The biomechanical basis of bone strength development during growth

Understanding the development of the material composition and structure of bone during growth, both key determinants of bone strength, and identifying factors that regulate the development of these properties are important for developing effective lifestyle interventions to optimize peak bone strength. New imaging technologies provide the ability to measure estimates of both the material composition and structure of bone, and thus, estimates of whole bone strength. During childhood and adolescence, bone structure is altered by growth in length and width, which is associated with increases in mass, and alterations in tissue density. These processes lead to a bone with an optimal size, shape, and architecture to withstand the normal physiological loads imposed on it. Longitudinal bone growth is the result of endochondral ossification, a process that continues throughout childhood and rapidly increases during the adolescent growth spurt. Along the shaft, long bones continually grow in width, thus improving the resistance to bending forces by depositing new bone on the periosteal surface with simultaneous resorption on the endocortical surface. Sexual dimorphism in periosteal bone formation and endosteal bone resorption result in sex-specific differences in adult bone conformation. Changes in linear and periosteal growth are closely tied to changes in bone mass, with approximately one quarter of adult total body bone mineral accrued during the 2 years around the adolescent growth spurt. These structural and material changes are under mechanical regulation and influenced by the hormonal environment. Overall, bones must continually adapt their geometry and mass to withstand loads from increases in bone length, muscle mass and external forces during growth. However, the tempo, timing, and extent of such adaptations are also closely regulated by several systemic hormones.