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A model-based bone milling state identification method via force sensing for a robotic surgical system

Al-Abdullah KI, Lim CP, Najdovski Z, Yassin W

Int J Med Robot, 2019 Jun;15(3):e1989.
PMID: 30721570 DOI: 10.1002/rcs.1989

BACKGROUND: This paper presents a model-based bone milling state identification method that provides intraoperative bone quality information during robotic bone milling. The method helps surgeons identify bone layer transitions during bone milling.
METHODS: On the basis of a series of bone milling experiments with commercial artificial bones, an artificial neural network force model is developed to estimate the milling force of different bone densities as a function of the milling feed rate and spindle speed. The model estimations are used to identify the bone density at the cutting zone by comparing the actual milling force with the estimated one.
RESULTS: The verification experiments indicate the ability of the proposed method to distinguish between one cortical and two cancellous bone densities.
CONCLUSIONS: The significance of the proposed method is that it can be used to discriminate a set of different bone density layers for a range of the milling feed rate and spindle speed.

Matched MeSH terms: Bone and Bones
Fulltext The State of Starch/Hydroxyapatite Composite Scaffold in Bone Tissue Engineering with Consideration for Dielectric Measurement as an Alternative Characterization Technique

Mohd Roslan MR, Mohd Kamal NL, Abdul Khalid MF, Mohd Nasir NF, Cheng EM, Beh CY, et al.

Materials (Basel), 2021 Apr 14;14(8).
PMID: 33919814 DOI: 10.3390/ma14081960

Hydroxyapatite (HA) has been widely used as a scaffold in tissue engineering. HA possesses high mechanical stress and exhibits particularly excellent biocompatibility owing to its similarity to natural bone. Nonetheless, this ceramic scaffold has limited applications due to its apparent brittleness. Therefore, this had presented some difficulties when shaping implants out of HA and for sustaining a high mechanical load. Fortunately, these drawbacks can be improved by combining HA with other biomaterials. Starch was heavily considered for biomedical device applications in favor of its low cost, wide availability, and biocompatibility properties that complement HA. This review provides an insight into starch/HA composites used in the fabrication of bone tissue scaffolds and numerous factors that influence the scaffold properties. Moreover, an alternative characterization of scaffolds via dielectric and free space measurement as a potential contactless and nondestructive measurement method is also highlighted.

Matched MeSH terms: Bone and Bones
Oxygen-Releasing Scaffolds for Accelerated Bone Regeneration

Touri M, Moztarzadeh F, Abu Osman NA, Dehghan MM, Brouki Milan P, Farzad-Mohajeri S, et al.

ACS Biomater Sci Eng, 2020 05 11;6(5):2985-2994.
PMID: 33463293 DOI: 10.1021/acsbiomaterials.9b01789

Hypoxia, the result of disrupted vasculature, can be categorized in the main limiting factors for fracture healing. A lack of oxygen can cause cell apoptosis, tissue necrosis, and late tissue healing. Remedying hypoxia by supplying additional oxygen will majorly accelerate bone healing. In this study, biphasic calcium phosphate (BCP) scaffolds were fabricated by robocasting, an additive manufacturing technique. Then, calcium peroxide (CPO) particles, as an oxygen-releasing agent, were coated on the BCP scaffolds. Segmental radial defects with the size of 15 mm were created in rabbits. Uncoated and CPO-coated BCP scaffolds were implanted in the defects. The empty (control) group received no implantation. Repairing of the bone was investigated via X-ray, histological analysis, and biomechanical tests at 3 and 6 months postoperatively, with immunohistochemical examinations at 6 months after operation. According to the radiological observations, formation of new bone was augmented at the interface between the implant and host bone and internal pores of CPO-coated BCP scaffolds compared to uncoated scaffolds. Histomorphometry analysis represented that the amount of newly formed bone in the CPO-coated scaffold was nearly two times higher than the uncoated one. Immunofluorescence staining revealed that osteogenic markers, osteonectin and octeocalcin, were overexpressed in the defects treated with the coated scaffolds at 6 months of postsurgery, demonstrating higher osteogenic differentiation and bone mineralization compared to the uncoated scaffold group. Furthermore, the coated scaffolds had superior biomechanical properties as in the case of 3 months after surgery, the maximal flexural force of the coated scaffolds reached to 134 N, while it was 92 N for uncoated scaffolds. The results could assure a boosted ability of bone repair for CPO-coated BCP scaffolds implanted in the segmental defect of rabbit radius because of oxygen-releasing coating, and this system of oxygen-generating coating/scaffold might be a potential for accelerated repairing of bone defects.

