Low magnitude mechanical loading is osteogenic in children with disabling conditions

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Ward, Kate¹; Alsop, Chrissie¹; Caulton, Janette²; Rubin, Clinton³; Adams, Judith¹; Mughal, Zulf⁴

Low magnitude mechanical loading is osteogenic in children with disabling conditions

J Bone Miner Res. March 2004;19(3):360-369

©2004 American Society for Bone and Mineral Research

Affiliations

¹Clinical Radiology, Imaging Science & Biomedical Engineering, University of Manchester, Manchester, United Kingdom

²The Manchester School of Physiotherapy, Manchester Royal Infirmary, University of Manchester, Manchester, United Kingdom

³Musculo‐Skeletal Research Laboratory, Department of Biomedical Engineering, State University of New York, Stony Brook, New York, USA

⁴Department of Paediatric Medicine, Saint Mary's Hospital for Women & Children, Manchester, United Kingdom
Abstract and keywords

The osteogenic potential of short durations of low‐level mechanical stimuli was examined in children with disabling conditions. The mean change in tibia vTBMD was +6.3% in the intervention group compared with −11.9% in the control group. This pilot randomized controlled trial provides preliminary evidence that low‐level mechanical stimuli represent a noninvasive, non‐pharmacological treatment of low BMD in children with disabling conditions.

Introduction: Recent animal studies have demonstrated the anabolic potential of low‐magnitude, high‐frequency mechanical stimuli to the trabecular bone of weight‐bearing regions of the skeleton. The main aim of this prospective, double‐blind, randomized placebo‐controlled pilot trial (RCT) was to examine whether these signals could effectively increase tibial and spinal volumetric trabecular BMD (vTBMD; mg/ml) in children with disabling conditions.

Materials and Methods: Twenty pre‐or postpubertal disabled, ambulant, children (14 males, 6 females; mean age, 9.1 ± 4.3 years; range, 4–19 years) were randomized to standing on active (n = 10; 0.3g , 90 Hz) or placebo (n = 10) devices for 10 minutes/day, 5 days/week for 6 months. The primary outcomes of the trial were proximal tibial and spinal (L2) vTBMD (mg/ml), measured using 3‐D QCT. Posthoc analyses were performed to determine whether the treatment had an effect on diaphyseal cortical bone and muscle parameters.

Results and Conclusions: Compliance was 44% (4.4 minutes per day), as determined by mean time on treatment (567.9 minutes) compared with expected time on treatment over the 6 months (1300 minutes). After 6 months, the mean change in proximal tibial vTBMD in children who stood on active devices was 6.27 mg/ml (+6.3%); in children who stood on placebo devices, vTBMD decreased by −9.45 mg/ml (−11.9%). Thus, the net benefit of treatment was +15.72 mg/ml (17.7%; p = 0.0033). In the spine, the net benefit of treatment, compared with placebo, was +6.72 mg/ml, (p = 0.14). Diaphyseal bone and muscle parameters did not show a response to treatment. The results of this pilot RCT have shown for the first time that low‐magnitude, high‐frequency mechanical stimuli are anabolic to trabecular bone in children, possibly by providing a surrogate for suppressed muscular activity in the disabled. Over the course of a longer treatment period, harnessing bone's sensitivity to these stimuli may provide a non‐pharmacological treatment for bone fragility in children.

Keywords: clinical/pediatrics; mechanical loading; bone QCT; novel entities; tibia; osteoporosis
Links

DOI: 10.1359/JBMR.040129

PubMed: 15040823

WoS: 000189249000003
History

Received: 2003-05-12

Revised: 2003-09-16

Accepted: 2003-10-15

Online: 2004-01-27

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