The effects of altered strain environments on bone tissue kinetics

The Potential of FGF-2 in Craniofacial Bone Tissue Engineering: A Review

Bone is a hard-vascularized tissue, which renews itself continuously to adapt to the mechanical and metabolic demands of the body. The craniofacial area is prone to trauma and pathologies that often result in large bone damage, these leading to both aesthetic and functional complications for patients. The "gold standard" for treating these large defects is autologous bone grafting, which has some drawbacks including the requirement for a second surgical site with quantity of bone limitations, pain and other surgical complications. Indeed, tissue engineering combining a biomaterial with the appropriate cells and molecules of interest would allow a new therapeutic approach to treat large bone defects while avoiding complications associated with a second surgical site. This review first outlines the current knowledge of bone remodeling and the different signaling pathways involved seeking to improve our understanding of the roles of each to be able to stimulate or inhibit them. Secondly, it highlights the interesting characteristics of one growth factor in particular, FGF-2, and its role in bone homeostasis, before then analyzing its potential usefulness in craniofacial bone tissue engineering because of its proliferative, pro-angiogenic and pro-osteogenic effects depending on its spatial-temporal use, dose and mode of administration.

Induction of periosteal bone formation by intraosseous BMP-2 injection in a mouse model of osteogenesis imperfecta

PURPOSE

Surgical interventions are routinely performed on children with osteogenesis imperfecta (OI) to stabilize long bones, often post fracture. We speculated that a combination of intramedullary reaming and intraosseous injection of recombinant bone morphogenetic protein-2 (BMP-2) could enhance periosteal ossification and ultimately cortical thickness and strength. This approach was conceptually tested in a preclinical model of genetic bone fragility.

METHODS

Six experimental groups were tested including no treatment, intramedullary reaming, and reaming with 5 µg BMP-2 injection performed in the tibiae of both wild type (WT) and Col1a2 ^G610C/+ (OI, Amish mutation) mice. Bone formation was examined at a two-week time point in ex vivo specimens by micro-computed tomography (microCT) analysis and histomorphometry with a dynamic bone label.

RESULTS

MicroCT data illustrated increases in tibial cortical thickness with intramedullary reaming alone (Saline) and reaming plus BMP-2 injection (BMP-2) compared to no intervention controls. In the OI mice, the periosteal bone increase was not statistically significant with Saline but there was an increase of +192% (p = 0.053) with BMP-2 injection. Dynamic histomorphometry on calcein label was used to quantify new woven bone formation; while BMP-2 induced greater bone formation than Saline, the anabolic response was blunted overall in the OI groups.

CONCLUSIONS

These data indicate that targeting the intramedullary compartment via reaming and intraosseous BMP-2 delivery can lead to gains in cortical bone parameters. It is suggested that the next step is to validate safety and functional improvements in a clinical OI setting.

The bone remodelling cycle

The bone remodelling cycle replaces old and damaged bone and is a highly regulated, lifelong process essential for preserving bone integrity and maintaining mineral homeostasis. During the bone remodelling cycle, osteoclastic resorption is tightly coupled to osteoblastic bone formation. The remodelling cycle occurs within the basic multicellular unit and comprises five co-ordinated steps; activation, resorption, reversal, formation and termination. These steps occur simultaneously but asynchronously at multiple different locations within the skeleton. Study of rare human bone disease and animal models have helped to elucidate the cellular and molecular mechanisms that regulate the bone remodelling cycle. The key signalling pathways controlling osteoclastic bone resorption and osteoblastic bone formation are receptor activator of nuclear factor-κB (RANK)/RANK ligand/osteoprotegerin and canonical Wnt signalling. Cytokines, growth factors and prostaglandins act as paracrine regulators of the cycle, whereas endocrine regulators include parathyroid hormone, vitamin D, calcitonin, growth hormone, glucocorticoids, sex hormones, and thyroid hormone. Disruption of the bone remodelling cycle and any resulting imbalance between bone resorption and formation leads to metabolic bone disease, most commonly osteoporosis. The advances in understanding the cellular and molecular mechanisms underlying bone remodelling have also provided targets for pharmacological interventions which include antiresorptive and anabolic therapies. This review will describe the remodelling process and its regulation, discuss osteoporosis and summarize the commonest pharmacological interventions used in its management.

Collagen Fiber Orientation in Primate Long Bones

Studies of variation in orientation of collagen fibers within bone have lead to the proposition that these are preferentially aligned to accommodate different kinds of load, with tension best resisted by fibers aligned longitudinally relative to the load, and compression best resisted by transversely aligned fibers. However, previous studies have often neglected to consider the effect of developmental processes, including constraints on collagen fiber orientation (CFO), particularly in primary bone. Here we use circularly polarized light microscopy to examine patterns of CFO in cross-sections from the midshaft femur, humerus, tibia, radius, and ulna in a range of living primate taxa with varied body sizes, phylogenetic relationships and positional behaviors. We find that a preponderance of longitudinally oriented collagen is characteristic of both periosteal primary and intracortically remodeled bone. Where variation does occur among groups, it is not simply understood via interpretations of mechanical loads, although prioritized adaptations to tension and/or shear are considered. While there is some suggestion that CFO may correlate with body size, this relationship is neither consistent nor easily explicable through consideration of size-related changes in mechanical adaptation. The results of our study indicate that there is no clear relationship between CFO and phylogenetic status. One of the principle factors accounting for the range of variation that does exist is primary tissue type, where slower depositing bone is more likely to comprise a larger proportion of oblique to transverse collagen fibers. Anat Rec, 300:1189-1207, 2017. © 2017 Wiley Periodicals, Inc.

Computational Methods for Bone Mechanics Studies

The use of computational methods in the study of bone mechanics is described, with emphasis on the finite element method. In addition to the use of stan dard finite element methods for calcuiation of the dis placement, stress-and-strain environment in refined models of bone, the use of a "remodeling finite ele ment" is described to simulate the time course of changes in bone architecture that are induced by me chanical loading. The algorithm, which involves re peated finite element analyses over time, is shown to be feasible for use on supercomputing platforms.

Edentulation alters material properties of cortical bone in the human craniofacial skeleton: functional implications for craniofacial structure in primate evolution

Skeletal adaptations to reduced function are an important source of skeletal variation and may be indicative of environmental pressures that lead to evolutionary changes. Humans serve as a model animal to investigate the effects of loss of craniofacial function through edentulation. In the human maxilla, it is known that edentulation leads to significant changes in skeletal structure such as residual ridge resorption and loss of cortical thickness. However, little is known about changes in bone tissue structure and material properties, which are also important for understanding skeletal mechanics but are often ignored. The aims of this study were to determine cortical material properties in edentulous crania and to evaluate differences with dentate crania and thus examine the effects of loss of function on craniofacial structure. Cortical bone samples from 15 edentulous human skulls were measured for thickness and density. Elastic properties and directions of maximum stiffness were determined by using ultrasonic techniques. These data were compared to those from dentate crania reported in a previous investigation. Cortical bone from all regions of the facial skeleton of edentulous individuals is thinner than in dentate skulls. Elastic and shear moduli, and density are similar or greater in the zygoma and cranial vault of edentulous individuals, whereas these properties are less in the maxilla. Most cortical bone, especially in edentulous maxillae, has reduced directional orientation. The loss of significant occlusal loads following edentulation may contribute to the change in material properties and the loss of orientation over time during the normal process of bone remodeling. These results suggest that area-specific cortical microstructural changes accompany bone resorption following edentulation. They also suggest that functional forces are important for maintaining bone mass throughout the craniofacial skeleton, even in areas such as the browridges, which have been thought to be little affected by function, because of low in vivo strains found there in several primate studies.

