Bone mass and morphology are strongly influenced by mechanical stimuli. The difficulty in defining the osteogenic components of the mechanical milieu, however, has resulted in a clinical preference for pharmaceutical, rather than biomechanical, intervention for osteoporosis. Accumulating evidence demonstrates that extremely low levels of biophysical stimuli (e.g., mechanical, electrical, pressure, ultrasound) can readily regulate the activity of both osteoblasts and osteoclasts. Further, it is clear that the bone cell population has the sensitivity to differentiate specific aspects of the biophysical signal, including duration, magnitude, frequency and distribution. This suggests that "appropriate" anabolic and antiresorptive biophysical signals can effectively modulate bone mass, density and strength. That the intensity of the osteoregulatory signal would intrinsically diminish as the bone structure adapts emphasizes that biophysical intervention could evolve into (or already are) self-regulating growth factors. With this in mind, it is possible that the potential benefits of a mechanically based intervention may overcome the limitations, contraindications, and unknowns of pharmaceutical treatments.
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