Differentiation of the bone-tissue remodeling response to axial and torsional loading in the turkey ulna

Do Paralympic athletes suffer from brittle bones? Prevalence and risk factors of low bone mineral density in Paralympic athletes

Background

Bone health may be a concern in Paralympic athletes, given the presence of multiple risk factors predisposing these athletes to low bone mineral density (BMD). Objective: We aimed to assess the prevalence of low BMD among Paralympic athletes participating in various sport disciplines, and to identify potential risk factors for low BMD.

Methods

Seventy Paralympic athletes, of whom 51 % were wheelchair-dependent, were included in this cross-sectional study. BMD of the whole-body, lumbar spine, total hip, and femoral neck were assessed by dual-energy x-ray absorptiometry. Comparisons between groups were conducted by one-way ANOVA, and regression analyses were conducted to identify potential risk factors for low BMD.

Results

The prevalence of low BMD (Z-score < -1.0) was highest at femoral neck (34 %), followed by total hip (31 %), whole-body (21 %), and lumbar spine (18 %). Wheelchair-dependent athletes had significantly lower BMD Z-scores compared to the non-wheelchair-dependent athletes at whole-body level (-0.5 ± 1.4 vs 0.2 ± 1.3; P = 0.04), total hip (-1.1 ± 1.2 vs 0.0 ± 1.1; P < 0.01), and femoral neck (-1.0 ± 1.3 vs -0.1 ± 1.2; P < 0.01). At the lumbar spine, low BMD was completely absent in wheelchair basketball and tennis players. Regression analyses identified body mass, wheelchair dependence, and type of sport, as the main risk factors for low BMD.

Conclusions

In this cohort of Paralympic athletes, low BMD is mainly present at the hip, and to a lesser extent at the whole-body and lumbar spine. The most prominent risk factors for low BMD in Paralympic athletes are related to mechanical loading patterns, including wheelchair use, the type of sport, and body mass.

Exploration of the synergistic role of cortical thickness asymmetry ("Trabecular Eccentricity" concept) in reducing fracture risk in the human femoral neck and a control bone (Artiodactyl Calcaneus)

The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded in rather simple bending, which causes net tension stress in the upper (superior) femoral neck and net compression stress in its inferior aspect ("T/C paradigm"). This T/C loading regime lacks in vivo proof. The "C/C paradigm" is a plausible alternative simplified load history that is characterized by a gradient of net compression across the entire femoral neck; action of the gluteus medius and external rotators of the hip are important in this context. It is unclear which paradigm is at play in natural loading due to lack of in vivo bone strain data and deficiencies in understanding mechanisms and manifestations of bone adaptation in tension vs. compression. For these reasons, studies of the femoral neck would benefit from being compared to a 'control bone' that has been proven, by strain data, to be habitually loaded in bending. The artiodactyl (sheep and deer) calcaneus model has been shown to be a very suitable control in this context. However, the application of this control in understanding the load history of the femoral neck has only been attempted in two prior studies, which did not examine the interplay between cortical and trabecular bone, or potential load-sharing influences of tendons and ligaments. Our first goal is to compare fracture risk factors of the femoral neck in both paradigms. Our second goal is to compare and contrast the deer calcaneus to the human femoral neck in terms of fracture risk factors in the T/C paradigm (the C/C paradigm is not applicable in the artiodactyl calcaneus due to its highly constrained loading). Our third goal explores interplay between dorsal/compression and plantar/tension regions of the deer calcaneus and the load-sharing roles of a nearby ligament and tendon, with insights for translation to the femoral neck. These goals were achieved by employing the analytical model of Fox and Keaveny (J. Theoretical Biology 2001, 2003) that estimates fracture risk factors of the femoral neck. This model focuses on biomechanical advantages of the asymmetric distribution of cortical bone in the direction of habitual loading. The cortical thickness asymmetry of the femoral neck (thin superior cortex, thick inferior cortex) reflects the superior-inferior placement of trabecular bone (i.e., "trabecular eccentricity," TE). TE helps the femoral neck adapt to typical stresses and strains through load-sharing between superior and inferior cortices. Our goals were evaluated in the context of TE. Results showed the C/C paradigm has lower risk factors for the superior cortex and for the overall femoral neck, which is clinically relevant. TE analyses of the deer calcaneus revealed important synergism in load-sharing between the plantar/tension cortex and adjacent ligament/tendon, which challenges conventional understanding of how this control bone achieves functional adaptation. Comparisons with the control bone also exposed important deficiencies in current understanding of human femoral neck loading and its potential histocompositional adaptations.

Bone adaptation and osteoporosis prevention in hibernating mammals

Hibernating bears and rodents have evolved mechanisms to prevent disuse osteoporosis during the prolonged physical inactivity that occurs during hibernation. Serum markers and histological indices of bone remodeling in bears indicate reduced bone turnover during hibernation, which is consistent with organismal energy conservation. Calcium homeostasis is maintained by balanced bone resorption and formation since hibernating bears do not eat, drink, urinate, or defecate. Reduced and balanced bone remodeling protect bear bone structure and strength during hibernation, unlike the disuse osteoporosis that occurs in humans and other animals during prolonged physical inactivity. Conversely, some hibernating rodents show varying degrees of bone loss such as osteocytic osteolysis, trabecular loss, and cortical thinning. However, no negative effects of hibernation on bone strength in rodents have been found. More than 5000 genes in bear bone tissue are differentially expressed during hibernation, highlighting the complexity of hibernation induced changes in bone. A complete picture of the mechanisms that regulate bone metabolism in hibernators still alludes us, but existing data suggest a role for endocrine and paracrine factors such as cocaine- and amphetamine-regulated transcript (CART) and endocannabinoid ligands like 2-arachidonoyl glycerol (2-AG) in decreasing bone remodeling during hibernation. Hibernating bears and rodents evolved the capacity to preserve bone strength during long periods of physical inactivity, which contributes to their survival and propagation by allowing physically activity (foraging, escaping predators, and mating) without risk of bone fracture following hibernation. Understanding the biological mechanisms regulating bone metabolism in hibernators may inform novel treatment strategies for osteoporosis in humans.

The skeleton in a physical world

All organisms exist within a physical space and respond to physical forces as part of daily life. In higher organisms, the skeleton is critical for locomotion in the physical environment, providing a carapace upon which the animal can move to accomplish functions necessary for living. As such, the skeleton has responded evolutionarily, and does in real-time, to physical stresses placed on it to ensure that its structure supports its function in the sea, in the air, and on dry land. In this article, we consider how those cells responsible for remodeling skeletal structure respond to mechanical force including load magnitude, frequency, and cyclicity, and how force rearranges cellular structure in turn. The effects of these forces to balance the mesenchymal stem cell supply of bone-forming osteoblasts and energy storing adipocytes are addressed. That this phenotypic switching is achieved at the level of both gene transactivation and alteration of structural epigenetic controls of gene expression is considered. Finally, as clinicians, we consider this information as it applies to a prescriptive for intelligent exercise.

Exercise Prescription for Osteoporosis: Back to Basics

This Perspectives provides a back-to-basics rationale for the ideal exercise prescription for osteoporosis. The relevance of fundamental principles of mechanical loading and bone adaptation determined from early animal studies is revisited. The application to human trials is presented, including recent advances. A model of broadscale implementation is described, and areas for further investigation are identified.

Lumbar Bone Mineral Adaptation: The Effect of Fast Bowling Technique in Adolescent Cricketers

INTRODUCTION

Localised bone mineral density (BMD) adaptation of the lumbar spine, particularly on the contralateral side to the bowling arm, has been observed in elite male cricket fast bowlers. No study has investigated this in adolescents, or the role of fast bowling technique on lumbar BMD adaptation. This study aims to investigate lumbar BMD adaptation in adolescent cricket fast bowlers, and its relationship with fast bowling technique.