Influence of exercise mode and osteogenic index on bone biomarker responses during short-term physical training

Prescribing exercise based on intensity, frequency, and duration of loading may maximize osteogenic responses in bone, but a model of the osteogenic potential of exercise has not been established in humans. In rodents, an osteogenic index (OI) has been used to predict the osteogenic potential of exercise. The current study sought to determine whether aerobic, resistance, or combined aerobic and resistance exercise programs conducted over eight weeks and compared to a control group could produce changes in biochemical markers of bone turnover indicative of bone formation. We further sought to determine whether an OI could be calculated for each of these programs that would reflect observed biochemical changes. We collected serum biomarkers [bone-specific alkaline phosphatase (BAP), osteocalcin, tartrate-resistant acid phosphatase (TRAP), C-terminal telopeptide fragment of type I collagen (CTx), deoxypyridinoline (DPD), 25-hydroxy vitamin D (25(OH)D), and parathyroid hormone (PTH)] in 56 women (20.3+/-1.8 years) before, during and after eight weeks of training. We also measured bone mineral density (BMD) at regional areas of interest using DXA and pQCT. Biomarkers of bone formation (BAP and osteocalcin) increased in the Resistance and Combined groups (p<0.05), while biomarkers of bone resorption (TRAP and DPD) decreased and increased, respectively, after training (p<0.05) in all groups. Small changes in volumetric and areal BMD (p<0.05) were observed in the distal tibia in the Aerobic and Combined groups, respectively. Mean weekly OIs were 16.0+/-1.9, 20.6+/-2.2, and 36.9+/-5.2 for the Resistance, Aerobic, and Combined groups, respectively. The calculated osteogenic potential of our programs did not correlate with the observed changes in biomarkers of bone turnover. The results of the present study demonstrate that participation in an eight week physical training program that incorporates a resistance component by previously inactive young women results in alterations in biomarkers of bone remodeling indicative of increased formation without substantial alterations in markers of resorption.

Regulation of mechanical signals in bone

OBJECTIVES

Response of the skeleton to application and removal of specific mechanical signals is discussed. Anabolic effects of high-frequency, low-magnitude vibrations, a mechanical intervention with a favorable safety profile, as well as the modulation of bone loss by genetic and epigenetic factors during disuse are highlighted.

METHODS

Review.

RESULTS

Bone responds to a great variety of mechanical signals and both high- and low-magnitude stimuli can be sensed by the skeleton. The ability of physical signals to influence bone morphology is strongly dependent on the signal's magnitude, frequency, and duration. Loading protocols at high signal frequencies (vibrations) allow a dramatic reduction in the magnitude of the signal. In the axial skeleton, these signals can be anabolic and anti-catabolic and increase the structural strength of the tissue. They further have shown potential in maxillofacial applications to accelerate the regeneration of bone within defects. Bone's sensitivity to the application and removal of mechanical signals is heavily under the control of the genome. Bone loss modulated by the removal of weight-bearing from the skeleton is profoundly influenced by factors such as genetics, gender, and baseline morphology.

CONCLUSIONS

Adaptation of bone to functional challenges is complex but it is clear that more is not necessarily better and that even very low-magnitude mechanical signals can be anabolic. The development of effective biomechanical interventions in areas such as orthodontics, craniofacial repair, or osteoporosis will require the identification of the specific components of bone's mechanical environment that are anabolic, catabolic, or anti-catabolic.

Effects of different types of palatal lateral excisions on growth and development of maxilla and dental arch

OBJECTIVE

This study aimed to explore the effects of different types of palatal lateral excisions on the growth and development of the maxilla and dental arch, and to investigate the underlying mechanisms.

METHODS

A total of 112 3-week-old Sprague-Dawley (SD) male rats were randomly divided into a control and 3 experimental groups: the mucoperiosteal denudation group, the mucosal flap excision group, and the periosteum excision group. In the experimental groups, bilateral mucoperiosteal, mucosal flap and periosteum were excised respectively in the lateral one half of the palate. Four rats in each group were randomly chosen for sacrifice every two weeks. The maxilla was dissected following the excision. The widths of the maxilla and dental arch were measured and the histological phenomena were investigated at different phases. At the same time, 12 animals in each group were sequentially injected with calcein every two weeks. Three animals in each group, whose fluorescent labeling was used, were sacrificed for investigating bone formation at Week 8 following injection.

RESULTS

(1) Each experimental group presented the constriction of the maxilla and dental arch. The upper first molars in the experimental groups inclined medially. The mucoperiosteal denudation group showed the largest degree of effect followed by the periosteum excision group. The indices of the mucosal flap excision group, which retained the structures of the periosteum layer, had the most approximate values to the control group; (2) Different histological changes among the experimental groups were detected. The fibers penetrated into the palatal bone as Sharpey's fibers in the mucoperiosteal denudation group. The pattern of bone deposition was the bundle type. Sharpey's fibers were not found in the mucosal flap and periosteum excision groups and the depositions of palatal bone were the lamellar type as those in the control group; (3) The rates of bone deposition in the experimental groups decreased compared with the control group. The rates in different phases were the most approximate values to those of the control group in the mucosal flap excision group, which has the same structure of periosteum as the control group.

CONCLUSION

There were different effects on the growth and development of the maxilla and dental arch in different types of palatal lateral excisions. Periosteum is important for bone formation and deposition pattern. The prevention of Sharpey's fibers forming and attaching to the palatine can effectively avert the following malformation.

