cord injury: reductions in stiffness and bone mineral at the distal femur and proximal tibia as a function of time

Computed tomography and finite element modeling were used to assess bone structure at the knee as a function of time after spinal cord injury. Analyzed regions experienced degradation in stiffness, mineral density, and content. Changes were well described as an exponential decay over time, reaching a steady state 3.5 years after injury.

INTRODUCTION

Spinal cord injury (SCI) is associated with bone fragility and an increased risk of fracture around the knee. The purpose of this study was to investigate bone stiffness and mineral content at the distal femur and proximal tibia, using finite element (FE) and computed tomography (CT) measures. A cross-sectional design was used to compare differences between non-ambulatory individuals with SCI as a function of time after injury (0-50 years).

METHODS

CT scans of the knee were obtained from 101 individuals who experienced an SCI 30 days to 50 years prior to participation. Subject-specific FE models were used to estimate stiffness under axial compression and torsional loading, and CT data was analyzed to assess volumetric bone mineral density (vBMD) and bone mineral content (BMC) for integral, cortical, and trabecular compartments of the epiphyseal, metaphyseal, and diaphyseal regions of the distal femur and proximal tibia.

RESULTS

Bone degradation was well described as an exponential decay over time (R2 = 0.33-0.83), reaching steady-state levels within 3.6 years of SCI. Individuals at a steady state had 40 to 85% lower FE-derived bone stiffness and robust decreases in CT mineral measures, compared to individuals who were recently injured (t ≤ 47 days). Temporal and spatial patterns of bone loss were similar between the distal femur and proximal tibia.

CONCLUSIONS

After SCI, individuals experienced rapid and profound reductions in bone stiffness and bone mineral at the knee. FE models predicted similar reductions to axial and torsional stiffness, suggesting that both failure modes may be clinically relevant. Importantly, CT-derived measures of bone mineral alone underpredicted the impacts of SCI, compared to FE-derived measures of stiffness.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01225055, NCT02325414).

Acute transcriptional up-regulation specific to osteoblasts/osteoclasts in medaka fish immediately after exposure to microgravity

Bone loss is a serious problem in spaceflight; however, the initial action of microgravity has not been identified. To examine this action, we performed live-imaging of animals during a space mission followed by transcriptome analysis using medaka transgenic lines expressing osteoblast and osteoclast-specific promoter-driven GFP and DsRed. In live-imaging for osteoblasts, the intensity of osterix- or osteocalcin-DsRed fluorescence in pharyngeal bones was significantly enhanced 1 day after launch; and this enhancement continued for 8 or 5 days. In osteoclasts, the signals of TRAP-GFP and MMP9-DsRed were highly increased at days 4 and 6 after launch in flight. HiSeq from pharyngeal bones of juvenile fish at day 2 after launch showed up-regulation of 2 osteoblast- and 3 osteoclast- related genes. Gene ontology analysis for the whole-body showed that transcription of genes in the category “nucleus” was significantly enhanced; particularly, transcription-regulators were more up-regulated at day 2 than at day 6. Lastly, we identified 5 genes, c-fos, jun-B-like, pai-1, ddit4 and tsc22d3, which were up-regulated commonly in the whole-body at days 2 and 6, and in the pharyngeal bone at day 2. Our results suggested that exposure to microgravity immediately induced dynamic alteration of gene expression levels in osteoblasts and osteoclasts.

Guidelines for Dual Energy X-Ray Absorptiometry Analysis of Trabecular Bone-Rich Regions in Mice: Improved Precision, Accuracy, and Sensitivity for Assessing Longitudinal Bone Changes