Matched MeSH terms: Bone and Bones
Fluid-structure interaction (FSI) modeling of bone marrow through trabecular bone structure under compression

Rabiatul AAR, Fatihhi SJ, Md Saad AP, Zakaria Z, Harun MN, Kadir MRA, et al.

Biomech Model Mechanobiol, 2021 Jun;20(3):957-968.
PMID: 33547975 DOI: 10.1007/s10237-021-01423-x

The present study has sought to investigate the fluid characteristic and mechanical properties of trabecular bone using fluid-structure interaction (FSI) approach under different trabecular bone orientations. This method imposed on trabecular bone structure at both longitudinal and transverse orientations to identify effects on shear stress, permeability, stiffness and stress regarded to the trabeculae. Sixteen FSI models were performed on different range trabecular cubes of 27 mm3 with eight models developed for each longitudinal and transverse direction. Results show that there was a moderate correlation between permeability and porosity, and surface area in the longitudinal and transverse orientations. For the longitudinal orientation, the permeability values varied between 3.66 × 10-8 and 1.9 × 10-7 and the sheer stress values varied between 0.05 and 1.8 Pa, whilst for the transverse orientation, the permeability values varied between 5.95 × 10-10 and 1.78 × 10-8 and the shear stress values varied between 0.04 and 3.1 Pa. Here, transverse orientation limits the fluid flow from passing through the trabeculae due to high shear stress disturbance generated within the trabecular bone region. Compared to physiological loading direction (longitudinal orientation), permeability is higher within the range known to trigger a response in bone cells. Additionally, shear stresses also increase with bone surface area. This study suggests the shear stress within bone marrow in real trabecular architecture could provide the mechanical signal to marrow cells that leads to bone anabolism and can depend on trabecular orientation.

Matched MeSH terms: Bone and Bones
Fulltext Application of Computational Method in Designing a Unit Cell of Bone Tissue Engineering Scaffold: A Review

Mustafa NS, Akhmal NH, Izman S, Ab Talib MH, Shaiful AIM, Omar MNB, et al.

Polymers (Basel), 2021 May 14;13(10).
PMID: 34069101 DOI: 10.3390/polym13101584

The design of a scaffold of bone tissue engineering plays an important role in ensuring cell viability and cell growth. Therefore, it is a necessity to produce an ideal scaffold by predicting and simulating the properties of the scaffold. Hence, the computational method should be adopted since it has a huge potential to be used in the implementation of the scaffold of bone tissue engineering. To explore the field of computational method in the area of bone tissue engineering, this paper provides an overview of the usage of a computational method in designing a unit cell of bone tissue engineering scaffold. In order to design a unit cell of the scaffold, we discussed two categories of unit cells that can be used to design a feasible scaffold, which are non-parametric and parametric designs. These designs were later described and being categorised into multiple types according to their characteristics, such as circular structures and Triply Periodic Minimal Surface (TPMS) structures. The advantages and disadvantages of these designs were discussed. Moreover, this paper also represents some software that was used in simulating and designing the bone tissue scaffold. The challenges and future work recommendations had also been included in this paper.