METHODS

39 adolescent fast bowlers underwent antero-posterior DXA scan of their lumbar spine. Hip, lumbopelvic and thoracolumbar joint kinematics, and vertical ground reaction kinetics were determined using 3D motion capture and force plates. Significant partial (covariate: fat free mass) and bivariate correlations of the technique parameters with whole lumbar (L1-L4) BMD and BMD asymmetry (L3 and L4) were advanced as candidate variables for multiple stepwise linear regression.

RESULTS

Adolescent fast bowlers demonstrated high lumbar Z-Scores (+1.0; 95%CI: 0.7 - 1.4) and significantly greater BMD on the contralateral side of L3 (9.0%; 95%CI: 5.8 - 12.1%) and L4 (8.2%; 95%CI: 4.9 - 11.5%). Maximum contralateral thoracolumbar rotation and maximum ipsilateral lumbopelvic rotation in the period between back foot contact (BFC) and ball release (BR), as well as contralateral pelvic drop at front foot contact (FFC), were identified as predictors of L1-L4 BMD, explaining 65% of the variation. Maximum ipsilateral lumbopelvic rotation between BFC and BR, as well as ipsilateral lumbopelvic rotation and contralateral thoracolumbar side flexion at BR, were predictors of lumbar asymmetry within L3 and L4.

CONCLUSION

Thoracolumbar and lumbopelvic motion are implicated in the aetiology of the unique lumbar bone adaptation observed in fast bowlers whereas vertical ground reaction force, independent of body mass, was not. This may further implicate the osteogenic potential of torsional rather than impact loading in exercise-induced adaptation.

Efficacy of shear strain gradients as an osteogenic stimulus

The question of which mechanical variables are responsible for inducing osteogenic activity is unresolved despite extensive experimental and theoretical investigation. Candidate variables include strain magnitude, loading frequency, the interaction of magnitude and frequency (strain rate), and strain gradients. An additional challenge is discerning the coordination of periosteal and endosteal expansion during growth, and whether this coordination (or lack thereof) is fully dependent or partially independent of the local mechanical environment. In this study, under the assumption that calculated stresses correspond to relative strain magnitudes, we specify alternative growth algorithms of bone cross-sectional size and geometry to explore skeletal growth under alternative scenarios of osteogenic activity that are tracking 1) an attractor stress, 2) local stress magnitude or 3) steepness of stress gradients. These developmental simulations are initiated from two initial geometries (symmetrical and asymmetrical ellipses) under a time-varying torsional load whose magnitude is proportional to body size growth in a model primate. In addition, we model endosteal expansion under three conditions hypothesized in the literature, in which endosteal expansion is 1) independent of the mechanical milieu, 2) completely dependent on the mechanical milieu, and 3) a "hybrid" model in which intrinsic biological (independent) growth is operative early but gives way to mechanically-sensitive (dependent) growth at later ages. Three variables were recorded over each growth simulation: the safety factor (ratio of yield stress to actual stress), an efficiency ratio (invested bone area per unit of stress), and proximity to an isostress condition (an optimal design criterion in which stress is invariant throughout the structure). The attractor stress algorithm produces the most "adapted" bones in terms of mechanical competence and economy of material. Localized osteogenic activity that is guided in direct proportion to stress magnitude produces competent bones but with variable adult geometries depending on conditions of endosteal expansion. Stress gradients also produce functional but relatively inefficient bones, with widely variable safety factors during growth and heterogeneous stress fields. If, in fact, the osteocyte network monitors strain gradients to generate osteogenic signals, the resulting morphology is competent but falls well short of an optimal mechanical solution.

The Bone Buttress Theory: The Effect of the Mechanical Loading of Bone on the Osseointegration of Dental Implants

Simple Summary

The bone, as a vertebrate support tissue, is capable of adapting its structure and function to the mechanical demands resulting from the loads that are produced during the performance of its activity. This regulatory action also occurs during the healing processes of a fracture. The purpose of this study was to determine to what extent a dynamic load was capable of modulating the bone healing response around a titanium implant. The study was carried out on experimental rabbits, to which dental implants were placed in the tibiae and there were two test groups, one in which they did not undergo exercise during healing period and another that ran daily during this process on a treadmill. The trail results showed an improvement in the osseointegration process of the implant in the group in which it was subjected to load. The importance of these results is that it opens the door to a better understanding of the mechanisms that can modulate bone healing, especially around dental implants, supporting implant loading protocols that are based on efficiency.

Abstract

Objectives: To determine the effect of mechanical loading of bone on the stability and histomorphometric variables of the osseointegration of dental implants using an experimental test in an animal model. Materials and Methods: A total of 4 human implants were placed in both tibiae of 10 New Zealand rabbits (n = 40). A 6-week osseointegration was considered, and the rabbits were randomly assigned to two groups: Group A (Test group) included 5 rabbits that ran on a treadmill for 20 min daily during the osseointegration period; Group B (Controls) included the other 5 that were housed conventionally. The monitored variables were related to the primary and secondary stability of the dental implants (implant stability quotient—ISQ), vertical bone growth, bone to implant contact (BIC), area of regenerated bone and the percentage of immature matrix. Results: The results of the study show a greater vertical bone growth (Group A 1.26 ± 0.48 mm, Group B 0.32 ± 0.47 mm, p < 0.001), higher ISQ values (Group A 11.25 ± 6.10 ISQ, 15.73%; Group B 5.80 ± 5.97 ISQ, 7.99%, p = 0.006) and a higher BIC (Group A 19.37%, Group B 23.60%, p = 0.0058) for implants in the test group, with statistically significant differences. A higher percentage of immature bone matrix was observed for implants in the control group (20.68 ± 9.53) than those in the test group (15.38 ± 8.84) (p = 0.108). A larger area of regenerated bone was also observed for the test implants (Group A 280.50 ± 125.40 mm², Group B 228.00 ± 141.40 mm²), but it was not statistically significant (p = 0.121). Conclusions: The mechanical loading of bone improves the stability and the histomorphometric variables of the osseointegration of dental implants.

Combating osteoporosis and obesity with exercise: leveraging cell mechanosensitivity

Osteoporosis, a condition of skeletal decline that undermines quality of life, is treated with pharmacological interventions that are associated with poor adherence and adverse effects. Complicating efforts to improve clinical outcomes, the incidence of obesity is increasing, predisposing the population to a range of musculoskeletal complications and metabolic disorders. Pharmacological management of obesity has yet to deliver notable reductions in weight and debilitating complications are rarely avoided. By contrast, exercise shows promise as a non-invasive and non-pharmacological method of regulating both osteoporosis and obesity. The principal components of exercise - mechanical signals - promote bone and muscle anabolism while limiting formation and expansion of fat mass. Mechanical regulation of bone and marrow fat might be achieved by regulating functions of differentiated cells in the skeletal tissue while biasing lineage selection of their common progenitors - mesenchymal stem cells. An inverse relationship between adipocyte versus osteoblast fate selection from stem cells is implicated in clinical conditions such as childhood obesity and increased marrow adiposity in type 2 diabetes mellitus, as well as contributing to skeletal frailty. Understanding how exercise-induced mechanical signals can be used to improve bone quality while decreasing fat mass and metabolic dysfunction should lead to new strategies to treat chronic diseases such as osteoporosis and obesity.