The effect of staining on the monotonic tensile mechanical properties of human cortical bone

Microdamage in the form of microcracks has been observed in cortical bone following in vivo and in vitro fatigue loading. It has been suggested that bone has an inherent ability to repair microdamage at physiological activity levels. If the biological remodelling and repair process cannot keep up with the rate of damage accumulation, as in ageing bone and in individuals such as athletes and military recruits, microdamage may accumulate even at physiological activity levels. Such microdamage accumulation is thought to contribute to stress and fragility fractures. It is therefore important to obtain quantitative data on the rate of damage accumulation so as to understand the etiology of skeletal fractures. Sequential labelling of microdamage using fluorochrome stains at different stages of mechanical loading is becoming standard for assessing damage evolution. Although verification of this staining technique is provided in the literature, it has not yet been reported if the stains change the mechanical properties of cortical bone. In this study, monotonic tensile tests were performed to investigate the effect of the staining on the monotonic tensile mechanical properties of cortical bone. Forty-eight specimens were machined from human femora obtained from three male subjects, aged 52-55 years, and all 48 specimens were systematically divided into one control and three treatment groups. Specimens in the first (n = 12) and second treatment groups (n = 12) were stained with alizarin complexone and calcein (0.0005 M), respectively, for 16 h under 50 mmHg vacuum. Specimens in the third treatment group (n = 12) were kept in calcium-supplemented saline solution under the same conditions of the first and second treatment groups. Specimens in the control group (n = 12) were removed from the freezer prior to testing and allowed to thaw at room temperature in saline solution. Differences among the mean values of the mechanical properties for four testing groups were determined by the Mann-Whitney test at a significance level of P < 0.05. The statistical results indicated that the chelating stains and the staining conditions have no significant effect on the mechanical properties of the cortical bone under monotonic tensile loading. This study demonstrated that microcrack labelling with the chelating stains under aforementioned conditions (stain concentration, staining time, etc.) is a reliable method in that staining cortical bone with alizarin complexone and calcein prior to testing does not affect tensile properties.

Biomechanical approach to the reconstruction of activity patterns in Neolithic Western Liguria, Italy

This paper investigates the changes in upper and lower limb robusticity and activity patterns that accompanied the transition to a Neolithic subsistence in western Liguria (Italy). Diaphyseal robusticity measures were obtained from cross-sectional geometric properties of the humerus and femur in a sample of 16 individuals (eight males and eight females) dated to about 6,000-5,500 BP. Comparisons with European Late Upper Paleolithics (LUP) indicate increased humeral robusticity in Neolithic Ligurian (NEOL) males, but not in females, with a significant reduction in right-left differences in both sexes. Sexual dimorphism in robusticity increases in upper and lower limb bones. Regarding the femur, while all female indicators of bending strength decrease steadily through time, values for NEOL males approach those of LUP. This suggests high, and unexpected, levels of mechanical stress for NEOL males, probably reflecting the effects of the mountainous terrain on lower limb remodeling. Comparisons between NEOL males and a small sample of LUP hunter-gatherers from the same area support this interpretation. In conclusion, cross-sectional geometry data indicate that the transition to Neolithic economies in western Liguria did not reduce functional requirements in males, and suggest a marked sexual division of labor involving a more symmetrical use of the upper limb, and different male-female levels of locomotory stress. When articulated with archaeological, faunal, paleopathological, and ethnographic evidence, these results support the hypothesis of repetitive, bimanual use of axes tied to pastoral activities in males, and of more sedentary tasks linked to agriculture in females.

Mobility in Upper Paleolithic and Mesolithic Europe: evidence from the lower limb

A growing body of archeological evidence suggests that the dramatic climatic events of the Last Glacial Maximum in Europe triggered important changes in foraging behavior, involving a significant decrease in mobility. In general, changes in mobility alter patterns of bending of the midshaft femur and tibia, resulting in changes in diaphyseal robusticity and shape. This relationship between levels of mobility and lower limb diaphyseal structure was used to test the hypothesized decrease in mobility. Cross-sectional geometric data were obtained for 81 Upper Paleolithic and Mesolithic European femora and tibiae. The sample was divided into three time periods: Early Upper Paleolithic (EUP), Late Upper Paleolithic (LUP), and Mesolithic (Meso). In addition, because decreased mobility often results in changes in sex roles, males and females were analyzed separately. All indicators of bending strength decrease steadily through time, although few of the changes reach statistical significance. There is, however, a highly significant change in midshaft femur shape, with LUP and Meso groups more circular in cross-section than the EUP sample, supporting archeologically based predictions of decreased mobility. Sexual dimorphism levels in diaphyseal strength remain low throughout the three time periods, suggesting a departure in Upper Paleolithic and Mesolithic foragers away from the pattern of division of labor by sex observed in modern hunter-gatherers. Results confirm that the onset of the Last Glacial Maximum represents a crucial stage in Late Pleistocene human evolution, and signals the appearance of some of the behavioral adaptations that are usually associated with the Neolithic, such as sedentism.

“Whither flows the fluid in bone?” An osteocyte's perspective

Bone represents a porous tissue containing a fluid phase, a solid matrix, and cells. Movement of the fluid phase within the pores or spaces of the solid matrix translates endogenous and exogenous mechanobiological, biochemical and electromechanical signals from the system that is exposed to the dynamic external environment to the cells that have the machinery to remodel the tissue from within. Hence, bone fluid serves as a coupling medium, providing an elegant feedback mechanism for functional adaptation. Until recently relatively little has been known about bone fluid per se or the influences governing the characteristics of its flow. This work is designed to review the current state of this emerging field. The structure of bone, as an environment for fluid flow, is discussed in terms of the properties of the spaces and channel walls through which the fluid flows and the influences on flow under physiological conditions. In particular, the development of the bone cell syncytium and lacunocanalicular system are presented, and pathways for fluid flow are described from the systemic to the organ, tissue, cellular and subcellular levels. Finally, exogenous and endogenous mechanisms for pressure-induced fluid movement through bone, including mechanical loading, vascular derived pressure gradients, and osmotic pressure gradients are discussed. The objective of this review is to survey the current understanding of the means by which fluid flow in bone is regulated, from the level of the skeletal system down to the level of osteocyte, and to provide impetus for future research in this area of signal transduction and coupling. An understanding of this important aspect of bone physiology has profound implications for restoration of function through innovative treatment modalities on Earth and in space, as well as for engineering of biomimetic replacement tissue.

Detecting microdamage in bone

Fatigue-induced microdamage in bone contributes to stress and fragility fractures and acts as a stimulus for bone remodelling. Detecting such microdamage is difficult as pre-existing microdamage sustained in vivo must be differentiated from artefactual damage incurred during specimen preparation. This was addressed by bulk staining specimens in alcohol-soluble basic fuchsin dye, but cutting and grinding them in an aqueous medium. Nonetheless, some artefactual cracks are partially stained and careful observation under transmitted light, or epifluorescence microscopy, is required. Fuchsin lodges in cracks, but is not site-specific. Cracks are discontinuities in the calcium-rich bone matrix and chelating agents, which bind calcium, can selectively label them. Oxytetracycline, alizarin complexone, calcein, calcein blue and xylenol orange all selectively bind microcracks and, as they fluoresce at different wavelengths and colours, can be used in sequence to label microcrack growth. New agents that only fluoresce when involved in a chelate are currently being developed--fluorescent photoinduced electron transfer (PET) sensors. Such agents enable microdamage to be quantified and crack growth to be measured and are useful histological tools in providing data for modelling the material behaviour of bone. However, a non-invasive method is needed to measure microdamage in patients. Micro-CT is being studied and initial work with iodine dyes linked to a chelating group has shown some promise. In the long term, it is hoped that repeated measurements can be made at critical sites and microdamage accumulation monitored. Quantification of microdamage, together with bone mass measurements, will help in predicting and preventing bone fracture failure in patients with osteoporosis.