Matched MeSH terms: Bone and Bones
Tissue-Engineered Hydroxyapatite Bone Scaffold Impregnated with Osteoprogenitor Cells Promotes Bone Regeneration in Sheep Model

Bajuri MY, Selvanathan N, Dzeidee Schaff FN, Abdul Suki MH, Ng AMH

Tissue Eng Regen Med, 2021 06;18(3):377-385.
PMID: 34043210 DOI: 10.1007/s13770-021-00343-2

BACKGROUND: Managing massive bone defects, a great challenge to orthopaedics reconstructive surgery. The problem arise is the supply of suitable bone is limited with many complications. Tissue-engineered hydroxyapatite bone (TEHB) scaffold impregnated with osteoprogenitor cells developed as an alternative to promote bone regeneration.
METHODS: This animal protocol has been approved by Universiti Kebangsaan Malaysia Animal Ethical Committee. The TEHB scaffold prepared from hydroxyapatite using gel casting method. A total of six adolescent female sheep were chosen for this study. Later, all the sheep were euthanized in a proper manner and the bone harvested for biomechanical study. Bone marrow was collected from iliac crest of the sheep and bone marrow stem cells (BMSCs) isolated and cultured. BMSCs then cultured in osteogenic medium for osteoprogenitor cells development and the plasma collected was seeded with osteoprogenitor cells mixed with calcium chloride. Bone defect of 3 cm length of tibia bone created from each sheep leg and implanted with autologous and TEHB scaffold in 2 different groups of sheep. Wound site was monitored weekly until the wound completely healed and conventional X-ray performed at week 1 and 24. Shear test was conducted to determine the shear force on the autologous bone and TEHB scaffold after implantation for 24 weeks.
RESULTS: All of the sheep survived without any complications during the study period and radiograph showed new bone formation. Later, the bone harvested was for biomechanical study. The highest shear force for the autologous group was 13 MPa and the lowest was 5 MPa while for the scaffold group, the highest was 10 MPa and the lowest was 3 MPa. Although, proximal and distal interface of autologous bone graft shows higher shear strength compared to the TEHB scaffold but there is no significant difference in both groups, p value > 0.05. Histologically in both proximal and distal interface in both arms shows bone healing and woven bone formation.
CONCLUSION: TEHB scaffold impregnated with osteoprogenitor cells has the potential to be developed as a bone substitute in view of its strength and capability to promote bone regeneration.

Matched MeSH terms: Bone and Bones
Fulltext The Role of Real Time Ultrasound in Differentiatingbetween Osteomyelitis and Tumour in Long Bones

George, J., Teo, S.C., Adan, M.

Malays Orthop J, 2008;2(1):33-37.
MyJurnal

Aim: This study was designed to evaluate the use of ultrasound in diagnosis of infection and tumour of long bones. Methodology: Patients referred from the orthopaedic unit with doubt regarding long bone clinical and/or radiological signs which could be tumour or infection were enrolled in this study. Analysis of ultrasound characteristics included presence of pericortical fluid over normal cortex well away from the primary lesion, wavy contour sign (fluid tracking in and out muscle planes), subperiosteal fluid and soft tissue mass displacing adjacent muscle planes. Results: Fourteen out of 15 patients with confirmed osteomyelitis were diagnosed by ultrasound examination. Ultrasound as a diagnostic tool has a sensitivity of 93% and specificity of 100%. The most accurate indicator was pericortical fluid noted up to several centimetres from the long bone abnormality seen on plain x-rays. Conclusion: Ultrasound is a safe, fast, cost-effective imaging modality that can play an important role in diagnosis of osteomyelitis as it then serves as a tool for ultrasound guided aspiration.

Matched MeSH terms: Bone and Bones
In vitro evaluation of osteoprotegerin in chitosan for potential bone defect applications

Jayash SN, Hashim NM, Misran M, Baharuddin NA

PeerJ, 2016;4:e2229.
PMID: 27635307 DOI: 10.7717/peerj.2229

The receptor activator of nuclear factor kappa-B (RANK)/RANK ligand/osteoprotegerin (OPG) system plays a critical role in bone remodelling by regulating osteoclast formation and activity. OPG has been used systemically in the treatment of bone diseases. In searching for more effective and safer treatment for bone diseases, we investigated newly formulated OPG-chitosan complexes, which is prepared as a local application for its osteogenic potential to remediate bone defects.

