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  • Osteoporosis, bone metabolism

    Hi Justin Keogh, Louis Amundsen and others,

    On Sunday evening I saw a feature on the use of bone growth
    stimulating proteins, presented on the Australian TV science
    programme "Beyond 2000". The snippet was on work done at the Bone
    Research Unit, attached to the Dept of Orthopaedics of the University
    of the Witwatersrand's Medical School. It featured a woman whose
    mandible, completely removed due to a tumour, was replaced with a pure
    titanium meshwork grille, (quite thin, and presumably mechanically
    non-functional), filled with a mixture of healthy bone chips and these
    "newly found" bone growth stimulating proteins. The result was absolutely
    amazing - a completely new jaw of healthy new bone that replaced
    the original item, and which was completely functional in three
    months, ready to receive a set of false teeth..

    The feature seemed to indicate that the jaw did not have to be extensively
    exercised, and that the major role in bone growth was in fact played
    by these chemical messengers, which switched osteoblastic and
    osteoclastic activity on and off. Now I don't believe that this is
    contrary to anything that has been said before, since these protein
    growth stimulants are clearly usually produced by cells stimulated by
    exercise - exercise is the key. However the feature stated that it
    would now be possible for completely new bones to be grown to replace
    the originals, and that osteoporotic sufferers would soon be allowed
    to receive injections of these bone growth stimulants which would
    cure them!

    The feature went even further - these protein growth stimulants
    apparently also stimulate organ growth, and it seems likely
    that soon damaged organs will be capable of being regenerated from
    small undamaged fragments. (Is this simply media hype?) I think that
    biomechanical engineers working on prostheses should be aware that the
    time of genetic and growth stimulant solutions to problems which use to
    demand prosthetics is dawning!

    I am sure that many of you are also aware of the work of
    Helminen, Kiviranta et al. (Finland) and Jill Urban et al. of the University
    of Oxford (I'll find and post the references soon!)
    on the production of proteoglycans in cartilage, under different
    loading regimes. They have found that cyclical loading of
    chondrocytes is closely linked to the production of PGs, but it seems that the
    ratio of loading to unloading time, and the frequency of loading are
    critical. If I remember correctly Prof Currey of the Univ of York
    found something similar with bone, loading the ulnas of turkeys. If
    he reads this message, it'd be interesting to hear about his work.
    Anyhow, the upshot of this is that I am convinced that the repitition frequency,
    magnitude, and rate of load change all play a role in determining
    bone removal and deposition. It would probably be a good idea to
    measure cyclic AMP levels versus load stimulation of bone cells. (The
    transduction of the load signal, is of course, a fascinating issue!)

    Interestingly the limb bones of many skeletons of South African
    antelope which I have looked at, at the Tvl Museum in Pretoria, all
    display the removal of bone in tension, and thickening in
    compression. The question arises as to whether this is generally
    true for all bones, throughout the animal kingdom,
    (do the ossicles of the ear, or the iliac wings also obey this rule,
    for example?), or whether the location of a bone also plays a role in
    determining whether it can continue to exist in a slightly tensile
    loading regime. Conversely can collagen happily exist in a
    feebly tensile or purely compressive field? (It seems happy enough
    in bone!) Is the collagen network placed
    under tension in bone, so that the bone is in fact a prestressed
    material? If so, how great is this prestressing in MPa, and what is
    the significance of prestressing for the mechanical behaviour of
    bone? How would the collagen be kept in tension?

    Mark W Swanepoel
    School of Mechanical Engineering
    University of the Witwatersrand
    South Africa

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