Advancing the deer calcaneus model for bone adaptation studies: ex vivo strains obtained after transecting the tension members suggest an unrecognized important role for shear strains

Sheep and deer calcanei are finding increased use as models for studies of bone adaptation, including advancing understanding of how the strain (deformation) environment influences the ontogenetic emergence of biomechanically relevant structural and material variations in cortical and trabecular bone. These artiodactyl calcanei seem ideal for these analyses because they function like simply loaded short-cantilevered beams with net compression and tension strains on the dorsal and plantar cortices, respectively. However, this habitual strain distribution requires more rigorous validation because it has been shown by limited in vivo and ex vivo strain measurements obtained during controlled ambulation (typically walking and trotting). The conception that these calcanei are relatively simply and habitually loaded 'tension/compression bones' could be invalid if infrequent, though biologically relevant, loads substantially change the location of the neutral axis (NA) that separates 'compression' and 'tension' regions. The effect on calcaneus strains of the tension members (plantar ligament and flexor tendon) is also not well understood and measuring strains after transecting them could reveal that they significantly modulate the strain distribution. We tested the hypothesis that the NA location previously described during simulated on-axis loads of deer calcanei would exhibit limited variations even when load perturbations are unusual (e.g. off-axis loads) or extreme (e.g. after transection of the tension members). We also examined regional differences in the predominance of the three strain modes (tension, compression, and shear) in these various load conditions in dorsal, plantar, medial, and lateral cortices. In addition to considering principal strains (tension and compression) and maximum shear strains, we also considered material-axis (M-A) shear strains. M-A shear strains are those that are aligned along the long axis of the bone and are considered to have greater biomechanical relevance than maximum shear strains because failure theories of composite materials and bone are often based on stresses or strains in the principal material directions. We used the same load apparatus from our prior study of mule deer calcanei. Results showed that although the NA rotated up to 8° medially and 15° laterally during these off-axis loads, it did not shift dramatically until after transection of all tension members. When comparing results based on maximum shear strain data vs. M-A shear strain data, the dominant strain mode changed only in the plantar cortex - as expected (in accordance with our a priori view) it was tension when M-A shear strains were considered (shear : tension = 0.2) but changed to dominant shear when maximum shear strain data were considered (shear : tension = 1.3). This difference leads to different conclusions and speculations regarding which specific strain modes and magnitudes most strongly influence the emergence of the marked mineralization and histomorphological differences in the dorsal vs. plantar cortices. Consequently, our prior simplification of the deer calcaneus model as a simply loaded 'tension/compression bone' (i.e. plantar/dorsal) might be incorrect. In vivo and in finite element analyses are needed to determine whether describing it as a 'shear-tension/compression' bone is more accurate. Addressing this question will help to advance the artiodactyl calcaneus as an experimental model for bone adaptation studies.

Static Preload Inhibits Loading-Induced Bone Formation

Nearly all exogenous loading models of bone adaptation apply dynamic loading superimposed upon a time invariant static preload (SPL) in order to ensure stable, reproducible loading of bone. Given that SPL may alter aspects of bone mechanotransduction (eg, interstitial fluid flow), we hypothesized that SPL inhibits bone formation induced by dynamic loading. As a first test of this hypothesis, we utilized a newly developed device that enables stable dynamic loading of the murine tibia with SPLs ≥ -0.01 N. We subjected the right tibias of BALB/c mice (4-month-old females) to dynamic loading (-3.8 N, 1 Hz, 50 cycles/day, 10 s rest) superimposed upon one of three SPLs: -1.5 N, -0.5 N, or -0.03 N. Mice underwent exogenous loading 3 days/week for 3 weeks. Metaphyseal trabecular bone adaptation (μCT) and midshaft cortical bone formation (dynamic histomorphometry) were assessed following euthanasia (day 22). Ipsilateral tibias of mice loaded with a -1.5-N SPL demonstrated significantly less trabecular bone volume/total volume (BV/TV) than contralateral tibias (-12.9%). In contrast, the same dynamic loading superimposed on a -0.03-N SPL significantly elevated BV/TV versus contralateral tibias (12.3%) and versus the ipsilateral tibias of the other SPL groups (-0.5 N: 46.3%, -1.5 N: 37.2%). At the midshaft, the periosteal bone formation rate (p.BFR) induced when dynamic loading was superimposed on -1.5-N and -0.5-N SPLs was significantly amplified in the -0.03-N SPL group (>200%). These data demonstrate that bone anabolism induced by dynamic loading is markedly inhibited by SPL magnitudes commonly implemented in the literature (ie, -0.5 N, -1.5 N). The inhibitory impact of SPL has not been recognized in bone adaptation models and, as such, SPLs have been neither universally reported nor standardized. Our study therefore identifies a previously unrecognized, potent inhibitor of mechanoresponsiveness that has potentially confounded studies of bone adaptation and translation of insights from our field. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Bone Density and Cross-sectional Geometry of the Proximal Femur Are Bilaterally Elevated in Elite Cricket Fast Bowlers

The skeleton of a cricket fast bowler is exposed to a unique combination of gravitational and torsional loading in the form of substantial ground reaction forces delivered through the front landing foot, and anterior-posterior shear forces mediated by regional muscle contractions across the lumbo-pelvic region. The objectives of this study were to compare the hip structural characteristics of elite fast bowlers with recreationally active age-matched controls, and to examine unilateral bone properties in fast bowlers. Dual-energy X-ray absorptiometry of the proximal femur was performed in 26 elite male fast bowlers and 26 normally active controls. Hip structural analysis (GE Lunar; enCORE version 15.0) determined areal bone mineral density (BMD) of the proximal femur, and cross-sectional area, section modulus (Z), cross-sectional moment of inertia, and femoral strength index at the narrow region of the femoral neck. Mean femoral neck and trochanter BMD were greater in fast bowlers than in controls (p <0.001). All bone geometry properties, except for cross-sectional moment of inertia, were superior in fast bowlers (p <0.05) following adjustment for height and lean mass. There were no asymmetries in BMD or bone geometry when considering leg dominance of the fast bowlers (p > 0.05). Elite fast bowlers have superior bone characteristics of the proximal femur, with results inferring enhanced resistance to axial compression (cross-sectional area), and bending (Z) forces, and enhanced strength to withstand a fall impact as indicated by their higher femoral strength index. No asymmetries in hip bone properties were identified, suggesting that both torsional and gravitational loading offer significant osteogenic potential.

Utility of osteon circularity for determining species and interpreting load history in primates and nonprimates

OBJECTIVES

Histomorphological analyses of bones are used to estimate an individual's chronological age, interpret a bone's load history, and differentiate species. Among various histomorphological characteristics that can influence mechanical properties of cortical bone, secondary osteon (Haversian system) population density and predominant collagen fiber orientation are particularly important. Cross-sectional shape characteristics of secondary osteons (On.Cr = osteon circularity, On.El = osteon ellipticality) are considered helpful in these contexts, but more robust proof is needed. We sought to determine if variations in osteon shape characteristics are sufficient for accurately differentiating species, load-complexity categories, and regional habitual strain-mode distributions (e.g., tension vs. compression regions).

MATERIALS AND METHODS

Circularly polarized light images were obtained from 100-micron transverse sections from diaphyses of adult deer calcanei; sheep calcanei, radii, and tibiae; equine calcanei, radii, and third metacarpals (MC3s); chimpanzee femora; and human femora and fibulae. Osteon cross-sectional area (On.Ar), On.Cr, and On.El were quantified indiscriminately and in the contexts of load-complexity and regional strain-mode distributions.

RESULTS

On.Cr and On.El, when examined independently in terms of all data, or mean (nested) data, for each bone, exceeded 80% accuracy in the inter-species comparisons only with respect to distinguishing humans from nonhumans. Correct classification among the nonhuman species was <70%. When On.Cr and On.El were coupled together and with On.Ar in discriminant function analyses (nested and unnested data) there were high misclassifications in all but human vs. nonhuman comparisons.

