Structural analysis of the human tibia by tomographic (pQCT) serial scans.

This study analyses the evaluation of tomographic indicators of tibia structure, assuming that the usual loading pattern shifts from uniaxial compression close to the heel to a combined compression, torsion and bending scheme towards the knee. To this end, pQCT scans were obtained at 5% intervals of the tibia length (S5-S95 sites from heel to knee) in healthy men and women (10/10) aged 20-40 years. Indicators of bone mass [cortical area, cortical/total bone mineral content (BMC)], diaphyseal design (peri/endosteal perimeters, cortical thickness, circularity, bending/torsion moments of inertia - CSMIs), and material quality [(cortical vBMD (bone mineral density)] were determined. The longitudinal patterns of variation of these measures were similar between genders, but male values were always higher except for cortical vBMD. Expression of BMC data as percentages of the minimal values obtained along the bone eliminated those differences. The correlative variations in cortical area, BMC and thickness, periosteal perimeter and CSMIs along the bone showed that cortical bone mass was predominantly associated with cortical thickness toward the mid-diaphysis, and with bone diameter and CSMIs moving more proximally. Positive relationships between CSMIs (y) and total BMC (x) showed men's values shifting to the upper-right region of the graph and women's values shifting to the lower-left region. Total BMC decayed about 33% from S5 to S15 (where minimum total BMC and CSMI values and variances and maximum circularity were observed) and increased until S45, reaching the original S5 value at S40. The observed gender-related differences reflected the natural allometric relationships. However, the data also suggested that men distribute their available cortical mass more efficiently than women. The minimum amount and variance of mass indicators and CSMIs, and the largest circularity observed at S15 reflected the assumed adaptation to compression pattern at that level. The increase in CSMIs (successively for torsion, A-P bending, and lateral bending), the decrease in circularity values and the changes in cortical thickness and periosteal perimeter toward the knee described the progressive adaptation to increasing torsion and bending stresses. In agreement with the biomechanical background, the described relationships: (i) identify the sites at which some changes in tibial stresses and diaphyseal structure take place, possibly associated with fracture incidence; (ii) allow prediction of mass indicators at any site from single determinations; (iii) establish the proportionality between the total bone mass at regions with highly predominant trabecular and cortical bone of the same individual, suitable for a specific evaluation of changes in trabecular mass; and (iv) evaluate the ability of bone tissue to self-distribute the available cortical bone according to specific stress patterns, avoiding many anthropometric and gender-derived influences.

Muscle atrophy and bone loss after 90 days' bed rest and the effects of flywheel resistive exercise and pamidronate: results from the LTBR study.

Muscle atrophy and bone loss pose substantial problems for long-term space flight and in clinical immobilization. We therefore tested the efficacy of flywheel resistive exercise and pamidronate to counteract such losses. Twenty five young healthy males underwent strict bed rest with -6 degrees head-down tilt for 90 days. Subjects were randomized into an exercise group that practiced resistive exercise with a 'flywheel' (FW) device every 2-3 days, a pamidronate group (Pam) that received 60 mg pamidronate i.v. 14 days prior to bed rest and a control group (Ctrl) that received none of these countermeasures. During the study, Ca(++) and protein intake were controlled. Peripheral quantitative computed tomography (pQCT) was used to assess bone mineral content (BMC) and muscle cross sectional area (mCSA) of calf and forearm. Measurements were taken twice during baseline data collection, after 28 and after 89 days bed rest, and after 14 days recovery. On the same days, urinary Pyridinoline excretion and serum levels of alkaline phosphatase, Ca(++) and PTH were measured. Pre-study exercise habits were assessed through the Freiburg questionnaire. Losses in calf mCSA were significantly reduced in FW (Ctrl: -25.6% +/- 2.5% Pam: -25.6% +/- 3.7%, FW: -17.3% +/- 2.7%), but not in the forearm mCSA (Ctrl: -6.4% +/- 4.33%, Pam: -7.7% +/- 4.1%, FW: -7.6% +/- 3.3%). Both diaphyseal and epiphyseal BMC losses of the tibia were mitigated in Pam and FW as compared to Ctrl, although this was significant only at the diaphysis. Inter-individual variability was significantly greater for changes in BMC than in mCSA, and correlation of BMC losses was poor among different locations of the tibia. A significant positive correlation was found between change in tibia epiphyseal BMC and serum cortisol levels. These findings suggest that both countermeasures are only partly effective to preserve BMC (FW and Pam) and mCSA (FW) of the lower leg during bed rest. The partial efficacy of flywheel exercise as well as the bones' response to unloading per se underlines the importance of mechanical stimuli. The huge variability of BMC changes, however, suggests that other factors affect changes in whole-bone strength following acute mechanical disuse.

Reproducibility of the jumping mechanography as a test of mechanical power output in physically competent adult and elderly subjects.