Trabecular bone is frequently studied in osteoporosis research because changes in trabecular bone are the most common cause of osteoporotic fractures. Dual energy X-ray absorptiometry (DXA) analysis specific to trabecular bone-rich regions is crucial to longitudinal osteoporosis research. The purpose of this study is to define a novel method for accurately analyzing trabecular bone-rich regions in mice via DXA. This method will be utilized to analyze scans obtained from the International Space Station in an upcoming study of microgravity-induced bone loss. Thirty 12-week-old BALB/c mice were studied. The novel method was developed by preanalyzing trabecular bone-rich sites in the distal femur, proximal tibia, and lumbar vertebrae via high-resolution X-ray imaging followed by DXA and micro-computed tomography (micro-CT) analyses. The key DXA steps described by the novel method were (1) proper mouse positioning, (2) region of interest (ROI) sizing, and (3) ROI positioning. The precision of the new method was assessed by reliability tests and a 14-week longitudinal study. The bone mineral content (BMC) data from DXA was then compared to the BMC data from micro-CT to assess accuracy. Bone mineral density (BMD) intra-class correlation coefficients of the new method ranging from 0.743 to 0.945 and Levene's test showing that there was significantly lower variances of data generated by new method both verified its consistency. By new method, a Bland-Altman plot displayed good agreement between DXA BMC and micro-CT BMC for all sites and they were strongly correlated at the distal femur and proximal tibia (r=0.846, p<0.01; r=0.879, p<0.01, respectively). The results suggest that the novel method for site-specific analysis of trabecular bone-rich regions in mice via DXA yields more precise, accurate, and repeatable BMD measurements than the conventional method.

Building bridges: leveraging interdisciplinary collaborations in the development of biomaterials to meet clinical needs

Our laboratory at Rice University has forged numerous collaborations with clinicians and basic scientists over the years to advance the development of novel biomaterials and the modification of existing materials to meet clinical needs. This review highlights collaborative advances in biomaterials research from our laboratory in the areas of scaffold development, drug delivery, and gene therapy, especially as related to applications in bone and cartilage tissue engineering.

Rapid loss of bone mass and strength in mice after abdominal irradiation

Localized irradiation is a common treatment modality for malignancies in the pelvic-abdominal cavity. We report here on the changes in bone mass and strength in mice 7-14 days after abdominal irradiation. Male C57BL/6 mice of 10-12 weeks of age were given a single-dose (0, 5, 10, 15 or 20 Gy) or fractionated (3 Gy × 2 per day × 7.5 days) X rays to the abdomen and monitored daily for up to 14 days. A decrease in the serum bone formation marker and ex vivo osteoblast differentiation was detected 7 days after a single dose of radiation, with little change in the serum bone resorption marker and ex vivo osteoclast formation. A single dose of radiation elicited a loss of bone mineral density (BMD) within 14 days of irradiation. The BMD loss was up to 4.1% in the whole skeleton, 7.3% in tibia, and 7.7% in the femur. Fractionated abdominal irradiation induced similar extents of BMD loss 10 days after the last fraction: 6.2% in the whole skeleton, 5.1% in tibia, and 13.8% in the femur. The loss of BMD was dependent on radiation dose and was more profound in the trabecula-rich regions of the long bones. Moreover, BMD loss in the total skeleton and the femurs progressed with time. Peak load and stiffness in the mid-shaft tibia from irradiated mice were 11.2-14.2% and 11.5-25.0% lower, respectively, than sham controls tested 7 days after a single-dose abdominal irradiation. Our data demonstrate that abdominal irradiation induces a rapid loss of BMD in the mouse skeleton. These effects are bone type- and region-specific but are independent of radiation fractionation. The radiation-induced abscopal damage to the skeleton is manifested by the deterioration of biomechanical properties of the affected bone.