DISCUSSION

Frequent misclassifications in nonhuman comparisons might reflect influences of habitual load complexity and/or strain-mode distributions, or other factors not accounted for by these two considerations.

Spatial distribution and remodeling of elastic modulus of bone in micro-regime as prediction of early stage osteoporosis

We assessed the local distribution of bone mechanical properties on a micro-nano-scale and its correlation to strain distribution. Left tibia samples were obtained from 5-month old female Sprague Dawley rats, including baseline control (n=9) and hindlimb suspended (n=9) groups. Elastic modulus was measured by nanoindentation at the dedicated locations. Three additional tibias from control rats were loaded axially to measure bone strain, with 6-10N at 1Hz on a Bose machine for strain measurements. In the control group, the difference of the elastic modulus between periosteum and endosteum was much higher at the anterior and posterior regions (2.6GPa), where higher strain differences were observed (45μɛ). Minimal elastic modulus difference between periosteum and endosteum was observed at the medial region (0.2GPa), where neutral axis of the strain distribution was oriented with lower strain difference (5μɛ). In the disuse group, however, the elastic modulus differences in the anterior posterior regions reduced to 1.2GPa from 2.6GPa in the control group, and increased in the medial region to 2.7GPa from 0.2GPa. It is suggested that the remodeling rate in a region of bone is possibly influenced by the strain gradient from periosteum to endosteum. Such pattern of moduli gradients was compromised in disuse osteopenia, suggesting that the remodeling in distribution of micro-nano-elastic moduli among different regions may serve as a predictor for early stage of osteoporosis.

Arctic Ground Squirrels Limit Bone Loss during the Prolonged Physical Inactivity Associated with Hibernation

Prolonged disuse (e.g., physical inactivity) typically results in increased bone porosity, decreased mineral density, and decreased bone strength, leading to increased fracture risk in many mammals. However, bears, marmots, and two species of ground squirrels have been shown to preserve macrostructural bone properties and bone strength during long seasons of hibernation while they remain mostly inactive. Some small hibernators (e.g., 13-lined ground squirrels) show microstructural bone loss (i.e., osteocytic osteolysis) during hibernation, which is not seen in larger hibernators (e.g., bears and marmots). Arctic ground squirrels (Urocitellus parryii) are intermediate in size between 13-lined ground squirrels and marmots and are perhaps the most extreme rodent hibernator, hibernating for up to 8 mo annually with body temperatures below freezing. The goal of this study was to quantify the effects of hibernation and inactivity on cortical and trabecular bone properties in arctic ground squirrels. Cortical bone geometrical properties (i.e., thickness, cross-sectional area, and moment of inertia) at the midshaft of the femur were not different in animals sampled over the hibernation and active seasons. Femoral ultimate stress tended to be lower in hibernators than in summer animals, but toughness was not affected by hibernation. The area of osteocyte lacunae was not different between active and hibernating animals. There was an increase in osteocytic lacunar porosity in the hibernation group due to increased lacunar density. Trabecular bone volume fraction in the proximal tibia was unexpectedly greater in the hibernation group than in the active group. This study shows that, similar to other hibernators, arctic ground squirrels are able to preserve many bone properties during hibernation despite being physically inactive for up to 8 mo.

The effect of mechanical stimulation on mineralization in differentiating osteoblasts in collagen-I scaffolds

Developing a viable and functional bone scaffold in vitro that is capable of surviving and bearing mechanical load in vivo requires an understanding of the cell biology of osteoprogenitor cells, particularly how they are influenced by mechanical stimulation during cell differentiation and maturation. In this study, mechanical load was applied using a modified FlexCell plate to impart confined compression to collagen-I scaffolds seeded with undifferentiated murine embryonic stem cells. The activity, presence, and expression of osteoblast-cadherin (OB-Cad) and connexin-43, as well as various pluripotent and osteogenic markers were examined at 5-30 days of differentiation as cells were stimulated to differentiate to osteoblasts with and without applied mechanical load. Fluorescence recovery after photobleaching, immunofluorescence, viability, von Kossa, and real-time polymerase chain reaction assessments revealed that mechanical prestimulation of this cell-seeded scaffold altered the expression of OB-Cad and connexin-43 and resulted in significant differences in the structure and organization of mineralization present in the collagen matrix. Specifically, cells in gels that were loaded for 40 h after 5 days of differentiation and then left to fully differentiate for 30 days produced a highly structured honeycomb-shaped mineralization in the matrix; an outcome that was previously shown to be indicative of late osteoblast/early osteocyte activity. This study highlights the potential of mechanical load to accelerate differentiation and enhance osteoblast communication and function during the differentiation process, and highlights a time point of cell differentiation within this scaffold to apply load in order to most effectively transduce a mechanical signal.

Tennis service stroke benefits humerus bone: is torsion the cause?

Regular tennis play is associated with impressive asymmetries in bone strength in favor of the racquet arm, particularly in the humerus. However, the relative effects of service and ground strokes are not known. Serendipitously, we encountered a 46-year-old regular tennis player who has played service and ground strokes with different arms for over 30 years, and thus allowed differentiation of stroke effects. Grip strength and peripheral quantitative computed tomography scans of both arms of radius at 4 % distal-proximal ulna length, radius and ulna at 60 % distal-proximal ulna length, and at distal (35 % length) humerus were analyzed in this player, and 12 male veteran players of similar age, height, and mass who played a conventional single-sided style. Confidence intervals (95 %) were calculated for asymmetries and bone, muscle and force parameters in the control players-values in the case study player were compared to these intervals. Sizeable differences in bone strength in favor of the serving arm humerus were observed in this player-comparable to those found in the control players. While asymmetries in favor of the ground stroke arm ulna were also evident, no sizeable asymmetry was found in proximal or distal radius, forearm or upper arm muscle size or hand grip force. These results suggest that the service stroke is responsible for the humeral hypertrophy observed in tennis players, and that ulna adaptation may be attributable to the ground strokes. The osteogenic potential of the service stroke may be related to the large torsional stresses it produces.

Greater tibial bone strength in male tennis players than controls in the absence of greater muscle output

Background/Objective

The greatest forces experienced by bones result from muscular contractions—muscles produce most force in high-velocity eccentric contractions. Bouncing movements, e.g., sprinting or hopping—where such contractions occur—are highly beneficial for lower limb bones. However, there is a growing body of evidence that torsional stresses are highly osteogenic. Sports in which frequent quick turning occurs—hence large torsional stresses can be expected—e.g., tennis, may also improve bone strength even in the absence of large ground reaction and muscle forces.

Methods

To investigate the relative effects of bouncing and turning movements on bones, we recruited 47 older men (mean age 62.4 ± 12.9 years). They were competitive sprinters (representing exposure to bouncing movement), competitive tennis players (turning movements), and inactive controls. Peripheral quantitative computed tomography scans of tibial diaphysis at 66% distal–proximal length were taken; muscle sizes from peripheral quantitative computed tomography and countermovement jump performance were also examined.

Results

Bone strength of tennis players was clearly greater than that of controls (23% greater bone mass; p < 0.001) and similar to that in sprinters. Tennis players' jump relative power and height were 15% and 25% lower than those of sprinters (p < 0.05) and similar to control values, being 2% greater and 6% lower, respectively (p > 0.5). Material eccentricity analysis suggests that torsional stresses may be a significant adaptive stimulus to tibial bone.

Conclusion

Results suggest that sports with quick turning movements are highly osteogenic, even in the absence of greater muscular output. This may be related to the large torsional stresses produced during turning movements.