OBJECTIVES: To compare the reproducibility of the newly developed jumping mechanography with other physical tests. DESIGN: Study 1: Repeated testing with an interval of 2 weeks to assess the short-term repetition error. Study 2: Testing on 5 successive days to assess learning effects. SETTING: Geriatric clinic, Esslingen, Germany. PARTICIPANTS: Study 1 had 36 subjects aged 24 to 88; Study 2 had 22 subjects aged 19 to 86. Locomotor competence in all subjects was assessed using the ability to walk unaided and to perform a tandem stand and tandem walk. MEASUREMENTS: The test battery consisted of timed up and go, freely chosen gait speed, maximum gait speed, chair-rising test, and maximum power in jumping mechanography. RESULTS: All subjects performed the jumping mechanography without major problems. Study 1: Of all tests, maximum power in jumping mechanography depicted the smallest intrasubject short-term error (3.6%), the largest intersubject coefficient of variation (45.4%), and the greatest test-retest correlation coefficient (r=0.99). Study 2: The only tests for which the learning effects were confined to the 1% range were the maximum gait speed test and the maximum power in jumping mechanography. CONCLUSION: Assessment of maximum power in jumping mechanography appears to have good test-retest reliability with negligible learning effects. Moreover, it results in a comparatively large intersubject variability, which makes it an interesting method in the assessment of aging effects in middle-aged to older subjects and patients.

Is muscle power output a key factor in the age-related decline in physical performance? A comparison of muscle cross section, chair-rising test and jumping power.

Ageing compromises locomotor capacity and is associated with an increased risk of falls. Several lines of evidence indicate that both changes in muscle mass and performance are causative. Most studies, however, do not discern between effects of ageing, sedentarism and comorbidity. The present study compares the age effects in muscle cross section, force and power in physically competent self-selected subjects of different age groups. A total of 169 women and 89 men between 18 and 88 years, without any disease, impairment or medication affecting the musculoskeletal system were enrolled in this study. Calf muscle cross-sectional area was assessed by computed tomography. Muscle force and power were assessed by jumping mechanography. No significant correlation between muscle cross section and age was found in the men. A weak correlation in the women disappeared after correction for height. Close correlations with age, however, were found for peak force and peak power. Correction for muscle cross section or body weight further increased these correlation coefficients, particularly for peak power specific to body weight (r = 0.81 in women and r = 0.86 in men). The non-sedentarian population investigated here depicted a reduction of >50% between the age of 20 and 80 without a reduction in muscle cross section. This suggests a crucial role for muscular power in the ageing process. Possibly, the jumping mechanography as a measurement of anti-gravitational power output is a promising extension of the chair-rising test, known to be predictive for immobilization and the risk of falls.

Progressive adaptation in physical activity and neuromuscular performance during 520d confinement.

To understand whether prolonged confinement results in reductions in physical activity and adaptation in the musculoskeletal system, six subjects were measured during 520 d isolation in the Mars500 study. We tested the hypothesis that physical activity reduces in prolonged confinement and that this would be associated with decrements of neuromuscular performance. Physical activity, as measured by average acceleration of the body's center of mass ("activity temperature") using the actibelt® device, decreased progressively over the course of isolation (p<0.00001). Concurrently, countermovement jump power and single-leg hop force decreased during isolation (p<0.001) whilst grip force did not change (p≥0.14). Similar to other models of inactivity, greater decrements of neuromuscular performance occurred in the lower-limb than in the upper-limb. Subject motivational state increased non-significantly (p = 0.20) during isolation, suggesting reductions in lower-limb neuromuscular performance were unrelated to motivation. Overall, we conclude that prolonged confinement is a form of physical inactivity and is associated with adaptation in the neuromuscular system.

Prevention of bone loss during 56 days of strict bed rest by side-alternating resistive vibration exercise.

Bed rest is a recognized model for muscle atrophy and bone loss in space flight and in clinical medicine. We hypothesized that whole body vibration in combination with resistive exercise (RVE) would be an effective countermeasure. Twenty healthy male volunteers underwent horizontal bed rest for 56 days and were randomly assigned either to a group that performed RVE 11 times per week or to a group that underwent bed rest only (Ctrl). Bone mineral content (BMC) was assessed by peripheral quantitative computed tomography (pQCT) in the tibia and the radius and by dual x-ray absorptiometry (DXA) in the hip and lumbar spine at baseline and at regular intervals during bed rest and a 12-month follow-up. RVE appeared to protect muscle size and function, and it also prevented bone loss (p-values between <0.001 and 0.01). Bone losses were largest in the distal tibia epiphysis, where BMC declined from 421.8 mg/mm (SD 51.3) to 406.6 mg/mm (SD 52.7) in Ctrl, but only from 411.1 mg/mm (SD 56.6) to 409.6 mg/mm (SD 66.7) in RVE. Most of the BMC losses were recovered by 12-month follow-up. Analyses showed that the epiphyseal cortex, rather than spongiosa, depicted the most pronounced changes during bed rest and recovery. These results suggest that the combined countermeasure applied in this study is effective to prevent bone losses from the tibia. This underlines the importance of mechanical usage for the maintenance of the human skeleton.