Sex difference between body composition and weight-bearing bone mineral density in Korean adult twins: healthy twin study

We performed a monozygotic (MZ) cotwin-control study using the MZ twin pair difference in bone mineral density (BMD) to assess the relationship between body composition and BMD at weight-bearing sites. This study controlled for common genetic factors and applied only to environmental factors, using 185 MZ twin pairs aged 30-50 years (140 male subjects, 230 female subjects). As expected, total lean mass (TLM) was greater in males and total fat mass (TFM) was greater in females. In male twins, TLM was associated with BMD at the legs, pelvis, and spine, with percent BMD increases of 0.41 (95% confidence interval [CI] 0.17-0.64), 0.62 (95% CI 0.35-0.89), and 0.27 (95% CI 0.01-0.54) for every 1 kg. In female twins, TFM was associated with BMD at the legs and pelvis, with percent BMD increases of 0.10 (95% CI 0.03-0.17) and 0.10 (95% CI 0.02-0.18) for every 1 kg. The results support the hypothesis that skeletal muscle and bone mass in middle-aged men are linked. In contrast, this association was not shown in women, and the impact of TFM on BMD was significant. Therefore, there were sex differences in the relationship of body composition on BMD.

Bone mineral density, bone mineral content, gingival crevicular fluid (matrix metalloproteinases, cathepsin K, osteocalcin), and salivary and serum osteocalcin levels in human mandible and alveolar bone under conditions of simulated microgravity

In astronauts and cosmonauts, exposure to microgravity has been associated with several physiological changes, including an osteoporosis like loss of bone mass. It has been reported that head-down tilt bed-rest studies mimic many of the observations seen in space flights. There has been no study of the effects of mandibular bone and alveolar bone loss in both sexes under conditions of simulated microgravity. This study was designed to investigate bone mineral density; bone mineral content; matrix metalloproteinase (MMP)-8, MMP-9, cathepsin K, and osteocalcin levels in gingival crevicular fluid (GCF); and salivary and serum osteocalcin levels in normal healthy men and women under conditions of simulated microgravity, namely, -6° head-down-tilt (HDT) bed rest. The subjects of this investigation were 10 male and 10 female volunteers who were exposed to 3 weeks of -6° HDT bed rest. Dual-energy X-ray absorptiometry was used to measure bone density and bone mineral content in alveolar bone from the mandibular canine to the third molar, as well as in the mandibular ramus, before, during, and after exposure to conditions of simulated microgravity. GCF (ie, MMP-8, MMP-9, cathepsin K, and osteocalcin) and salivary and serum osteocalcin levels were measured by enzyme-linked immunosorbent assays. Bone mineral density and bone mineral content were significantly lower under conditions of simulated microgravity in both sexes. The decreases were greater in women than in men, but the differences between sexes were not significant. Cathepsin, osteocalcin, MMP-8, and MMP-9 levels were significantly higher under conditions of simulated microgravity than under normal conditions; the increases were greater in women than in men, but the differences were not significant. Additional, more comprehensive, studies with larger sample sizes are now necessary for the investigation of simulated microgravity and microgravity.

Gene expression patterns in bone following mechanical loading

The advent of high-throughput measurements of gene expression and bioinformatics analysis methods offers new ways to study gene expression patterns. The primary goal of this study was to determine the time sequence for gene expression in a bone subjected to mechanical loading during key periods of the bone-formation process, including expression of matrix-related genes, the appearance of active osteoblasts, and bone desensitization. A standard model for bone loading was employed in which the right forelimb was loaded axially for 3 minutes per day, whereas the left forearm served as a nonloaded contralateral control. We evaluated loading-induced gene expression over a time course of 4 hours to 32 days after the first loading session. Six distinct time-dependent patterns of gene expression were identified over the time course and were categorized into three primary clusters: genes upregulated early in the time course, genes upregulated during matrix formation, and genes downregulated during matrix formation. Genes then were grouped based on function and/or signaling pathways. Many gene groups known to be important in loading-induced bone formation were identified within the clusters, including AP-1-related genes in the early-response cluster, matrix-related genes in the upregulated gene clusters, and Wnt/β-catenin signaling pathway inhibitors in the downregulated gene clusters. Several novel gene groups were identified as well, including chemokine-related genes, which were upregulated early but downregulated later in the time course; solute carrier genes, which were both upregulated and downregulated; and muscle-related genes, which were primarily downregulated.