Matched MeSH terms: Bone and Bones
Fulltext Ameloblastic carcinoma: A case with cervical node and pulmonary metastases

Khoo SP, Ong ST

Ann Dent, 1998;5(1):49-52.
MyJurnal

Odontogenic carcinomas of the jaws are subclassified into malignant ameloblastoma, ameloblastic carcinoma and primary intraosseous carcinoma arising from within the bone. These may arise from residual islands of epithelium derived from dental lamina or epithelial lining of dental cysts. Ameloblastic carcinoma is extremely rare. An aggressive case of ameloblastic carcinoma occumng in a 59-year-old Malay man is presented. Wide excision of the primary lesion with radical neck dissection was carried out. He developed lung metastasis 4 months post-operatively. Despite chemotherapy upon discovery of lung metastasis, he expired 7 months following the initial diagnosis.

Matched MeSH terms: Bone and Bones
Fulltext Optimization of gelatin extraction and physico-chemical properties of catfish (Clarias gariepinus) bone gelatin

Sanaei, A.V., Mahmoodani, F., See, S.F., Yusop, S.M., Babji, A.S.

International Food Research Journal, 2013;20(1):423-430.
MyJurnal

The extraction of catfish (Clarias gariepinus) bone gelatin was optimized by using Response Surface Methodology (RSM) involving 4-factors, 5-levels Central Composite Design (CCD). The optimum conditions for extraction were produced by a pre-treatment of 3.35% HCl for 14.5 h along with hot water extraction at 67.23°C for 5.2 h. Results showed that the predicted yield by RSM (61.81%) was closely matched the experimental yield of 60.54%. The results also indicated that the extracted bone gelatin possessed high protein content (81.75%) and imino acid (proline and hydroxyproline) (144 residues per 1000 residues), with gel strength (230.25 g), viscosity (4.64 mPa.s) and isoionic point (5.35) comparable to that of bovine gelatin. The results suggested that RSM is a great optimizing tool for extraction of gelatin from clarias catfish bone and values of the physicochemical properties of gelatin are higher or comparable than those from other fish species and bovine gelatin.

Matched MeSH terms: Bone and Bones
Fulltext Antibacterial property of locally produced hydroxyapatite

Tin-Oo, M.M., Gopalakrishnan, V., Samsuddin, A.R., Al Salihi, K.A., Shamsuria, O.

Archives of Orofacial Sciences, 2007;2(1):41-44.
MyJurnal

Use of synthetic hydroxyapatite (HA) in biomedical applications is well warranted. It has shown to have an excellent biocompatibility in human tooth and bones. Additionally it has been documented to possess antibacterial potentials. The present study was conducted to assess the presence of any such potential in locally produced (HA) using Streptococcus mutans, a common pathogen in the oral cavity. The study was carried out using 50, 100, 150, 200, 300, 400 and 800 mg/ml concentration of HA. The antibacterial property of HA was assessed using Miles and Misra method. Our studies showed that bacterial growth inhibitions of S. mutans occurred from 50 mg/ml, and complete inhibition was perceived at concentrations at 200mg/ml of HA. The antibacterial property HA should be used to good advantage as a bioactive biomaterial in dental and maxillofacial applications.

Matched MeSH terms: Bone and Bones
Fulltext Spectroscopic studies of cow femurs and Porites species coral from Sabah

Fadhlia Zafarina Zakaria, Fauziah Abdul Aziz, Thevarajah, Nahulan

Journal of Nuclear and Related Technologies, 2007;2007(1):181-184.
MyJurnal

Some cortical bone specimens from the femurs of adult cows and sea coral of Porites species were studied by using Fourier Transform Infrared Spectroscopy, FTIR. Carbonate were shown to be present by indication of C-O stretch found between 1510-1410 cm -1 in both cortical bone and Porites. Based on the comparison of the relative intensity of CO3 2- bands with respect to the PO4 3- bands, peak intensity of Porites was found to be higher than peak intensity of cortical bone at carbonate band. This explains that Porites skeleton is made up of CaCO3 while bone consists of a mineral, hydroxyapatite Ca5(PO4)3OH with the present of carbonate ions, typically from 3 to 7 wt%.

Matched MeSH terms: Bone and Bones
Fulltext The Use Demineralized Freeze-Dried Bovine Bone Xenograft In Reducing Post-Surgical Periodontal Pocket Depth

Baharuddin, N.A., Kamin, S., Samsuddin, A.R.