Embryonic stem cell-derived osteocytes are capable of responding to mechanical oscillatory hydrostatic pressure

Osteoblasts can be derived from embryonic stem cells (ESCs) by a 30 day differentiation process, whereupon cells spontaneously differentiate upon removal of LIF and respond to exogenously added 1,25α(OH)2 vitamin D3 with enhanced matrix mineralization. However, bone is a load-bearing tissue that has to perform under dynamic pressure changes during daily movement, a capacity that is executed by osteocytes. At present, it is unclear whether ESC-derived osteogenic cultures contain osteocytes and whether these are capable of responding to a relevant cyclic hydrostatic compression stimulus. Here, we show that ESC-osteoblastogenesis is followed by the generation of osteocytes and then mechanically load ESC-derived osteogenic cultures in a compression chamber using a cyclic loading protocol. Following mechanical loading of the cells, iNOS mRNA was upregulated 31-fold, which was consistent with a role for iNOS as an immediate early mechanoresponsive gene. Further analysis of matrix and bone-specific genes suggested a cellular response in favor of matrix remodeling. Immediate iNOS upregulation also correlated with a concomitant increase in Ctnnb1 and Tcf7l2 mRNAs along with increased nuclear TCF transcriptional activity, while the mRNA for the repressive Tcf7l1 was downregulated, providing a possible mechanistic explanation for the noted matrix remodeling. We conclude that ESC-derived osteocytes are capable of responding to relevant mechanical cues, at least such that mimic oscillatory compression stress, which not only provides new basic understanding, but also information that likely will be important for their use in cell-based regenerative therapies.

Torsion and antero-posterior bending in the in vivo human tibia loading regimes during walking and running

Bending, in addition to compression, is recognized to be a common loading pattern in long bones in animals. However, due to the technical difficulty of measuring bone deformation in humans, our current understanding of bone loading patterns in humans is very limited. In the present study, we hypothesized that bending and torsion are important loading regimes in the human tibia. In vivo tibia segment deformation in humans was assessed during walking and running utilizing a novel optical approach. Results suggest that the proximal tibia primarily bends to the posterior (bending angle: 0.15°-1.30°) and medial aspect (bending angle: 0.38°-0.90°) and that it twists externally (torsion angle: 0.67°-1.66°) in relation to the distal tibia during the stance phase of overground walking at a speed between 2.5 and 6.1 km/h. Peak posterior bending and peak torsion occurred during the first and second half of stance phase, respectively. The peak-to-peak antero-posterior (AP) bending angles increased linearly with vertical ground reaction force and speed. Similarly, peak-to-peak torsion angles increased with the vertical free moment in four of the five test subjects and with the speed in three of the test subjects. There was no correlation between peak-to-peak medio-lateral (ML) bending angles and ground reaction force or speed. On the treadmill, peak-to-peak AP bending angles increased with walking and running speed, but peak-to-peak torsion angles and peak-to-peak ML bending angles remained constant during walking. Peak-to-peak AP bending angle during treadmill running was speed-dependent and larger than that observed during walking. In contrast, peak-to-peak tibia torsion angle was smaller during treadmill running than during walking. To conclude, bending and torsion of substantial magnitude were observed in the human tibia during walking and running. A systematic distribution of peak amplitude was found during the first and second parts of the stance phase.

In vivo loading model to examine bone adaptation in humans: a pilot study

Bone is typically well suited for its habitual loading environment because of its ability to adapt. Although characteristics of the mechanical loading environment predict the bone adaptive response in animals, this has not been prospectively validated in humans. Here, we describe an in vivo loading model in which women apply forces to the radius by leaning onto their hand. We characterized the strain environment imposed on the radius using cadaveric experimentation and conducted a prospective study in which 19 adult women loaded their distal radii 50 cycles/day, 3 days/week, for 28 weeks and seven additional adult women served as controls. In four cadaveric specimens, loading caused compressive principal strains of -1,695 ± 396 με with radial bending dorsally and towards the ulna. Prospective in vivo loading produced measurable improvements to bone and appeared to protect against bone loss associated with seasonal fluctuations in physical activity and sun exposure. Experimental subjects had significant gains to bone volume (BV) and moments of inertia, while, control subjects had significant losses in BMC and moments of inertia. The loading model is thus suitable as a model system for exploring bone adaptation in humans, and may eventually be clinically useful for strengthening the radius of women.

The potential benefits and inherent risks of vibration as a non-drug therapy for the prevention and treatment of osteoporosis

The delivery of mechanical signals to the skeleton using vibration is being considered as a non-drug treatment of osteoporosis. Delivered over a range of magnitudes and frequencies, vibration has been shown to be both anabolic and anti-catabolic to the musculoskeletal tissues, yet caution must be emphasized as these mechanical signals, particularly chronic exposure to higher intensities, is a known pathogen to many physiological systems. In contrast, accumulating preclinical and clinical evidence indicates that low intensity vibration (LIV) improves bone quality through regulating the activity of cells responsible for bone remodeling, as well as biasing the differentiation fate of their mesenchymal and hematopoietic stem cell progenitors. In vitro studies provide insights into the biologic mechanisms of LIV, and indicate that cells respond to these low magnitude signals through a distinct mechanism driven not by matrix strain but acceleration. These cell, animal, and human studies may represent the foundation of a safe, non-drug means to protect and improve the musculoskeletal system of the elderly, injured, and infirmed.

High-frequency and low-magnitude whole body vibration with rest days is more effective in improving skeletal micro-morphology and biomechanical properties in ovariectomised rodents

We explored the optimal regime in preventing or treating bone loss, using ovariectomised rodents loaded by mechanical stimuli with rest days during the loading cycle. Eighty-four Sprague-Dawley rats, aged 6 months, were randomly divided into 7 groups after bilateral ovariectomy. Mechanical vibration with 1-day rest (ML1R), with 3-day rest (ML3R), with 5-day rest (ML5R), with 7-day rest (ML7R), daily loading (DL), comparing the ovariectomised group (OVX) with baseline (BCL) measurements. After a recovery of one week, all the rodents were loaded daily by whole body vibration at 35 Hz and 0.25 g for 15 minutes. Eight weeks later, a three-point bending test of the radius and micro-CT scanning of the femoral head were performed after animal sacrifice. Large improvements in biomechanical properties occurred in all the experimental groups for failure load, elastic modulus and deflection, while a significantly enhanced efficacy was detected in ML7R compared with daily loading (p<0.05). In micro-CT scanning, bone volume fraction, trabecular thickness, number and separation were improved by the regime in all experimental groups, while ML7R showed a significant improvement over daily loading (p<0.05). Early bone loss in human subjects may be improved by high-frequency and low-magnitude whole body vibration with rest days or daily stimuli. Mechanical stimulus with a 7-day rest was more effective in improving biomechanical properties and micro-morphology compared with daily loading. This may have clinical implications in relation to the prevention and treatment of hip fractures, and in postoperative management following hip arthroplasty.

Mechanical regulation of signaling pathways in bone

A wide range of cell types depend on mechanically induced signals to enable appropriate physiological responses. The skeleton is particularly dependent on mechanical information to guide the resident cell population towards adaptation, maintenance and repair. Research at the organ, tissue, cell and molecular levels has improved our understanding of how the skeleton can recognize the functional environment, and how these challenges are translated into cellular information that can site-specifically alter phenotype. This review first considers those cells within the skeleton that are responsive to mechanical signals, including osteoblasts, osteoclasts, osteocytes and osteoprogenitors. This is discussed in light of a range of experimental approaches that can vary parameters such as strain, fluid shear stress, and pressure. The identity of mechanoreceptor candidates is approached, with consideration of integrins, pericellular tethers, focal adhesions, ion channels, cadherins, connexins, and the plasma membrane including caveolar and non-caveolar lipid rafts and their influence on integral signaling protein interactions. Several mechanically regulated intracellular signaling cascades are detailed including activation of kinases (Akt, MAPK, FAK), β-catenin, GTPases, and calcium signaling events. While the interaction of bone cells with their mechanical environment is complex, an understanding of mechanical regulation of bone signaling is crucial to understanding bone physiology, the etiology of diseases such as osteoporosis, and to the development of interventions to improve bone strength.