Effects of mechanical stimulation in osteogenic differentiation of bone marrow-derived mesenchymal stem cells on aligned nanofibrous scaffolds

Mechanical stimulation is one of the factors that regulating bone regeneration and healing. In this study, the biological responses of bone marrow derived mesenchymal stem cells (MSCs) to mechanical stimuli on aligned nanofibers and cast films were investigated. The uniaxial cyclic strain (1% strain and 1 Hz) was applied continuously to the cell substrates and osteoblastic activities were assessed at weeks 1, 2, and 4. The MSCs morphology on the aligned nanofibers was more elongated and spindle-like than MSCs on the cast films. Strain stimulation significantly attenuated the proliferation at week one but was significantly enhanced at week 4 for both types of substrates. Only the MSCs on strained nanofibers had greater alkaline phosphatase (ALP) levels at week one, while the ALP hindered the MSCs on both substrates at week 4. Strain application played a greater influence on osteocalcin expression for the cast films than the nanofibers at week 4. Clearly, the cellular response to strain induction was highly dependent on the surface—cell adhesion, which itself was greatly influenced by the surface texture of the substrate.

The effects of frequency-dependent dynamic muscle stimulation on inhibition of trabecular bone loss in a disuse model

Clinical electrical muscle stimulation has been shown to alleviate muscle atrophy resulting from functional disuse, yet little is known about its effect on the skeleton. The objective of this study is to evaluate the potential of dynamic muscle stimulation on disused trabecular bone, and to investigate the importance of optimized stimulation frequency in the loading regimen. Fifty-six skeletally mature Sprague-Dawley rats were divided into seven groups for the 4-week experiment: baseline control, age-matched control, hindlimb suspended (HLS), and HLS with muscle stimulation at 1 Hz, 20 Hz, 50 Hz, and 100 Hz. Muscle stimulation was carried out for 10 min per day for 5 days per week, total of 4 weeks. The metaphyseal and epiphyseal trabecular regions of the distal femurs were analyzed with microcomputed tomography and histomorphometry methods. HLS alone for 4-week resulted in a significant amount of trabecular bone loss and structural deterioration. Muscle contraction at 1 Hz was not sufficient to inhibit trabecular bone loss and resulted in similar amount of loss to that of HLS alone. Bone quantity and structure were significantly improved by applying muscle stimulation at mid-frequency (20 Hz and 50 Hz). Dynamic stimulation at 50 Hz demonstrated the greatest preventive effect on the skeleton against functional disused alone animals (up to +147% in bone volume fraction, +38% in trabecular number and -36% in trabecular separation). Histomorphometric analysis showed that the stimulation, regardless of its frequency, did not have an effect on the bone formation indices, such as mineral apposition rate and bone formation rate. Overall, the data demonstrated the potentials of frequency-dependent dynamic muscle contraction in regulating skeletal adaptive responses under disuse conditions. Dynamic muscle stimulation, with a specific regimen, may be beneficial to future orthopedic research in developing a countermeasure for disuse osteopenia and osteoporosis.

Hydrostatic pressure sensation in cells: integration into the tensegrity model

Hydrostatic pressure (HP) is a mechanical stimulus that has received relatively little attention in the field of the cell biology of mechanotransduction. Generalized models, such as the tensegrity model, do not provide a detailed explanation of how HP might be detected. This is significant, because HP is an important mechanical stimulus, directing cell behaviour in a variety of tissues, including cartilage, bone, airways, and the vasculature. HP sensitivity may also be an important factor in certain clinical situations, as well as under unique environmental conditions such as microgravity. While downstream cellular effects have been well characterized, the initial HP sensation mechanism remains unclear. In vitro evidence shows that HP affects cytoskeletal polymerization, an effect that may be crucial in triggering the cellular response. The balance between free monomers and cytoskeletal polymers is shifted by alterations in HP, which could initiate a cellular response by releasing and (or) activating cytoskeleton-associated proteins. This new model fits well with the basic tenets of the existing tensegrity model, including mechanisms in which cellular HP sensitivity could be tuned to accommodate variable levels of stress.

