Regulation of mechanical signals in bone

Structured Authors – Judex S, Gupta S, Rubin C 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.