Trabecular bone strain changes associated with subchondral comminution of the distal tibia

OBJECTIVE

To measure trabecular bone strain changes resulting from three increasing subchondral bone defects in the distal tibia.

DESIGN

Cadaveric biomechanical model.

SETTING

Contact radiographs were made from sagittal sections of human cadaveric distal tibia under no load and loaded to 400 N. Digital images, made from contact radiographs of unloaded specimens, were compared to corresponding digital images of loaded specimens using custom software that measures trabecular deformation and calculates trabecular bone strain.

INTERVENTION

Twelve specimens were initially loaded intact in compression. Testing was repeated after creating three increasing circular subchondral bone defects in the center of a sagittal cross-section of the distal tibia. Defects were 10%, 20%, and 30% of the sagittal diameter of the distal tibia.

MAIN OUTCOME MEASURES

Maximum shear strain, maximum principal strain, and minimum principal strain were measured in six discrete regions in the trabecular bone in the distal tibia.

RESULTS

Small defects (10%) caused minimal strain elevations. Significant increases in trabecular bone strain were measured with medium (20%) and large (30%) defects. Compressive strain increases as high as 1400 microstrain (10 strain) were measured adjacent to and proximal to the defects with medium and large defects.

CONCLUSIONS

Subchondral defects cause size-dependent elevations in trabecular bone strain in the distal tibia. Medium and large defects caused rapidly increasing trabecular bone deformation under load.

Trabecular bone strain changes associated with subchondral bone defects of the tibial plateau

OBJECTIVE

To measure trabecular bone strain changes resulting from three increasing subchondral bone defects in the medial tibial plateau.

DESIGN

Cadaveric biomechanical model.

SETTING

Contact radiographs were made from coronal sections of human cadaveric proximal tibia under no load and loaded to 400 newtons (N). Digital images made from contact radiographs of unloaded specimens were compared to corresponding digital images of loaded specimens using in-house software that detects trabecular deformation and measure trabecular bone strain.

INTERVENTION

Ten specimens were loaded intact and with three increasing circular subchondral bone defects and centered under the subchondral plates in the medial tibial plateau that were 10%, 20%, and 30% of the coronal width of the medial plateau.

MAIN OUTCOME MEASURE

Maximum shear strain and minimum principal strain were measured at approximately 2,600 discrete points in the trabecular bone in the medial tibial plateau.

RESULTS

Trabecular strain increased most dramatically as defects increased from the medium (20%) to the large (30%) defect. The regions of greatest strain elevation were between the physeal scar and joint line near the medial cortex. Small (10%) and medium (20%) defects resulted in modest strain elevations.

CONCLUSIONS

Subchondral defects cause size-dependent elevations in trabecular bone strain in the medial tibial plateau. A size threshold may exist, above which the trabecular bone is subjected to rapidly increasing deformation under load.

L-type calcium channels mediate mechanically induced bone formation in vivo

Cell and tissue culture studies suggest that the long-lasting (L-type) voltage-sensitive calcium channels (VSCC) play a role in the signaling cascade in bone cells after mechanical loading. We investigated whether the L-type VSCC mediates mechanically induced bone formation in vivo using two L-type VSCC antagonists verapamil and nifedipine. Female Sprague-Dawley rats were divided into five groups: control group (Veh), two verapamil-treated groups (20 mg/kg, Vera-L; 100 mg/kg, Vera-H), and two nifedipine-treated groups (20 mg/kg, Nife-L; 100 mg/kg, Nife-H). One bout of mechanical loading was applied to the right tibia 90 minutes after oral administration of verapamil or 30 minutes after oral administration of nifedipine. Mechanical loading increased mineralizing surface (MS/bone surface [BS]), mineral apposition rate (MAR), and bone formation rate (BFR/BS) on the endocortical surface in loaded tibias of control animals compared with nonloaded (left) tibias. Verapamil and nifedipine suppressed the load-induced increase in BFR/BS observed in vehicle-treated controls by 56-61% (p < 0.01) and 56-74% (p < 0.01), respectively. Yet, significant differences in MS/BS and BFR/BS between right and left limbs were found in verapamil- and nifedipine-treated animals, indicating that the treatments did not completely abolish load-induced bone formation. This study shows that blocking the L-type calcium channel in vivo substantially suppresses the mechanically induced increase in bone formation that normally would occur and suggests that the L-type calcium channel mediates mechanically induced bone adaptation in vivo.

Validation of a technique for studying functional adaptation of the mouse ulna in response to mechanical loading

Functional adaptation of the mouse ulna in response to artificial loading in vivo was assessed using a technique previously developed in the rat. Strain gauge recordings from the mouse ulnar midshaft during locomotion showed peak strains of 1680 muepsilon and maximum strain rates of 0.03 sec(-1). During falls from 20 cm these reached 2620 muepsilon and 0.10 sec(-1). Axial loads of 3.0 N and 4.3 N, applied through the olecranon and flexed carpus, engendered peak strains at the lateral ulnar midshaft of 2000 muepsilon and 3000 muepsilon, respectively. The left ulnae of 17, 17-week-old female CD1 mice were loaded for 10 min with a 4 Hz trapezoidal wave engendering a strain rate of 0.1 sec(-1) for 5 days/week for 2 weeks. The mice were killed 3 days later. The response of the cortical bone of the diaphysis was assessed histomorphometrically using double calcein labels administered on days 3 and 12 of the loading period. Loading to peak strains of 2000 muepsilon stimulated lamellar periosteal bone formation, but no response endosteally. The greatest increase in cortical bone area was 4 mm distal to the midshaft (5 +/- 0.4% compared with 0.1 +/- 0.1% in controls [p < 0.01]). Periosteal bone formation rate (BFR) at this site was 0.73 +/- 0.06 microm(2)/microm per day, compared with 0.03 +/- 0.02 microm(2)/microm per day in controls (p < 0.01). Loading to peak strains of 3000 muepsilon induced a mixed woven/lamellar periosteal response and lamellar endosteal bone formation. Both of these were greatest 3-4 mm distal to the ulnar midshaft. At this level, the loading-induced periosteal response increased cortical bone area by 21 +/- 4% compared with 0.03 +/- 0.02% in controls, and resulted in a BFR of 2.84 +/- 0.42 microm(2)/microm per day, compared with 0.01 +/- 0.01 microm(2)/microm per day in controls (p < 0.05). Endosteal new bone formation resulted in a 2 +/- 0.4% increase in cortical bone area, compared with 0.4 +/- 0.3% in controls, and a BFR of 1.05 +/- 0.23 microm(2)/microm per day, compared with 0.22 +/- 0.15 microm(2)/microm per day in controls (p < 0.05). These data show that the axial ulna loading technique developed in the rat can be used successfully in the mouse. As in the rat, a short daily period of loading results in an osteogenic response related to peak strain magnitude. One important advantage in using mice over rats involves the potential for assessing the effects of loading in transgenics.