Ultrasonically determined thickness of long cortical bones: two-dimensional simulations of in vitro experiments

Previously it has been demonstrated that cortical bone thickness can be estimated from ultrasonic guided-wave measurements, in an axial transmission configuration, together with an appropriate analytical model. This study considers the impact of bone thickness variation within the measurement region on the ultrasonically determined thickness (UTh). To this end, wave velocities and UTh were determined from experiments and from time-domain finite-difference simulations of wave propagation, both performed on a set of ten human radius specimens (29 measurement sites). A two-dimensional numerical bone model was developed with tunable material properties and individualized geometry based on x-ray computed-tomography reconstructions of human radius. Cortical thickness (CTh) was determined from the latter. UTh data for simulations were indeed in a excellent accordance (root-mean-square error was 0.26 mm; r2=0.94, p<0.001) with average CTh within the measurement region. These results indicate that despite variations in cortical thickness along the propagation path, the measured phase velocity can be satisfactorily modeled by a simple analytical model (the A(0) plate mode in this case). Most of the variability (up to 85% when sites were carefully matched) observed in the in vitro ultrasound data was explained through simulations by variability in the cortical thickness alone.

Bone surface topology mapping and its role in trabecular bone quality assessment using scanning confocal ultrasound

INTRODUCTION

Quantitative ultrasound (QUS) has been used to assess non-invasively bone quality, in which ultrasound velocity (UV) is a primary acoustic property.

METHODS

While UV calculation requires the tissue thickness in the ultrasound path, a bone surface topology mapping (STM) method was developed in this study for enhancing the accuracy of the UV measurement. STM accuracy was verified by both aluminum and a QUS heel phantom, indicating that the STM can determine the phantom thickness within 0.02 mm thickness error and the aluminum calibration step within 0.1 mm thickness error. STM performance was further evaluated using 25 cadaveric human calcanei samples.

RESULTS

The UV calculations using STM had a significant better correlation to bone mineral density (BMD) (r = 0.75, p < 0.05), volume fraction (r = 0.72, p < 0.05) and modulus (r = 0.69, p < 0.05) than the UV with fixed thickness. The later correlation coefficients were r = 0.64 for BMD, r = 0.65 for volume fraction, and r = 0.58 for modulus. The nBUA value determined using STM was also highly correlated to BMD (r(2) = 0.74) and modulus (r(2) = 0.62). This was comparable to the correlation result for BUA (BMD: r(2) = 0.76; Modulus: r(2) = 0.64).

CONCLUSION

These results suggested that STM technique in scanning ultrasound is capable of determining calcaneus bone thickness and hence enhancing the accuracy of UV measurement.

Investigating the effect of remodelling signal type on the finite element based predictions of bone remodelling around the thrust plate prosthesis: A patient-specific comparison

The resorption of bone in the human femur following total hip arthroplasty is recognized to be related to the loading in the bone surrounding the prosthesis. However, the precise nature of the mechanical signal that influences the biological remodelling activity of the bone is not completely understood. In this study, a validated finite element modelling methodology was combined with a numerical algorithm to simulate the biological changes over time. This was used to produce bone remodelling predictions for an implanted thrust plate prosthesis (Centerpulse Orthopedics Limited) in a patient specific bone model. The analysis was then repeated using different mechanical signals to drive the remodelling algorithm. The results of these simulations were then compared to the patient-specific clinical data, to distinguish which of the candidate signals produced predictions consistent with the clinical evidence. Good agreement was found for a range of strain energy based signals and also deviatoric remodelling signals. The results, however, did not support the use of compressive dilatational strain as a candidate remodelling signal.