The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: tensioned wires vs. half-pins

BACKGROUND

A weight-bearing platform applied at the distal end of an Ilizarov external frame allows patients with hindfoot transfixations, foot deformities or plantar skin lesions to bear weight. This leads to an indirect loading of the fracture or osteotomy site. However, the effect on the fracture/osteotomy site's motion or compressive loads is unknown. The aim of this study was to analyze the mechanical effects of a weight-bearing platform on the traditional all-wire, four-ring frame in comparison to a two-ring frame consisting of half-pins.

METHODS

Two frame configurations, with either anatomically positioned wires or half-pins, were analyzed with and without a weight-bearing platform applied underneath the distal ring. Composite tibiae with a mid-diaphyseal osteotomy of 3.5 mm were used in all the experiments. An axial load was applied with the use of a universal test machine (UTS®). Interfragmentary movements, the relative movements of bone fragments and movements between rings were recorded using displacement transducers. Compressive loads at the osteotomy site were recorded with loading cells.

RESULTS

Indirect loading with a weight-bearing platform altered the force transmission through the osteotomy. Indirect loading of the tibiae decreased the extent of the axial micro-motion by 50% under the applied weight load when compared to direct weight loading (p < 0.05). The half pin frame was 25% stiffer than the wire frame under both direct and indirect loading of the tibiae (p < 0.05). Compressive loads under indirect loading were reduced by 67% in the wire frame and by 57% in the half-pin frames compared to direct loading of the bones (p < 0.05). While axial loading in the wire frames resulted in plain axial movements at the site of the osteotomy, it was coupled with translational movements and angular displacements in the half pin mountings. This effect was more apparent in the case of indirect loading.

CONCLUSIONS

A weight-bearing platform has substantial influence on the biomechanical performance of an Ilizarov external fixator. Half-pins induce greater stiffness to the Ilizarov external fixator and allow the usage of only one ring per bone segment, but shear stresses at the osteotomy under axial loading should be considered. The results allow an estimation of the size and direction of interfragmentary movements based on the extent of weight bearing.

Total knee arthroplasty in motivated patients with knee osteoarthritis and athletic activity approach type goals: a conceptual decision-making model

Knee osteoarthritis is one of the most common disabling medical conditions. With longer life expectancy the number of total knee arthroplasty (TKA) procedures being performed worldwide is projected to increase dramatically. Patient education, physical activity, bodyweight levels, expectations and goals regarding the ability to continue athletic activity participation are also increasing. For the subset of motivated patients with knee osteoarthritis who have athletic activity approach type goals, early TKA may not be the best knee osteoarthritis treatment option to improve satisfaction, quality of life and outcomes. The purpose of this clinical commentary is to present a conceptual decision-making model designed to improve the knee osteoarthritis treatment intervention outcome for motivated patients with athletic activity approach type goals. The model focuses on improving knee surgeon, patient and rehabilitation clinician dialogue by rank ordering routine activities of daily living and quality of life evoking athletic activities based on knee symptom exacerbation or re-injury risk. This process should help establish realistic patient expectations and goals for a given knee osteoarthritis treatment intervention that will more likely improve self-efficacy, functional independence, satisfaction and outcomes while decreasing the failure risk associated with early TKA.

Skeletal nutrient vascular adaptation induced by external oscillatory intramedullary fluid pressure intervention

BACKGROUND

Interstitial fluid flow induced by loading has demonstrated to be an important mediator for regulating bone mass and morphology. It is shown that the fluid movement generated by the intramedullary pressure (ImP) provides a source for pressure gradient in bone. Such dynamic ImP may alter the blood flow within nutrient vessel adjacent to bone and directly connected to the marrow cavity, further initiating nutrient vessel adaptation. It is hypothesized that oscillatory ImP can mediate the blood flow in the skeletal nutrient vessels and trigger vasculature remodeling. The objective of this study was then to evaluate the vasculature remodeling induced by dynamic ImP stimulation as a function of ImP frequency.

METHODS

Using an avian model, dynamics physiological fluid ImP (70 mmHg, peak-peak) was applied in the marrow cavity of the left ulna at either 3 Hz or 30 Hz, 10 minutes/day, 5 days/week for 3 or 4 weeks. The histomorphometric measurements of the principal nutrient arteries were done to quantify the arterial wall area, lumen area, wall thickness, and smooth muscle cell layer numbers for comparison.

RESULTS

The preliminary results indicated that the acute cyclic ImP stimuli can significantly enlarge the nutrient arterial wall area up to 50%, wall thickness up to 20%, and smooth muscle cell layer numbers up to 37%. In addition, 3-week of acute stimulation was sufficient to alter the arterial structural properties, i.e., increase of arterial wall area, whereas 4-week of loading showed only minimal changes regardless of the loading frequency.

CONCLUSIONS

These data indicate a potential mechanism in the interrelationship between vasculature adaptation and applied ImP alteration. Acute ImP could possibly initiate the remodeling in the bone nutrient vasculature, which may ultimately alter blood supply to bone.

Grizzly bears (Ursus arctos horribilis) and black bears (Ursus americanus) prevent trabecular bone loss during disuse (hibernation)

Disuse typically causes an imbalance in bone formation and bone resorption, leading to losses of cortical and trabecular bone. In contrast, bears maintain balanced intracortical remodeling and prevent cortical bone loss during disuse (hibernation). Trabecular bone, however, is more detrimentally affected than cortical bone in other animal models of disuse. Here we investigated the effects of hibernation on bone remodeling, architectural properties, and mineral density of grizzly bear (Ursus arctos horribilis) and black bear (Ursus americanus) trabecular bone in several skeletal locations. There were no differences in bone volume fraction or tissue mineral density between hibernating and active bears or between pre- and post-hibernation bears in the ilium, distal femur, or calcaneus. Though indices of cellular activity level (mineral apposition rate, osteoid thickness) decreased, trabecular bone resorption and formation indices remained balanced in hibernating grizzly bears. These data suggest that bears prevent bone loss during disuse by maintaining a balance between bone formation and bone resorption, which consequently preserves bone structure and strength. Further investigation of bone metabolism in hibernating bears may lead to the translation of mechanisms preventing disuse-induced bone loss in bears into novel treatments for osteoporosis.

Distraction osteogenesis for correction of three-dimensional deformities with shortening of lower limbs by Taylor Spatial Frame

INTRODUCTION

Surgical results of correction of three-dimensional deformities with shortening of lower limbs by simple two-ring system of Taylor Spatial Frame have been reported. The deformities were caused by various kinds of skeletal disorders.

METHODS

Ten cases were successfully corrected using distraction osteogenesis, being one case showed recurrence of deformity due to the nature of the disease.

RESULTS

The ranges of corrected deformities were 5 degrees-55 degrees in coronal angulation, 2 degrees-47 degrees in sagittal angulation, and 5 degrees-40 degrees in rotational deformities. Amount of lengthening ranged from 1.2 to 6.0 cm. Pin-site infection occurred in five cases, being no other complications. External fixation index was longer in a group of rotational correction over 10 degrees.

CONCLUSION

The current report seems the first series of cases with four-dimensional deformities treated by distraction osteogenesis by TSF and may help to determine the indication of use of TSF in case of treatment of patients suffering from deformities in the lower limbs.