Bone adaptation response to sham and bending stimuli in mice

This study presents inbred-strain-related differences in tibial bone adaptation response to low-force loading in four-point bending and sham (pad pressure) arrangements in mice. Our previous work in mice has shown that at relatively high but equal bending forces (9 N or a bending moment of 16.88 N-mm), C57BL/6J mice respond with significantly greater bone formation than C3H/HeJ mice. Because of high tibial strains, the majority of the bone response in our previous study was woven bone. In this, study, we reduced the loading forces to 5 N or a bending moment of 9.38 N-mm (to decrease the woven-bone formation response) and investigated inbred-strain-related bone adaptation differences resulting from bending and sham loading (reported here for the first time in C57BL/6J) in these mice. Twenty-four female mice within each inbred mouse strain (C3H/HeJ [C3H] and C57BL/6J [B6]) were randomly divided into the two loading groups (12 per group sham and bending, total of 48 mice). All of the external loading was done for 36 cycles at 2 Hz, 3 d/wk for 3 wk. The bone adaptation response at lower forces exhibited a pattern similar to that seen for the higher forces in the previous study, suggesting that the patterns of bone adaptation were inbred strain related and independent of bending force magnitude. The bending-related periosteal mineral apposition surface (pMS) and mineral apposition rate (MAR) were respectively 40% and 45% greater in B6 than in C3H. The cortical bone adaptation response to bending was greater when compared to sham or pad pressure for each inbred strain of mice, suggesting that the majority of the bone adaptation response was the result of bending stimulus and not local pressure from pad contact. In addition, regardless of loading arrangement (sham or bending), the bone adaptation response in C57BL/6J mice was greater than C3H/HeJ.

Fractures--a preventable hazard of racing thoroughbreds?

Fractures are a common cause of loss among Thoroughbred racehorses. A large proportion of these injuries occurs in the absence of a specific traumatic event and show typical characteristics of stress fractures. The fractures show a high degree of consistency in their morphology; they frequently share the same locations as incomplete cracks and they are often associated with pre-existing pathology (periosteal and endosteal new bone formation and intracortical remodelling). Bone is able to adapt to changes in its mechanical environment. Studies of the Thoroughbred racehorse show modification of the geometric properties of the third metacarpal bone in response to training. These modifications are associated with reduced bone strains. Intense training before the adaptive response is completed and bone strain reduced increases the risk of fatigue damage. Fatigue of bone is associated with progressive microdamage, which is important in the pathogenesis of stress fractures. However, the biological repair mechanism of bone (remodelling) is also instrumental in the development of stress fractures. Horses exercised before bone repair is complete are likely to be at significantly greater risk of sustaining a catastrophic stress fracture. A number of key questions regarding the importance of microdamage, remodelling and training schedules in the prevention of stress fractures are addressed in this review.

Postmenopausal osteoporosis as a failure of bone's adaptation to functional loading: a hypothesis

There is substantial evidence that bones' ability to withstand functional loading without damage depends on the processes of bone modeling and remodeling, which are responsible for establishing and maintaining bone architecture, being influenced by a feedback mechanism related to the control of functional strains. It is probably useful to consider the diminished ability to maintain bone strength in postmenopausal osteoporosis as a failure of this mechanism. Acceptance of this approach would not only increase understanding of the etiology of postmenopausal osteoporosis but also significantly influence the ways in which it is investigated and treated. This would not mean that the many other factors affecting bone mass and bone cell activity will be ignored, but rather these factors will be put in perspective. Research to prevent or treat osteoporosis could be directed usefully to understanding how osteoblasts, lining cells, and osteocytes respond to mechanically derived information and how these responses are converted into stimuli controlling structurally appropriate modeling and remodeling. Evidence suggesting that early strain-related responses of bone cells in males and females involve the estrogen receptor (ER) could explain decreased effectiveness of this pathway when ER levels are low.

Time course for bone formation with long-term external mechanical loading

Increased mechanical loading of bone with the rat tibia four-point bending device stimulates bone formation on periosteal and endocortical surfaces. With long-term loading cell activity diminishes, and it has been reported that early gains in bone size may reverse. This study examined the time course for bone cellular and structural response after 6, 12, and 18 wk of loading at 1,200-1, 700 microstrain (muepsilon). Bone formation rates, measured by histomorphometry, were compared within groups, between loaded and contralateral nonloaded tibiae, and between weeks. Formation surface, mineral apposition rate, and bone formation rate on periosteal and endocortical surfaces were elevated after 6 wk of loading. By 12 wk of loading, periosteal and endocortical formation surface and endocortical mineral apposition rates were elevated. By 18 wk of loading, periosteal adaptation appeared complete, whereas endocortical mineral apposition rate remained elevated. No periosteal resorption was observed. Average thickness of new bone formed, from baseline to collection, was greater in loaded than nonloaded tibiae by week 6 and was maintained through week 18. Early increases in bone formation result in periosteal apposition of new bone that persists after formation ceases.

An ex vivo model to study transport processes and fluid flow in loaded bone

Load-induced fluid flow has been postulated to provide a mechanism for the transmission of mechanical signals (e.g. via shear stresses, enhancement of molecular transport, and/or electrical effects) and the subsequent elicitation of a functional adaptation response (e.g. modeling, remodeling, homeostasis) in bone. Although indirect evidence for such fluid flow phenomena can be found in the literature pertaining to strain generated potentials, actual measurement of fluid displacements in cortical bone is inherently difficult. This problem motivated us to develop and introduce an ex vivo perfusion model for the study of transport processes and fluid flow within bone under controlled mechanical loading conditions. To this end, a closed-loop system of perfusion was established in the explanted forelimb of the adult Swiss alpine sheep. Immediately prior to mechanical loading, a bolus of tracer was introduced intraarterially into the system. Thereafter, the forelimb of the left or right side (randomized) was loaded cyclically, via Schanz screws inserted through the metaphyses, producing a peak compressive strain of 0.2% at the middiaphysis of the anterior metacarpal cortex. In paired experiments with perfusion times totalling 2, 4, 8 and 16 min, the concentration of tracer measured at the middiaphysis of the cortex in cross section was significantly higher in the loaded bone than in the unloaded contralateral control. Fluorometric measurements of procion red concentration in the anterior aspect alone showed an enhancement in transport at early stages of loading (8 cycles, 2 min) but no effect in transport after higher number of cycles or increased perfusion times, respectively. This reflects both the small size of the molecular tracer, which would be expected to be transported rapidly by way of diffusive mechanisms alone, as well as the loading mode to which the anterior aspect was exposed. Thus, using our new model it could be shown that load-induced fluid flow represents a powerful mechanism to enhance molecular transport within the lacunocanalicular system of compact bone tissue. Based on these as well as previous studies, it appears that the degree of this effect is dependent on tracer size as well as the mechanical loading mode to which a given area of tissue is exposed.