Fluid shifts due to microgravity and their effects on bone: a review of current knowledge

Bone loss during long-term space flight is potentially a significant problem. Bone mineral density measurements show that bone is lost at a rate of about 1% per month from the lumbar spine, and 1.5% per month from the hip. Bone density changes are not uniform throughout the skeleton, and there is accumulating evidence that the distribution of bone density changes may be related to fluid shifts observed in microgravity. The paper summarises the data relating fluid shift of bone density changes in microgravity. In addition, microgravity and ground-based experiment were carried out to investigate the effects of interstitial fluid flow on bone formation. Data from these experiments were interpreted in light of the review data relating fluid shift to bone density changes in microgravity. Both experiments assessed the effect of an external pneumatic venous tourniquet on bone distal to the tourniquet. In the first experiment, a pneumatic tourniquet was designed to be placed around one ankle of a single astronaut on a 180-day mission on the MIR space station. Ultrasound measurements of both calcanei were made during the mission, and dual energy x-ray densitometry (x-ray absorption) measurements were performed at the start and end of the mission. In the second experiment, ground-based experiments have been performed to investigate possible mechanisms for the action of such a tourniquet on bone. A venous tourniquet was designed to be placed around the hind limb of a rat, proximal to the knee, applying a continuous pressure of 30 mmHg. The tourniquet increased significantly tibial fluid weight, periosteal bone formation and intracortical bone remodelling. Some of the effects appeared to due to a nitric oxide dependant pathway. It is proposed that tissue fluid pressures have an effect on bone that is independent of mechanical load, which may explain the variation in bone mineral density observed in space flight.

The fetus cannot exercise like an astronaut: gravity loading is necessary for the physiological development during second half of pregnancy

On the basis of published Magnetic Resonance Images and the values of the specific fetal and amniotic fluid weights, apparent weight of the fetus from the 18th week of gestation until term was determined. Up to the 21-22nd gestation week the fetus is in conditions similar to neutral floating, while after the 26th gestation week the apparent weight of the fetus is 60-80% of the actual weight. Decreased effect of the buoyant forces that affect the fetus in human species during the last trimester has a number of implications for the colonization of the solar system. During space flight it is impossible to apply the existing countermeasures against microgravity deconditioning of the muscular and cardiovascular systems to the fetus. Absence of gravitational loading during the last trimester of gestation would cause hypotrophy of the spinal extensors and lower extremities muscles, reduction in the amount of myosin heavy chain type I in the extensor muscles of the trunk and legs, hypoplasy and osteopeny of the vertebras and lower extremities long bones, and hypotrophy of the left ventricle of the heart muscle. Because of decreased capacity of postural and locomotor stability, acquisition of the gross developmental milestones such as sitting, standing and walking could be delayed. In the authors' opinion, only artificial gravity (rotating platform) during space flight will allow physiological development of the human fetus. Independency of offspring's of the guinea pig as regards locomotion and nursing increases probability of successful breeding in microgravity compared with rat offspring's, and make this species a candidate for future experiments under conditions of microgravity and hypergravity. Examining the gestation of this species in different gravities requires first the experimental determination of the amount of buoyant force to which the fetus is exposed in physiological conditions.

Cortical and trabecular bone mineral loss from the spine and hip in long-duration spaceflight

We measured cortical and trabecular bone loss using QCT of the spine and hip in 14 crewmembers making 4- to 6-month flights on the International Space Station. There was no compartment-specific loss of bone in the spine. Cortical bone mineral loss in the hip occurred primarily by endocortical thinning.

INTRODUCTION

In an earlier study, areal BMD (aBMD) measurements by DXA showed that cosmonauts making flights of 4- to 12-month duration on the Soviet/Russian MIR spacecraft lost bone at an average rate of 1%/month from the spine and 1.5%/month from the hip. However, because DXA measurements represent the sum of the cortical and trabecular compartments, there is no direct information on how these bone envelopes are affected by spaceflight.

MATERIALS AND METHODS

To address this, we performed a study of crewmembers (13 males and 1 female; age range, 40-55 years) on long-duration missions (4-6 months) on the International Space Station (ISS). We used DXA to obtain aBMD of the hip and spine and volumetric QCT (vQCT) to assess integral, cortical, and trabecular volumetric BMD (vBMD) in the hip and spine. In the heel, DXA was used to measure aBMD, and quantitative ultrasound (QUS) was used to measure speed of sound (SOS) and broadband ultrasound attenuation (BUA).

