Bone dynamics: stress, strain and fracture

Bone is a dynamic tissue whose functional mass is controlled by the balance between the endocrine drive towards bone resorption and the mechanically-engendered drive towards bone formation. Strain is the key intermediate variable between loading forces and bone remodelling. Animal studies have shown that static loading of bone has no osteogenic effect; bone loss occurs as if there were no loading at all. However, dynamic loading, that is, cyclic change in internal strain, is strongly osteogenic, with relatively few cycles required for maximum effect. However, if a sufficient number of cycles is applied, repetitive loading can cause stress fractures. This number decreases as internal strains increase. Thus strain redistribution within bone, as caused by muscle fatigue or improper sports equipment, is a significant cause of fracture.