Ann Dent, 2003;10(1):-.
MyJurnal

This study evaluated the effectiveness of demineralized freeze-dried bone xenograft in reducing post-surgical pocket depth in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were selected for this study. The bony defects were matched for tooth type, location and pocket depth. Following an initial non-surgical treatment, only pockets of 5 to 7 mm deep were indicated for surgery. Periodontal pockets were measured pre-operatively and at 3, 6 and 9 months post-surgically. The study protocol included a split mouth design, where surgical treatment was carried out at both test and control sites. The test sites were assigned demineralized freeze-dried bone xenograft and the control sites were subjected to debridement alone without the use of demineralized freeze-dried bone xenograft. The results from this study showed a statistically significant difference in the mean pocket depth at 6 and 9 months post-operatively for both test and control groups, but there was no statistically significant difference at 3 months. In conclusion, demineralized freeze-dried bone xenograft was ineffective in reducing periodontal pocket depth in patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Matched MeSH terms: Bone and Bones
Fulltext A review on hydroxyapatite-based scaffolds as a potential bone graft substitute for bone tissue engineering applications

Krishnamurithy, G.

JUMMEC, 2013;16(2):1-6.
MyJurnal

The biocompatibility and similarity of hydroxyapatite (HA) to the mineral composition of the bone has made HA a potential candidate in bone tissue engineering (BTE). Over the past few decades, its application as bone graft in combination with stem cells has gained much importance. The use of bone marrow-derived mesenchymal stromal cells (MSCs) will enhance the rate and quality of defect repair. However, application of hydroxyapatite as a material to develop a 3-dimension scaffold or carrier to support MSCs in vitro is still in its infant stage. This review will discuss the source, manufacturing methods and advantages of using HA scaffolds in bone tissue engineering applications.

Matched MeSH terms: Bone and Bones
Fulltext Establishing freeze drying process for cortical and cancellous bone allograft cubes

Ariffin, A.A., Chan, H.H., Yusof, N., Mohd, S., Ng, W.M., Mansor A.

JUMMEC, 2019;22(1):66-71.
MyJurnal

Freeze drying is a dehydration method to dry bone under freezing environment, enabling removal of water
with no or minimial effects on bone strength and durability. Larger size bones obviously require longer freeze
drying time to reduce water content to the required level for long term storage at room temperature. For small
size bone cubes or chips, it is a normal practice to pool cortical and cancellous bones for freeze drying. The
study was aimed at determining if different type of bones of the same size influence the drying time. Human
bone cubes of 10 mm x 10 mm x 10 mm were prepared from cortical bone of tibiae and cancellous bone from
femoral heads. The bone cubes were freeze dried to reduce water content to less than 6%. Moisture content
was monitored using gravimetric method.Weight and density of cortical bone were significantly higher than
cancellous bone despite of having similar small size (p

Matched MeSH terms: Bone and Bones
The effects of gonadotropin-releasing hormone agonist (buserelin) and orchidectomy on bone turnover markers and histomorphometry in rats

Mohamad NV, Ima-Nirwana S, Chin KY

Aging Male, 2020 Dec;23(5):327-334.
PMID: 29495911 DOI: 10.1080/13685538.2018.1446075

This study aimed to compare the skeletal effect between GnRH agonist therapy and orchidectomy in male rats assessed using serum turnover markers and bone histomorphometry. Three-month-old male Sprague-Dawley rats (n = 46) were divided into three experimental arms, baseline, buserelin, and orchidectomy. In the buserelin arm, the rats received a daily subcutaneous injection of either normal saline or buserelin acetate at 25 µg/kg or 75 µg/kg. In the orchidectomy arm, the rats were either sham-operated or orchidectomized. The rats were euthanized after the three-month treatment. Blood was collected for the evaluation of bone turnover markers. Femurs were harvested for bone histomorphometry examination. A significant increase in serum C-telopeptide of type 1 collagen was observed in the orchidectomized group compared with the sham group (p bone volume, number and significantly increased trabecular separation in rats compared with their respective controls (p bone microarchitecture and increased bone resorption similar to orchidectomy after three months.