RESULTS AND CONCLUSIONS

aBMD was lost at rates of 0.9%/month at the spine (p < 0.001) and 1.4-1.5%/month at the hip (p < 0.001). Spinal integral vBMD was lost at a rate of 0.9%/month (p < 0.001), and trabecular vBMD was lost at 0.7%/month (p < 0.05). In contrast to earlier reports, these changes were generalized across the vertebrae and not focused in the posterior elements. In the hip, integral, cortical, and trabecular vBMD was lost at rates of 1.2-1.5%/month (p < 0.0001), 0.4-0.5%/month (p < 0.01), and 2.2-2.7%/month (p < 0.001), respectively. The cortical bone loss in the hip occurred primarily by cortical thinning. Calcaneal aBMD measurements by DXA showed smaller mean losses (0.4%/month) than hip or spine measurements, with SOS and BUA showing no change. In summary, our results show that ISS crewmembers, on average, experience substantial loss of both trabecular and cortical bone in the hip and somewhat smaller losses in the spine. These results do not support the use of calcaneal aBMD or QUS measurements as surrogate measures to estimate changes in the central skeleton.

Does Lower-Body BMD Develop at the Expense of Upper-Body BMD in Female Runners?

PURPOSE

Evidence suggests that exercise plays an important role in stimulating site-specific bone mineral density (BMD). However, what is less well understood is how these benefits dissipate throughout the body. Hence, the purpose of the present study was to compare the levels of, and the correlation between, BMD recorded at 10 sites in female endurance runners, and to investigate possible determinants responsible for any inter-site differences observed.

METHODS

Repeated measures ANOVA was used to compare the BMD between sites and factor analysis was used to describe the pattern of intersite correlations. Allometric ANCOVA was used to identify the primary determinants of bone mass and how these varied between sites.

RESULTS

The ANOVA and factor analysis identified systematic differences in BMD between sites, with the greatest BMD being observed in the lower-body sites, in particular the legs. An investigation into the possible mechanisms responsible for these differences revealed "distances run" (km.wk-1) as a positive, and "years of training" as a negative determinant of bone mass (P < 0.001). However, the effect of a number of determinants varied between sites (P < 0.05). Specifically, the ANCOVA identified that running further distances resulted in higher bone mass in the arms and legs. In contrast, training for additional years appeared to result in lower bone mass in the arms and lumbar spine. Calcium intake was also found to be positively associated with bone mass in the legs but negatively associated at all other sites.

CONCLUSIONS

A combination of running exercise and calcium intake would appear to stimulate the bone mass of women endurance runners at lower-body sites but at the expense of bone mass at upper-body sites.

Guided ultrasonic waves in long bones: modelling, experiment and in vivo application

Existing ultrasound devices for assessing the human tibia are based on detecting the first arriving signal, corresponding to a wave propagating at, or close to, the bulk longitudinal velocity in bone. However, human long bones are effectively irregular hollow tubes and should theoretically support the propagation of more complex guided modes similar to Lamb waves in plates. Guided waves are attractive because they propagate throughout the bone thickness and can potentially yield more information on bone material properties and architecture. In this study, Lamb wave theory and numerical simulations of wave propagation were used to gain insights into the expected behaviour of guided waves in bone. Experimental measurements in acrylic plates, using a prototype low-frequency axial pulse transmission device, confirmed the presence of two distinct propagating waves: the first arriving wave propagating at, or close to, the longitudinal velocity, and a slower second wave whose behaviour was consistent with the lowest order Lamb antisymmetrical (A0) mode. In a pilot study of healthy and osteoporotic subjects, the velocity of the second wave differed significantly between the two groups, whereas the first arriving wave velocity did not, suggesting the former to be a more sensitive indicator of osteoporosis. We conclude that guided wave measurements may offer an enhanced approach to the ultrasonic characterization of long bones.