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.

Muscle and bone plasticity after spinal cord injury: review of adaptations to disuse and to electrical muscle stimulation

The paralyzed musculoskeletal system retains a remarkable degree of plasticity after spinal cord injury (SCI). In response to reduced activity, muscle atrophies and shifts toward a fast-fatigable phenotype arising from numerous changes in histochemistry and metabolic enzymes. The loss of routine gravitational and muscular loads removes a critical stimulus for maintenance of bone mineral density (BMD), precipitating neurogenic osteoporosis in paralyzed limbs. The primary adaptations of bone to reduced use are demineralization of epiphyses and thinning of the diaphyseal cortical wall. Electrical stimulation of paralyzed muscle markedly reduces deleterious post-SCI adaptations. Recent studies demonstrate that physiological levels of electrically induced muscular loading hold promise for preventing post-SCI BMD decline. Rehabilitation specialists will be challenged to develop strategies to prevent or reverse musculoskeletal deterioration in anticipation of a future cure for SCI. Quantifying the precise dose of stress needed to efficiently induce a therapeutic effect on bone will be paramount to the advancement of rehabilitation strategies.

Mammalian hibernation as a model of disuse osteoporosis: the effects of physical inactivity on bone metabolism, structure, and strength

Reduced skeletal loading typically leads to bone loss because bone formation and bone resorption become unbalanced. Hibernation is a natural model of musculoskeletal disuse because hibernating animals greatly reduce weight-bearing activity, and therefore, they would be expected to lose bone. Some evidence suggests that small mammals like ground squirrels, bats, and hamsters do lose bone during hibernation, but the mechanism of bone loss is unclear. In contrast, hibernating bears maintain balanced bone remodeling and preserve bone structure and strength. Differences in the skeletal responses of bears and smaller mammals to hibernation may be due to differences in their hibernation patterns; smaller mammals may excrete calcium liberated from bone during periodic arousals throughout hibernation, leading to progressive bone loss over time, whereas bears may have evolved more sophisticated physiological processes to recycle calcium, prevent hypercalcemia, and maintain bone integrity. Investigating the roles of neural and hormonal control of bear bone metabolism could give valuable insight into translating the mechanisms that prevent disuse-induced bone loss in bears into novel therapies for treating osteoporosis.

Decreased bone turnover with balanced resorption and formation prevent cortical bone loss during disuse (hibernation) in grizzly bears (Ursus arctos horribilis)

Disuse uncouples bone formation from resorption, leading to increased porosity, decreased bone geometrical properties, and decreased bone mineral content which compromises bone mechanical properties and increases fracture risk. However, black bear bone properties are not adversely affected by aging despite annual periods of disuse (i.e., hibernation), which suggests that bears either prevent bone loss during disuse or lose bone and subsequently recover it at a faster rate than other animals. Here we show decreased cortical bone turnover during hibernation with balanced formation and resorption in grizzly bear femurs. Hibernating grizzly bear femurs were less porous and more mineralized, and did not demonstrate any changes in cortical bone geometry or whole bone mechanical properties compared to active grizzly bear femurs. The activation frequency of intracortical remodeling was 75% lower during hibernation than during periods of physical activity, but the normalized mineral apposition rate was unchanged. These data indicate that bone turnover decreases during hibernation, but osteons continue to refill at normal rates. There were no changes in regional variation of porosity, geometry, or remodeling indices in femurs from hibernating bears, indicating that hibernation did not preferentially affect one region of the cortex. Thus, grizzly bears prevent bone loss during disuse by decreasing bone turnover and maintaining balanced formation and resorption, which preserves bone structure and strength. These results support the idea that bears possess a biological mechanism to prevent disuse osteoporosis.

Black bear femoral geometry and cortical porosity are not adversely affected by ageing despite annual periods of disuse (hibernation)

Disuse (i.e. inactivity) causes bone loss, and a recovery period that is 2-3 times longer than the inactive period is usually required to recover lost bone. However, black bears experience annual disuse (hibernation) and remobilization periods that are approximately equal in length, yet bears maintain or increase cortical bone material properties and whole bone mechanical properties with age. In this study, we investigated the architectural properties of bear femurs to determine whether cortical structure is preserved with age in bears. We showed that cross-sectional geometric properties increase with age, but porosity and resorption cavity density do not change with age in skeletally immature male and female bears. These findings suggest that structural properties substantially contribute to increasing whole bone strength with age in bears, particularly during skeletal maturation. Porosity was not different between skeletally immature and mature bears, and showed minimal regional variations between anatomical quadrants and radial positions that were similar in pattern and magnitude between skeletally immature and mature bears. We also found gender dimorphisms in bear cortical bone properties: females have smaller, less porous bones than males. Our results provide further support for the idea that black bears possess a biological mechanism to prevent disuse osteoporosis.

Ontogenetic relationships between in vivo strain environment, bone histomorphometry and growth in the goat radius

Vertebrate long bone form, at both the gross and the microstructural level, is the result of many interrelated influences. One factor that is considered to have a significant effect on bone form is the mechanical environment experienced by the bone during growth. The work presented here examines the possible relationships between in vivo bone strains, bone geometry and histomorphology in the radii of three age/size groups of domestic goats. In vivo bone strain data were collected from the radii of galloping goats, and the regional cortical distribution of peak axial strain magnitudes, radial and circumferential strain gradients, and longitudinal strain rates related to regional patterns in cortical growth, porosity, remodelling and collagen fibre orientation. Although porosity and remodelling decreased and increased with age, respectively, these features showed no significant regional differences and did not correspond to regional patterns in the mechanical environment. Thicker regions of the radius's cortex were significantly related to high strain levels and higher rates of periosteal, but not endosteal, growth. However, cortical growth and strain environment were not significantly related. Collagen fibre orientation varied regionally, with a higher percentage of transverse fibres in the caudal region of the radius and primarily longitudinal fibres elsewhere, and, although consistent through growth, also did not generally correspond to regional strain patterns. Although strain magnitudes increased during ontogeny and regional strain patterns were variable over the course of a stride, mean regional strain patterns were generally consistent with growth, suggesting that regional growth patterns and histomorphology, in combination with external loads, may play some role in producing a relatively 'predictable' strain environment within the radius. It is further hypothesized that the absence of correlation between regional histomorphometric patterns and the measured strain environments is the result of the variable mechanical environment. However, the potential effects of other physiological and mechanical factors, such as skeletal metabolism and adjacent muscle insertions, that can influence the gross and microstructural morphology of the radius during ontogeny, cannot be ignored.

Effects of Immobilization on the Biomechanical Properties of the Broiler Tibia and Gastrocnemius Tendon

Researchers have provided much insight into the various factors that influence the incidence of musculoskeletal problems in the poultry industry. However, a better understanding of the mechanobiology of broiler bone and tendon can have a positive effect on the welfare of the production bird and assist in the development of improved production practices. This study investigated the mechanical adaptability responses due to disuse on the biomechanical properties of the broiler tibia and gastrocnemius tendon. Beginning at 3 wk of age, broilers were placed in a harness system designed to eliminate load bearing of the leg. After 2 wk of this treatment, the average values for body mass and shank length of the birds were 58 and 85% of the values for the controls, respectively. The treatment reduced the mineral content of the tibia by approximately 50%, tibia structural strength by 40%, and tibia material strength by 8%. The structural strength and toughness of the gastrocnemius tendon were reduced by 10 and 30%, respectively, whereas the material strength, material toughness, and material stiffness of the tendon increased by approximately 75, 65, and 70%, respectively.