Comparison of bone mineral content and biochemical markers of bone metabolism in stall- vs. pasture-reared horses

Sixteen Arabian yearlings were assigned randomly to 2 groups, confined to stall and pastured, to investigate the effects of confinement vs. pasture-rearing on bone mineral content and biochemical markers of bone metabolism over a 140 day period. Following an 84 day pretraining period, 6 horses from each group were selected randomly to complete a 56 day training period. Serum osteocalcin concentrations were determined from blood samples collected every 14 days. Urinary deoxypyridinoline concentrations and mineral content of the third metacarpus, as determined by lateral and medial radiographic bone aluminum equivalency (RBAE), were determined every 28 days from 24 h urine samples and radiographs of the left forelimb, respectively. In comparison with starting values, lateral RBAE was lower in the confined horses at Day 28 and remained lower throughout most of the project, while pastured horses had increasing lateral RBAE. Horses kept in stalls had lower medial RBAE at Day 28 than pasture-reared horses. Medial RBAE tended to remain lower in confined horses than in pastured horses throughout most of the project. The onset of training failed to negate the loss of mineral. Serum osteocalcin concentrations were lower and urinary deoxypyridinoline concentrations were higher in the confined horses at Days 14 and 28, respectively, compared with the pastured horses, and subsequently returned to baseline. These results suggest that housing yearling/2-year-old horses in stalls may be associated with a loss of bone mineral content in comparison with horses maintained on pasture.

Mechanical loading attenuates bone loss due to immobilization and calcium deficiency

Our purpose was to determine the effects of a mechanical loading intervention on mass, geometry, and strength of rat cortical bone during a period of disuse concurrent with calcium deficiency (CD). Adult female rats were assigned to unilateral hindlimb immobilization, immobilized-loaded, or control (standard chow, 1.85% calcium) treatments. Both immobilized groups were fed a CD rat chow (0.01% calcium) to induce high bone turnover. Three times weekly, immobilized-loaded rats were subjected to 36 cycles of 4-point bending of the immobilized lower leg. After 6 wk, the immobilized rats exhibited decreased tibial shaft bone mineral density (-12%), ultimate load (-19%), and stiffness (-20%; tested in 3-point bending to failure) vs. control rats. Loading prevented this decline in bone density and attenuated decreases in ultimate load and stiffness. Elastic modulus was unaffected by disuse or loading. Bone cross-sectional area in the immobilized-loaded rats was equivalent to that of control animals, even though endocortical resorption continued unabated. On the medial periosteum, percent mineralizing surface doubled vs. that in immobilized rats. This loading regimen stimulated periosteal mineralization and maintained bone mineral density, thereby attenuating the loss in bone strength incurred with disuse and concurrent calcium deficiency.

Experimental elucidation of mechanical load-induced fluid flow and its potential role in bone metabolism and functional adaptation

Several researchers have developed theories implicating some manifestation of mechanical forces such as stress, strain, and strain energy density for the initiation of cellular processes associated with functional adaptation. The mechanisms underlying dynamic bone growth and repair in response to mechanical stimuli, however, are not fully understood. Load-induced fluid flow has been postulated to provide a mechanism for the transmission of mechanical signals (eg, via shear stresses, enhancement of molecular transport, or electrical effects) and the subsequent elicitation of a functional adaptation response in bone. Although indirect evidence for such fluid flow phenomena can be found in the literature pertaining to strain-generated potentials, experimental studies are inherently difficult. This motivated the authors to develop theoretical as well as ex vivo, in vitro, and in vivo experimental methods for the study of transport processes and fluid flow within bone under well-controlled mechanical loading conditions. By introducing tracer substances such as disulphine blue, procion red, and microperoxidase into the experimental system, transport and fluid flow could be visualized at tissue, cellular, and subcellular levels, respectively. Based on these studies, it could be shown that load-induced fluid flow represents a powerful mechanism to enhance molecular transport within compact bone tissue. Furthermore, the distribution of transport-elucidating tracers is a function of mechanical loading parameters as well as the location within the cross-section of the bone cortex.

Histomorphometry of distraction osteogenesis in a caprine tibial lengthening model

Standardized histomorphometry of bone formation and remodeling during distraction osteogenesis (DO) has not been well characterized. Increasing the rhythm or number of incremental lengthenings performed per day is reported to enhance bone formation during limb lengthening. In 17 skeletally immature goats, unilateral tibial lengthenings to 20 or 30% of original length were performed at a rate of 0.75 mm/day and rhythms of 1, 4, or 720 times per day using standard Ilizarov external fixation and an autodistractor system. Two additional animals underwent frame application and osteotomy without lengthening and served as osteotomy healing controls. Histomorphometric indices were measured at predetermined regions from undecalcified tibial specimens. Within the distraction region, bone formation and remodeling activity were location dependent. Intramembranous bone formed linearly oriented columns of interconnecting trabecular plates of woven and lamellar type bone. Total new bone volume and bone formation indices were significantly increased within the distraction and osteotomy callus regions (Tb.BV/TV, 226% [p < 0.05]; BFR/BS, 235-650% [p < 0.01]) respectively, compared with control metaphyseal bone. Bone formation indices were greatest adjacent to the mineralization zones at the center of the distraction gap; mineral apposition rate 96% (p < 0.01); mineralized bone surfaces 277% [p < 0.001]); osteoblast surfaces 359% [p < 0.001]); and bone formation rate (650% [p < 0.01]). There was no significant difference (p < 0.14; R = 0.4) in the bone formation rate of the distracted callus compared with the osteotomy control callus. Within the original cortices of the lengthened tibiae, bone remodeling indices were significantly increased compared with osteotomy controls; activation frequency (200% [p < 0.05]); osteoclast surfaces (295% [p < 0.01]); erosion period (75%); porosity (240% [p < 0.001]). Neither the rhythm of distraction nor the percent lengthening appeared to significantly influence any morphometric parameter evaluated. Distraction osteogenesis shares many features of normal fracture gap healing. The enhanced bone formation and remodeling appeared to result more from increased recruitment and activation of bone forming and resorbing cells rather than from an increased level of individual cellular activity.

A mechanical and histomorphometric analysis of bone bonding by hydroxyapatite-coated strain gages

Identification of the strains controlling bone remodeling is important for determining ways to prevent bone loss due to load deprivation, or implant placement. Long-term monitoring of strains can potentially provide the best information. Glues are resorbed within 2-3 weeks. Two formulations of microcrystalline hydroxyapatite (HA) were used to attach strain gages to rat femora to assess their long-term in vivo strain measurement capability. Seven male rats received HA-coated gages, and 2 animals underwent a sham procedure. The gages were prepared using a published technique and placed on the antero-lateral aspect of the left femora. After 6-7 weeks, the animals were euthanized and both femora explanted. Gages were attached to the right femora with cyanoacrylate. All femora were tested in cantilever bending, then embedded, sectioned, and stained with mineralized bone stain. The undecalcified sections were examined using transmitted and ultraviolet light microscopy. Mechanical testing showed one HA formulation provided 70-100% bonding. Histology showed intimate contact between the gage and bone surface. Histomorphometry indicated increased bone activity under the gage compared to the remaining bone, the controls, and the shams. The results indicate that microcrystalline HAs bond to bone quickly and can allow long term in vivo measurements.

