Mechanical loading histories and cortical bone remodeling.

A conceptual framework is presented for understanding and investigating structural adaptation of cortical bone. The magnitudes, orientations, and sense (tension or compression) of the physiologically incurred cyclic principal strains vary markedly throughout the skeleton. It is probable, therefore, that the strain/remodeling response of bone is site specific. Furthermore, there is some indication that immature bone is more responsive to alterations of cyclic strains than mature bone. Animal experimental studies and complementary stress and strain analyses suggest that the structural adaptation due to changes in cyclic strain fields may be a very nonlinear response. Bone loss in mature animals due to immobilization is sensitive to even small changes in the cyclic bone strains. Under normal conditions, however, there appears to be a broad range of physical activity in which bone is relatively unresponsive to changes in loading history. With severe repeated loading, bone hypertrophy can be pronounced. These observations open the possibility that bone atrophy and hypertrophy are controlled by different mechanisms. Therefore, two (or more) complementary control systems may be involved in the regulation of bone mass by bone cyclic strain histories. It is probable that bone mechanical microdamage is one control stimulus for affecting an increase in bone mass.