Whole Body Vibration and Passive Standing for Treatment of Sublesional Osteoporosis After Spinal Cord Injury: Device Optimization & Assessment

Individuals who sustain a spinal cord injury (SCI) experience sublesional osteoporosis (SLOP) which affects the bones of the lower extremities. As a result, these bones become fragile and susceptible to fractures. To tackle SLOP pharmacological and rehabilitation interventions have been proposed; however few have produced a significant and sustainable increase in bone mineral density (BMD).

This study investigated whole-body vibration (WBV) as an alternative to tackling SLOP in SCI. Two commercially available vibration platforms, WAVE® and Juvent™, were tested for feasibility and efficacy in the SCI population. The effects of knee angle, frequency and amplitude of vibration in propagation characteristics were also assessed.

The results demonstrated that variations in frequency generate the most noticeable changes in propagation characteristics, followed by variations in knee angle and amplitude. The recommended vibration parameters which could potentially have the greatest osteogenic effect on the bones of the lower extremity are 160°, 45 Hz, and 0.6 mm on the WAVE® platform.

Year	Entry
2004	Verschueren SMP, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6‐month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res. March 2004;19(3):352-359.
1997	Umemura Y, Ishiko T, Yamauchi T, Kurono M, Mashiko S. Five jumps per day increase bone mass and breaking force in rats. J Bone Miner Res. September 1997;12(10):1480-1485.
2004	Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z. Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Miner Res. March 2004;19(3):360-369.
1977	Parfitt AM. The cellular basis of bone turnover and bone loss: a rebuttal of the osteocytic resorption—bone flow theory. Clin Orthop Relat Res. September 1977;127:236-247.
2002	Rubin C, Turner AS, Mallinckrodt C, Jerome C, Mcleod K, Bain S. Mechanical strain, induced noninvasively in the high-frequency domain, is anabolic to cancellous bone, but not cortical bone. Bone. March 2002;30(3):445-452.
1998	Harazin B, Grzesik J. The transmission of vertical whole-body vibration to the body segments of standing subjects. J Sound Vibrat. 1998;215(4):775-787.
1981	Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ III. Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporosis. J Clin Invest. February 1981;67(2):328-335.
2007	Garman R, Gaudette G, Donahue L-R, Rubin C, Judex S. Low-level accelerations applied in the absence of weight bearing can enhance trabecular bone formation. J Orthop Res. June 2007;25(6):732-740.
1990	Reich KM, Gay CV, Frangos JA. Fluid shear stress as a mediator of osteoblast cyclic adenosine monophosphate production. J Cell Physiol. April 1990;143(1):100-103.
1998	Martin RB, Burr DB, Sharkey NA. Skeletal Tissue Mechanics. New York, NY: Springer-Verlag; 1998.
2001	Rubin C, Turner AS, Bain S, Mallinckrodt C, McLeod K. Low mechanical signals strengthen long bones. Nature. August 9, 2001;412(6847):603-604.
2002	Rubin C, Turner AS, Müller R, Mittra E, McLeod K, Lin W, Qin Y. Quantity and quality of trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechanical intervention. J Bone Miner Res. February 2002;17(2):349-357.
2004	Rubin C, Recker R, Cullen D, Ryaby J, McCabe J, McLeod K. Prevention of postmenopausal bone loss by a low‐magnitude, high‐frequency mechanical stimuli: a clinical trial assessing compliance, efficacy, and safety. J Bone Miner Res. March 2004;19(3):343-351.
1977	Carter DR, Hayes WC. The compressive behavior of bone as a two-phase porous structure. J Bone Joint Surg. 1977;59A(7):954-962.
2007	Judex S, Lei X, Han D, Rubin C. Low-magnitude mechanical signals that stimulate bone formation in the ovariectomized rat are dependent on the applied frequency but not on the strain magnitude. J Biomech. 2007;40(6):1333-1339.
2005	Schriefer JL, Warden SJ, Saxon LK, Robling AG, Turner CH. Cellular accommodation and the response of bone to mechanical loading. J Biomech. September 2005;38(9):1838-1845.
2003	Rubin CP, Pope M, Fritton C, Magnusson M, Hansson T, McLeod K. Transmissibility of 15-Hertz to 35-Hertz vibrations to the human hip and lumbar spine: determining the physiologic feasibility of delivering low-level anabolic mechanical stimuli to skeletal regions at greatest risk of fracture because of osteoporosis. Spine. December 1, 2003;28(23):2621-2627.
1995	Duncan RL, Turner CH. Mechanotransduction and the functional response of bone to mechanical strain. Calcif Tiss Int. December 1995;57(5):344-358.