Strain gradients correlate with sites of periosteal bone formation

We examined the hypothesis that peak magnitude strain gradients are spatially correlated with sites of bone formation. Ten adult male turkeys underwent functional isolation of the right radius and a subsequent 4-week exogenous loading regimen. Full field solutions of the engendered strains were obtained for each animal using animal-specific, orthotropic finite element models. Circumferential, radial, and longitudinal gradients of normal strain were calculated from these solutions. Site-specific bone formation within 24 equal angle pie sectors was determined by automated image analysis of microradiographs taken from the mid-diaphysis of the experimental radii. The loading regimen increased mean cortical area (+/-SE) by 32.3 +/- 10.5% (p = 0.01). Across animals, some periosteal bone formation was observed in every sector. The amount of periosteal new bone area contained within each sector was not uniform. Circumferential strain gradients (r2 = 0.36) were most strongly correlated with the observed periosteal bone formation. SED (a scalar measure of stress/strain magnitude with minimal relation to fluid flow) was poorly correlated with periosteal bone formation (r2 = 0.01). The combination of circumferential, radial, and longitudinal strain gradients accounted for over 60% of the periosteal new bone area (r2 = 0.63). These data indicate that strain gradients, which are readily determined given a knowledge of the bone's strain environment and geometry, may be used to predict specific locations of new bone formation stimulated by mechanical loading.

A method suitable for in vivo measurement of bone strain in humans

Strain gages are the gold-standard for measurement of bone strains in vivo. The use of strain gages in humans, however, is limited by the need for surgery to implant them and by the use of cyanoacrylate adhesives to bond them to bone. Cyanoacrylate adhesives are not FDA approved for implantation in humans, making it difficult to justify their use in experimental procedures. To surmount this difficulty, a method was developed to bond strain gages to bone using an approved substance: polymethylmethacrylate (PMMA). The technique and the validating experiments are presented. The PMMA bonding method gave strain gage readings within an average of 0.25% (range 0-5%) of those found using cyanoacrylate bonding in a side by side comparison on cast acrylic. On bone, the PMMA bonding method produced results comparable to extensometer readings. This method of strain gage application is accurate and straightforward. It is currently being successfully used for in vivo strain measurements in both humans and animals for up to several days following gage application.

Prostaglandin E2 increases the skeletal response to mechanical loading

The study tested the influence of prostaglandin E2 (PGE2) on the skeletal response to increased in vivo mechanical loading through a four-point bending device. One hundred and twenty Sprague-Dawley female rats (6 months old, 354 +/- 34 g) were divided into 12 groups to accommodate all possible combinations of doses of loads (25, 30, or 35 N) and PGE2 (0, 0.1, 0.3, or 1 mg/kg). Rats received subcutaneous injections of PGE2 daily and in vivo loading of the right tibia every Monday, Wednesday, and Friday for four weeks. Histomorphometric analysis of the periosteal and endocortical surfaces following in vivo dual fluorochrome labeling was performed on both the loaded region of the right tibial diaphysis and a similar region of the left tibial diaphysis. Without PGE2, the threshold for loading to stimulate bone formation was 30 N (peak strain 1360 mu epsilon) at the periosteal surface and 25 N (peak strain 580 mu epsilon) at the endocortical surface. Without loading, the minimum dose of PGE2 to stimulate bone formation at all surfaces was 1 mg/kg/day. When 1 mg/kg/day PGE2 was combined with the minimum effective load, an additive effect of PGE2 and loading on bone formation was observed at the endocortical surface, but a synergistic effect was noted at the periosteal surface. No combined effect of ineffective doses of loading and PGE2 was found. A synergistic effect at peak strains of approximately 1625 mu epsilon on the periosteal surface could suggest either the involvement of locally produced growth factors or autoregulation of endogenous synthesis of PGE2 by exogenously administered PGE2.

The mechanical or metabolic function of secondary osteonal bone in the monkey Macaca fascicularis

Secondary osteonal bone is believed by many to serve a mechanical function, altering the properties and/or orientation of bone in response to fluctuating mechanical demands or in the prevention and/or repair of fatigue microdamage. Based on this belief, secondary osteons should be concentrated mainly in regions experiencing high peak-strain conditions. Others contend that secondary osteonal bone functions primarily in meeting the body's calcium needs, and should be expected to form principally in low peak-strain regions so as to avoid compromising the mechanical strength of the bone. These two hypotheses were tested by examining the distribution of secondary osteonal bone in both relatively high- and low-strain regions of the macaque face. Previous strain-gauge studies have demonstrated a steep strain gradient in the macaque face, with relatively high peak strains in the anterior portion of the zygomatic arch and in the mandibular corpus. Relatively low peak strains have been found in the posterior portion of the zygomatic arch and supraorbital bar. Results presented here show that in the mature macaques, there is no consistent relation between newly forming secondary osteons (i.e. those labelled with fluorescent dyes) and peak strain levels. From these data it is concluded that, in the non-perturbed adult, either mechanical and metabolic factors contribute equally to the observed pattern or that metabolically driven remodelling is initiated without regard to strain levels. In immature macaques, however, the relation between peak strain levels and secondary osteon density is positive, with a significantly higher density of labelled osteons in the high strain regions. From these data it is concluded that, in immature individuals, mechanical factors are predominantly responsible for the initiation of secondary osteonal remodelling.

Tissue adaptation as a dynamical process far from equilibrium

It is well established that tissue growth, maintenance, and degeneration are biochemically regulated processes influenced by mechanical function. Biomechanical models have been developed to predict adaptive processes; for example, computer simulation of bone remodeling around orthopaedic implants can accurately predict the effect of certain implant design variables. However, the same success remains to be achieved with other adaptive processes such as joint morphogenesis or osteoporosis. We propose that, to become capable of stimulating such adaptive processes, biomechanical models should capture the inherently irreversible nature of tissue adaptation and therefore should not rely on the assumption of a "homeostatic" equilibrium. In this article, it is proposed that tissue adaptation is an unstable process of moving between tissue states that are far from the equilibrium state--and that to simulate it, independent sensors and positive feedback stimuli should be employed.

Cyclic mechanical property degradation during fatigue loading of cortical bone

Fatigue damage accumulation has been demonstrated in living bone and postulated as a stimulus to the bone modeling and remodeling response. Mechanical property degradation is one manifestation of fatigue damage accumulation. This study examines changes in secant modulus and cyclic energy dissipation behavior during axial load-controlled fatigue loading of cortical bone specimens. The findings suggest that secant modulus degradation and cyclic energy dissipation are greatly increased at loading levels above critical damage strain thresholds of 2500 and 4000 mu epsilon in tensile and compressive fatigue, respectively. Tensile and compressive fatigue loading also caused different forms of modulus degradation at loading levels above these thresholds. Bone behaves as a linear viscoelastic material below these thresholds, even after prior property degradation at higher loading levels. Cyclic energy dissipation was proportional to the 2.1 power of the applied effective strain range for all loadings below 2500 mu epsilon. Above 2500 mu epsilon, tensile fatigue loading caused cyclic energy dissipation proportional to the 5.8 power of the applied effective strain range. Compressive fatigue loading dissipated cyclic energy proportional to the 4.9 power of applied effective strain range over 4000 mu epsilon. Lifetime energy dissipation over all fatigue tests to fracture at a single loading level was well fitted by the same power law in the number of cycles to failure raised to the 0.6 power. Loading levels of 2500 mu epsilon in tension and 4000 mu epsilon in compression are within the ranges observed in living animals, and thus these phenomena may play a role in initiating the remodeling response in live bone tissue.