Matched MeSH terms: Bone and Bones
Fulltext Angiogenic and osteogenic potentials of dental stem cells in bone tissue engineering

Yusof MFH, Zahari W, Hashim SNM, Osman ZF, Chandra H, Kannan TP, et al.

J Oral Biol Craniofac Res, 2017 10 19;8(1):48-53.
PMID: 29556464 DOI: 10.1016/j.jobcr.2017.10.003

Manipulation of dental stem cells (DSCs) using current technologies in tissue engineering unveil promising prospect in regenerative medicine. DSCs have shown to possess angiogenic and osteogenic potential in both in vivo and in vitro. Neural crest derived DSCs can successfully be isolated from various dental tissues, exploiting their intrinsic great differentiation potential. In this article, researcher team intent to review the characteristics of DSCs, with focus on their angiogenic and osteogenic differentiation lineage. Clinical data on DSCs are still lacking to prove their restorative abilities despite extensive contemporary literature, warranting research to further validate their application for bone tissue engineering.

Matched MeSH terms: Bone and Bones
Influence of Adolescents' Physical Activity on Bone Mineral Acquisition: A Systematic Review Article

Zulfarina MS, Sharkawi AM, Aqilah-S N ZS, Mokhtar SA, Nazrun SA, Naina-Mohamed I

Iran J Public Health, 2016 Dec;45(12):1545-1557.
PMID: 28053920

BACKGROUND: This study conducted to examine and to provide a systematic literature over the influence of adolescents' physical activity (PA) in maximizing`s peak bone mass (PBM). PBM or the 'bone bank' is an important determinant in achieving healthy bone. PA is one of the bone's lifestyle contributors and high PBM is one of the major strategies for preventing osteoporosis.
METHODS: A computerized literature search using Medline (Ovid) and Scopus were conducted to identify relevant observational studies on the influence of different level of PA on bone acquisition among the healthy adolescent population. All articles included, were limited to original articles and English language.
RESULTS: Nine studies met the inclusion criteria. Reported bone outcomes were of bone mass, bone structure and bone strength. Eight studies showed positive association between adolescents' PA and high bone variables. The influence of PA may differ according to sex, skeletal sites and bone outcomes.
CONCLUSION: This study supported the importance of increase adolescents' regular PA in optimizing PBM thus preventing osteoporosis at later life.

Matched MeSH terms: Bone and Bones
Fulltext Vitamin e and bone structural changes: an evidence-based review

Naina Mohamed I, Borhanuddin B, Shuid AN, Mohd Fozi NF

Evid Based Complement Alternat Med, 2012;2012:250584.
PMID: 23118786 DOI: 10.1155/2012/250584

Purpose. This paper explores the effects of vitamin E on bone structural changes. Methods. A systematic review of the literature was conducted to identify relevant studies about vitamin E and osteoporosis/bone structural changes. A comprehensive search in Medline and CINAHL for relevant studies published between the years 1946 and 2012 was conducted. The main inclusion criteria were published in English, studies had to report the association or effect of vitamin E and osteoporosis-related bone changes, and the osteoporosis-related bone changes should be related to lifestyle variables, aging, or experimentally-induced conditions. Results. The literature search identified 561 potentially relevant articles, whereby 11 studies met the inclusion criteria. There were three human epidemiological studies and eight animal experimental studies included in this paper. Four animal studies reported positive bone structural changes with vitamin E supplementation. The rest of the studies had negative changes or no effect. Studies with positive changes reported better effects with tocotrienol vitamin E isomer supplementation. Conclusions. This evidence-based review underscores the potential of vitamin E being used for osteoporosis. The effect of one of the vitamin E isomers, tocotrienols, on bone structural changes warrants further exploration. Controlled human observational studies should be conducted to provide stronger evidence.

Matched MeSH terms: Bone and Bones
Fulltext Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis

Tan VP, Macdonald HM, Kim S, Nettlefold L, Gabel L, Ashe MC, et al.

J. Bone Miner. Res., 2014 Oct;29(10):2161-81.
PMID: 24737388 DOI: 10.1002/jbmr.2254

A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.

Matched MeSH terms: Bone and Bones/physiology*

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