1984	Lanyon LE, Rubin CT. Static vs dynamic loads as an influence on bone remodelling. J Biomech. 1984;17(12):897-905.
1998	Turner CH, Pavalko FM. Mechanotransduction and functional response of the skeleton to physical stress: the mechanisms and mechanics of bone adaptation. J Orthop Sci. November 1998;3(6):346-355.
2001	Rubin C, Xu G, Judex S. The anabolic activity of bone tissue, suppressed by disuse, is normalized by brief exposure to extremely low‐magnitude mechanical stimuli. FASEB J. October 2001;15(12):2225-2229.
1990	Griffin MJ. Handbook of Human Vibration. London, UK: Academic Press Limited; 1990.
1984	Rubin CT, Lanyon LE. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg. March 1984;66A(3):397-402.
2002	Burr DB, Robling AG, Turner CH. Effects of biomechanical stress on bones in animals. Bone. May 2002;30(5):781-786.
2008	Kiiski J, Heinonen A, Järvinen TL, Kannus P, Sievänen H. Transmission of vertical whole body vibration to the human body. J Bone Miner Res. August 2008;23(8):1318-1325.
1994	Turner CH, Forwood MR, Otter MW. Mechanotransduction in bone: do bone cells act as sensors of fluid flow? FASEB J. August 1994;8(11):875-878.
2008	Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. September 2008;83(9):1032-1045.
1994	Weinbaum S, Cowin SC, Zeng Y. A model for the excitation of osteocytes by mechanical loading-induced bone fluid shear stresses. J Biomech. March 1994;27(3):339-360.
1989	Martin RB, Burr DB. Structure, Function, and Adaptation of Compact Bone. New York, NY: Raven Press; 1989.
1998	Majumdar S, Kothari M, Augat P, Newitt DC, Link TM, Lin JC, Lang T, Lu Y, Genant HK. High-resolution magnetic resonance imaging: three-dimensional trabecular bone architecture and biomechanical properties. Bone. May 1998;22(5):445-454.
1999	Burger EH, Klein-Nulend J. Mechanotransduction in bone: role of the lacunocanalicular network. FASEB J. May 1999;12(9001):S101-S112.
1998	Turner CH. Three rules for bone adaptation to mechanical stimuli. Bone. November 1998;23(5):399-407.
2006	Robling AG, Castillo AB, Turner CH. Biomechanical and molecular regulation of bone remodeling. Annu Rev Biomed Eng. 2006;8:455-498.
2004	Warden SJ, Turner CH. Mechanotransduction in the cortical bone is most efficient at loading frequencies of 5–10 hz. Bone. February 2004;34(2):261-270.
2000	Robling AG, Burr DB, Turner CH. Partitioning a daily mechanical stimulus into discrete loading bouts improves the osteogenic response to loading. J Bone Miner Res. August 2000;15(8):1596-1602.
2001	Robling AG, Burr DB, Turner CH. Recovery periods restore mechanosensitivity to dynamically loaded bone. J Exp Biol. 2001;204(19):3389-3399.
2002	Robling AG, Hinant FM, Burr DB, Turner CH. Improved bone structure and strength after long‐term mechanical loading is greatest if loading is separated into short bouts. J Bone Miner Res. August 2002;17(8):1545-1554.
2006	Gilsanz V, Wren TAL, Sanchez M, Dorey F, Judex S, Rubin C. Low‐level, high‐frequency mechanical signals enhance musculoskeletal development of young women with low bmd. J Bone Miner Res. September 2006;21(9):1464-1474.
1984	Rubin CT. Skeletal strain and the functional significance of bone architecture. Calcif Tiss Int. March 1984;36(suppl 1):S11-S18.
1995	Mullender MG, Huiskes R. Proposal for the regulatory mechanism of Wolff's law. J Orthop Res. July 1995;13(4):503-512.
1994	Frost HM. Wolff's law and bone's structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod. June 1994;64(3):175-188.

Year

Entry

2004

Verschueren SMP, Roelants M, Delecluse C, Swinnen S, Vanderschueren D, Boonen S. Effect of 6‐month whole body vibration training on hip density, muscle strength, and postural control in postmenopausal women: a randomized controlled pilot study. J Bone Miner Res. March 2004;19(3):352-359.

1997

Umemura Y, Ishiko T, Yamauchi T, Kurono M, Mashiko S. Five jumps per day increase bone mass and breaking force in rats. J Bone Miner Res. September 1997;12(10):1480-1485.

2004

Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z. Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Miner Res. March 2004;19(3):360-369.

1977

Parfitt AM. The cellular basis of bone turnover and bone loss: a rebuttal of the osteocytic resorption—bone flow theory. Clin Orthop Relat Res. September 1977;127:236-247.

2002

Rubin C, Turner AS, Mallinckrodt C, Jerome C, Mcleod K, Bain S. Mechanical strain, induced noninvasively in the high-frequency domain, is anabolic to cancellous bone, but not cortical bone. Bone. March 2002;30(3):445-452.