An Inexpensive Weight Bearing Indicator Used for Rehabilitation of Patients With Lower Extremity Injuries

Background. Partial or nonweight bearing is a useful treatment prescribed by medical professionals (e.g., orthopedists, podiatrists) for patients rehabilitating from lower extremity injuries However, there is significant variability in patient conformance with the commonly used, but very imprecise “weight scale method.” Furthermore, the few commercially available load monitoring devices are rarely used because of their high cost. Method of Approach. As a simple and inexpensive alternative to current load monitoring methods and commercial products, a new medical device called a snap dome weight bearing indicator (WBI) has been developed to gently warn a patient when they have exceeded a limited percentage of their body weight on the recovering leg or foot. When installed in a patient’s shoe or medical appliance, the device does so by utilizing the reversible buckling phenomena of a snap dome to provide a tactile and audible feedback when the prescribed weight has been exceeded. To demonstrate the feasibility of this new device, the performance of (1) the snap dome by itself and (2) several WBI designs developed were tested. The most useful of the new designs include one incorporating a heel cup for loose fitting medical appliances and a podiatric off-loading indicator (POLI). In addition, a pilot study and manufacturing cost analysis of the POLI device were performed to investigate patient usability and affordability issues. Results. The particular four-leg snap domes used in device prototypes performed quite well with regards to buckling load consistency between domes, the linearity of buckling load by stacking domes in a parallel arrangement, and buckling load repeatability of a single dome. The performance of each WBI prototype was tested with regards to load transfer, tactile, and audible feedback to the patient, patient comfort, and ease of installation. Prototype performance was generally very good or excellent except for the POLI device, which does not provide sufficient tactile or audible feedback for many patients. A costing analysis of the POLI device suggests that it can be manufactured in the U.S. for around one dollar. Conclusions. The generally positive results from performance testing of commercially available snap domes and WBI prototypes suggest that this new medical device will indeed be an inexpensive, yet effective conformance tool for orthopedists and podiatrists to use in prescribing partial or no weight bearing for a patient.

Mathematical analysis of trabecular 'trajectories' in apparent trajectorial structures: the unfortunate historical emphasis on the human proximal femur

Wolff's "law" of the functional adaptation of bone is rooted in the trajectory hypothesis of cancellous bone architecture. Wolff often used the human proximal femur as an example of a trajectorial structure (i.e. arched trabecular patterns appear to be aligned along tension/compression stress trajectories). We examined two tenets of the trajectory hypothesis; namely, that the trabecular tracts from the tension- and compression-loaded sides of a bending environment will: (1) follow 'lines' (trajectories) of tension/compression stress that resemble an arch with its apex on a neutral axis, and (2) form orthogonal (90 degrees ) intersections. These predictions were analysed in proximal femora of chimpanzees and modern humans, and in calcanei of sheep and deer. Compared to complex loading of the human femoral neck, the chimpanzee femoral neck reputedly receives relatively simpler loading (i.e. temporally/spatially more consistent bending), and the artiodactyl calcaneus is even more simply loaded in bending. In order to directly consider Wolff's observations, measurements were also made on two-dimensional, cantilevered beams and curved beams, each with intersecting compression/tension stress trajectories. Results in the calcanei showed: (1) the same nonlinear equation best described the dorsal ("compression") and plantar ("tension") trabecular tracts, (2) these tracts could be exactly superimposed on the corresponding compression/tension stress trajectories of the cantilevered beams, and (3) trabecular tracts typically formed orthogonal intersections. In contrast, trabecular tracts in human and chimpanzee femoral necks were non-orthogonal (mean approximately 70 degrees ), with shapes differing from trabecular tracts in calcanei and stress trajectories in the beams. Although often being described by the same equations, the trajectories in the curved beams had lower r(2) values than calcaneal tracts. These results suggest that the trabecular patterns in the calcanei and stress trajectories in short beams are consistent with basic tenets of the trajectory hypothesis while those in human and chimpanzee femoral necks are not. Compared to calcanei, the more complexly loaded human and chimpanzee femoral necks probably receive more prevalent/predominant shear, which is best accommodated by non-orthogonal, asymmetric trabecular tracts. The asymmetrical trabecular patterns in the proximal femora may also reflect the different developmental 'fields' (trochanteric vs. neck/head) that formed these regions, of which there is no parallel in the calcanei.

Molecular pathways mediating mechanical signaling in bone

Bone tissue has the capacity to adapt to its functional environment such that its morphology is "optimized" for the mechanical demand. The adaptive nature of the skeleton poses an interesting set of biological questions (e.g., how does bone sense mechanical signals, what cells are the sensing system, what are the mechanical signals that drive the system, what receptors are responsible for transducing the mechanical signal, what are the molecular responses to the mechanical stimuli). Studies of the characteristics of the mechanical environment at the cellular level, the forces that bone cells recognize, and the integrated cellular responses are providing new information at an accelerating speed. This review first considers the mechanical factors that are generated by loading in the skeleton, including strain, stress and pressure. Mechanosensitive cells placed to recognize these forces in the skeleton, osteoblasts, osteoclasts, osteocytes and cells of the vasculature are reviewed. The identity of the mechanoreceptor(s) is approached, with consideration of ion channels, integrins, connexins, the lipid membrane including caveolar and non-caveolar lipid rafts and the possibility that altering cell shape at the membrane or cytoskeleton alters integral signaling protein associations. The distal intracellular signaling systems on-line after the mechanoreceptor is activated are reviewed, including those emanating from G-proteins (e.g., intracellular calcium shifts), MAPKs, and nitric oxide. The ability to harness mechanical signals to improve bone health through devices and exercise is broached. Increased appreciation of the importance of the mechanical environment in regulating and determining the structural efficacy of the skeleton makes this an exciting time for further exploration of this area.

Phylogenetic Signal in Bone Microstructure of Sauropsids

In spite of the fact that the potential usefulness of bone histology in systematics has been discussed for over one and a half centuries, the presence of a phylogenetic signal in the variation of histological characters has rarely been assessed. A quantitative assessment of phylogenetic signal in bone histological characters could provide a justification for performing optimizations of these traits onto independently generated phylogenetic trees (as has been done in recent years). Here we present an investigation on the quantification of the phylogenetic signal in the following bone histological, microanatomical, and morphological traits in a sample of femora of 35 species of sauropsids: vascular density, vascular orientation, index of Haversian remodeling, cortical thickness, and cross-sectional area (bone size). For this purpose, we use two methods, regressions on distance matrices tested for significance using permutations (a Mantel test) and random tree length distribution. Within sauropsids, these bone microstructural traits have an optimal systematic value in archosaurs. In this taxon, a Mantel test shows that the phylogeny explains 81.8% of the variation of bone size and 86.2% of the variation of cortical thickness. In contrast, a Mantel test suggests that the phylogenetic signal in histological traits is weak: although the phylogeny explains 18.7% of the variation of vascular density in archosaurs, the phylogenetic signal is not significant either for vascular orientation or for the index of Haversian remodeling. However, Mantel tests seem to underestimate the proportion of variance of the dependent character explained by the phylogeny, as suggested by a PVR (phylogenetic eigenvector) analysis. We also deal with some complementary questions. First, we evaluate the functional dependence of bone vascular density on bone size by using phylogenetically independent contrasts. Second, we perform a variation partitioning analysis and show that the phylogenetic signal in bone vascular density is not a by-product of phylogentic signal in bone size. Finally, we analyze the evolution of cortical thickness in diapsids by using an optimization by squared change parsimony and discuss the functional significance of this character in terms of decreased buoyancy in crocodiles and mass saving in birds. These results are placed in the framework of the constructional morphology model, according to which the variation of a character in a clade has a historical (phylogenetic) component, a functional (adaptive) component, and a structural (architectural) component.