Habitual Site-Specific Upper Extremity Loading is Associated with Increased Bone Mineral of the Ultradistal Radius in Young Women

Effect of External Mechanical Stimuli on Human Bone: a narrative review

Bone is a living composite material that has the capacity to adapt and respond to both internal and external stimuli. This capacity allows bone to adapt its structure to habitual loads and repair microdamage. Although human bone evolved to adapt to normal physiologic loading (for example from gravitational and muscle forces), these same biological pathways can potentially be activated through other types of external stimuli such as pulsed electromagnetic fields, mechanical vibration, and others. This review summarizes what is currently known about how human bone adapts to various types of external stimuli. We highlight how studies on sports-specific athletes and other exercise interventions have clarified the role of mechanical loading on bone structure. We also discuss clinical scenarios, such as spinal cord injury, where mechanical loading is drastically reduced, leading to rapid bone loss and permanent alterations to bone structure. Finally, we highlight areas of emerging research and unmet clinical need.

Relating Bone Strain to Local Changes in Radius Microstructure Following 12 Months of Axial Forearm Loading in Women

Work in animal models suggests that bone structure adapts to local bone strain, but this relationship has not been comprehensively studied in humans. Here, we quantified the influence of strain magnitude and gradient on bone adaptation in the forearm of premenopausal women performing compressive forearm loading (n = 11) and nonloading controls (n = 10). High resolution peripheral quantitative computed tomography (HRpQCT) scans of the distal radius acquired at baseline and 12 months of a randomized controlled experiment were used to identify local sites of bone formation and resorption. Bone strain was estimated using validated finite element (FE) models. Trabecular strain magnitude and gradient were higher near (within 200 μm) formation versus resorption (p < 0.05). Trabecular formation and resorption occurred preferentially near very high (>95th percentile) versus low (<5th percentile) strain magnitude and gradient elements, and very low strain elements were more likely to be near resorption than formation (p < 0.05). In the cortical compartment, strain gradient was higher near formation versus resorption (p < 0.05), and both formation and resorption occurred preferentially near very high versus low strain gradient elements (p < 0.05). At most, 54% of very high and low strain elements were near formation or resorption only, and similar trends were observed in the control and load groups. These findings suggest that strain, likely in combination with other physiological factors, influences adaptation under normal loads and in response to a novel loading intervention, and represents an important step toward defining exercise interventions to maximize bone strength.

Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis

PURPOSE

Wrist fractures are common, contribute significantly to morbidity in women with postmenopausal osteoporosis, and occur predominantly at the ultradistal radius, a site rich in trabecular bone. This exploratory analysis of the phase 3 ACTIVE study evaluated effects of abaloparatide versus placebo and teriparatide on forearm bone mineral density (BMD) and risk of wrist fracture.

METHODS

Forearm BMD was measured by dual energy X-ray absorptiometry in a subset of 982 women from ACTIVE, evenly distributed across the three treatment groups. Wrist fractures were ascertained in the total cohort (N = 2463).

RESULTS

After 18 months, ultradistal radius BMD changes from baseline were 2.25 percentage points greater for abaloparatide compared with placebo (95% confidence interval (CI) 1.38, 3.12, p < 0.001) and 1.54 percentage points greater for abaloparatide compared with teriparatide (95% CI 0.64, 2.45, p < 0.001). At 18 months, 1/3 radius BMD losses (versus baseline) were similar for abaloparatide compared with placebo (-0.42; 95% CI -1.03, 0.20; p = 0.19) but losses with teriparatide exceeded those of placebo (-1.66%; 95% CI -2.27, -1.06; p < 0.001). The decline with abaloparatide was less than that seen with teriparatide (group difference 1.22%; 95% CI 0.57, 1.87; p < 0.001). The radius BMD findings, at both ultradistal and 1/3 sites, are consistent with the numerically lower incidence of wrist fractures observed in women treated with abaloparatide compared with teriparatide (HR = 0.43; 95% CI 0.18, 1.03; p = 0.052) and placebo (HR = 0.49, 95% CI 0.20, 1.19, p = 0.11).

CONCLUSIONS

Compared with teriparatide, abaloparatide increased BMD at the ultradistal radius (primarily trabecular bone) and decreased BMD to a lesser extent at the 1/3 radius (primarily cortical bone), likely contributing to the numerically lower wrist fracture incidence observed with abaloparatide.

Circum-menarcheal bone acquisition is stress-driven: A longitudinal study in adolescent female gymnasts and non-gymnasts

Mechanical loading through youth exercise is highly modifiable and represents a strategy to maximize peak adult bone mass, with the potential for broad implementation across the population to lower fracture risk. For girls, circum-menarcheal growth is critical, with around 50% of adult bone acquired over a 4-year period. Here, we prospectively followed 10 gymnasts and 12 age-matched non-gymnasts across approximately 4 years circum-menarche. A combination of pQCT and subject-specific finite element models were used to measure differences in bone acquisition and structure between the groups, and to determine the degree to which specific mechanical factors predict change in bone structure. At baseline, gymnasts had stronger bone, including 26% higher BMC, 51% greater compressive strength, and 21% higher trabecular density. Over the study period, both groups more than doubled their bone strength. Pre-menarcheal principal stresses predicted change in pQCT variables for non-gymnasts, but not gymnasts. The bone of non-gymnasts became more asymmetrical than the bone of gymnasts. Our results suggest that exposure to the diverse, intense mechanical signals of gymnastic loading during adolescence imparts substantial benefits to bone geometry and mechanical function. Specifically, the bone of gymnasts is better able to resist loading from multiple directions, and operates with a higher factor of safety compared to non-gymnasts.

Distal radius fractures in athletes: approaches and treatment considerations

Fractures of the distal radius are common injuries in both athletes and nonathletes. Management is dictated by the nature of the fracture and the patient's level of competition, age, and sport-specific demands. Treatment strategies range from nonoperative treatment for stable injuries to primarily operative treatment for unstable fractures, particularly in active athletes. Once the decision has been made to treat a distal radius fracture operatively, a wide variety of fixation options are available. However, no technique has proven superior to all others, and no single method of fixation will lead to acceptable results in all types of distal radius fractures. This study will highlight important considerations when treating distal radius fractures in athletes, describe the various fixation options available, and discuss our method for determining the fixation needs of each fracture.

The role of physical activity and diet on bone mineral indices in young men: a cross-sectional study

Background

Osteoporotic fractures are a significant cause of morbidity and mortality, particularly in developed countries. Increasing peak bone mass in young people may be the most important primary prevention strategy to reduce the risk of osteoporosis. This study aimed to examine the relationship between dietary factors and physical activity on bone mineralization in young men.

Methods

Thirty-five healthy men aged 18–25 y had anthropometric measures, body composition, resting metabolic rate, blood pressure, blood lipids, food intake, physical activity and cardiorespiratory fitness assessed.

Results

Participants who consumed more than 1000 mg/d of calcium were taller and had higher levels of whole body mineral content than participants who consumed less than 1000 mg/d of calcium. Similarly, participants who expended more than 20% of total daily energy engaged in moderate- to vigorous-intensity physical activity had higher cardiorespiratory fitness and higher levels of body mass adjusted bone mineral content than participants who did not meet this level of energy expenditure. There were no differences in blood pressure or blood lipids between participants in calcium or in physical activity energy expenditure categories.

Conclusions

A high intake of dietary calcium and high daily energy expenditure engaged in moderate- to vigorous-intensity physical activity were positively associated with bone mineralization in young men, particularly in the lumbar region.