Bone strain gage data and theoretical models of functional adaptation

The in vivo implantation of strain gages on the surface of bones has proven to be a very useful technique for studying the relationship between in vivo loading and bone growth and adaptation. However, data from such experiments have yet to be well incorporated within the context of theoretical models of bone adaptation. Methods for analyzing bone rosette strain gage recordings within the framework of strain energy density-based computational modeling/remodeling theories are presented. A new strain energy density based parameter, energy equivalent strain, is proposed as a single scalar measure of cyclic strain magnitudes and the concept of a daily strain stimulus is also introduced. As an illustrative example, the approach is applied to analyze previously reported in vivo data from the anteromedial human tibia (Lanyon et al., 1975, Acta orthop. Scand. 46, 256-268).

Perspectives: a vital biomechanical model of the endochondral ossification mechanism

BACKGROUND

Mechanical usage effects could explain many features of endochondral ossification and related processes. Mineralization of growth plate cartilage could reduce its mechanical strains enough to make its resorption begin and to guide it in space. By removing most of its mineralized vertical septae, resorption could overload the remainder enough to increase woven bone formation on them and construct the primary spongiosa. After it finishes mineralizing, the primary spongiosa could become stiff enough to begin partial disuse in strain terms, so BMU-based remodeling would begin replacing it with lamellar bone. This would construct the secondary spongiosa. In transferring loads from the growth plate to the cortex, the central metaphyseal spongiosa becomes deloaded. This disuse would make remodeling remove it in the diaphyseal marrow space.

METHODS

The slow growth of epiphyses and apophyses gives their spongiosas more time to adapt to their loads than the metaphyseal spongiosa beneath faster growing growth plates. Compared to metaphyseal trabeculae, this leads to fewer and thicker epiphyseal trabeculae that turn over more slowly and should persist for life because they carry loads for life.

RESULTS

Rapid turnover of metaphyseal cortex in very young subjects could let it strain enough to form woven bone. Increased thickness and slower turnover of this cortex in older subjects could reduce its strains enough to make lamellar bone form there instead. This would compose this cortex mostly of woven bone in the very young and of lamellar bone in adults.

CONCLUSIONS

This model assigns particular importance to the stiffness and strains of tissues (as distinguished from their strength and stresses), to the relative rates of some processes, and to responses of the skeleton's biologic mechanisms to a tissue's typical largest mechanical strains (as distinguished from their stresses).

Mechanical loading stimulates rapid changes in periosteal gene expression

Although mechanical forces regulate bone mass and morphology, little is known about the signals involved in that regulation. External force application increases periosteal bone formation by increasing surface activation and formation rate. In this study, the early tibial periosteal response to external loads was compared between loaded and nonloaded contralateral tibia by examining the results of blot hybridization analyses of total RNA. To study the impact of external load on gene expression, RNA blots were sequentially hybridized to cDNAs encoding the protooncogene c-fos, cytoskeletal protein beta-actin, bone matrix proteins alkaline phosphatase (ALP), osteopontin (Op), and osteocalcin (Oc), and growth factors insulin-like growth factor I (IGF-I) and transforming growth factor-beta (TGF-beta). The rapid yet transient increase in levels of c-fos mRNA seen within 2 hours after load application indirectly suggests that the initial periosteal response to mechanical loading is cell proliferation. This is also supported by the concomitant decline in levels of mRNAs encoding bone matrix proteins ALP, Op, and Oc, which are typically produced by mature osteoblasts. Another early periosteal response to mechanical load appeared to be the rapid induction of growth factor synthesis as TGF-beta and IGF-I mRNA levels were increased in the loaded limb with peak levels being observed 4 hours after loading. These data indicate that the acute periosteal response to external mechanical loading was a change in the pattern of gene expression which may signal cell proliferation. The altered pattern of gene expression observed in the present study supports previous evidence of increased periosteal cell proliferation seen both in vivo and in vitro following mechanical loading.

Perspectives: applications of a biomechanical model of the endochondral ossification mechanism

A biomechanical model of endochondral ossification (Frost and Jee, 1994. Anat. Rec., 240:435-446) can help to explain: (1) some differences in fracture patterns in children and adults, (2) increased fractures during the human adolescent growth spurt, (3) localization of stress fractures and pseudofractures to cortical instead of trabecular bone, (4) increased bone mass in adult-acquired and childhood obesity, (5) subchondral bone densification and osteopenia in some arthroses, (6) why and where mammals lose spongiosa with aging, (7) why, as percents of the original bone stock, metaphyseal trabecular bone losses with aging usually exceed cortical bone losses, (8) why osteochondritis dissecans and aseptic necroses of bone localize in epiphyses instead of metaphyses, (9) some features of growth plate histology in rickets and the chondrodystrophies, (10) why spontaneous fractures in osteoporotic patients affect vertebral more than metaphyseal spongiosa, (11) why osteopenias develop in most chronic, debilitating diseases, and (12) why histomorphometric values can differ in iliac bone biopsies obtained by the "vertical" Jamshidi and "horizontal" Bordier-Meunier techniques.

Periosteal bone formation stimulated by externally induced bending strains

The rat tibia four-point bending model is a new mechanical loading model in which force is applied through external pads to the rat lower limb. The advantages of the model are controlled force application to a well-defined bone, noninvasive external loading, and the addition of loads to normal daily activity. A disadvantage of the model is that the pads create local pressure on the leg at the contact sites. This study examined the differences in tibial response to bending strains and to local pressure under the pads. A total of 30 adult Sprague-Dawley rats were randomized into three external loading groups: bending, cyclic pressure, and static pressure. The right leg of each rat was externally loaded to create either bending or local pressure without bending; the left leg served as a control. Strains on the lateral surface averaged 1200 mu epsilon in compression during bending load application and < 200 mu epsilon in compression during pressure loading. Histomorphometric data were collected from three regions: the maximal bending region, under the loading pads, and outside the maximal bending region. In the maximal bending region, bending loads created greater mineral apposition rate (MAR) on the lateral surface and greater MAR and formation surface on the medial surface of loaded than control tibiae. The region under the bending pad was exposed to similar bending strains and showed the same pattern of increased MAR as sections from the maximal bending region. Cyclic pressure had no effect on periosteal MAR or formation surface. Static pressure increased MAR only on the lateral tibial surface. Bending stimulates bone formation in regions with the highest bending strains. Similar forces applied only in the form of pressure loading do not stimulate tibial formation either at the contact site or between loading pads. These results suggest that externally applied forces of moderate magnitude stimulate bone formation primarily as a result of increased bending strains, not local pressure at the contact site.