Functional adaptation of bone: The mechanostat and beyond

The conceptual model of the mechanostat proposed by Harold Frost in 1983 is among the most significant contributions to musculoskeletal research today. This model states that bone and other musculoskeletal tissues including cartilage, tendon and muscle respond to habitual exercise/loading and that changes in the loading environment lead to adequate structural adaptation of (bone) tissue architecture. The analogy with a thermostat clearly indicates presence of a physiological feedback system which is able to adjust bone mass and structure according to the engendered loads. In the bioengineering community, the mechanostat has been mathematically formulated as a feedback algorithm using a set point criterion based on a particular mechanical quantity such as strain, strain energy density among others. As pointed out by Lanyon and Skerry, while it is widely thought that in a single individual, there exists a single mechanostat set point, this view is flawed by the fact that different bones throughout the skeleton require a specific strain magnitude to maintain bone mass. Consequently, different bones respond differently to increases or decreases in loading depending on the sensitivity of the mechanostat. Osteocytes, i.e., cells embedded in the bone matrix are believed to be the major bone cells involved in sensing and transduction of mechanical loads. The purpose of this chapter is to review the concept of the mechanostat and its role in bone pathophysiology. To do this we provide examples of why and how the skeleton responds to complex loading stimuli made up of numerous different parameters including strain magnitude, frequency and rest intervals among others. We describe latest in vivo and ex vivo loading models, which allow exploration of various mechanobiological relations in the mechanostat model utilising controlled mechanical environments. A review of the bone cells and signalling transduction cascades involved in mechanosensation and bone adaptation will also be provided. Furthermore, we will discuss the mechanostat in a clinical context, e.g., how factors such as sex, age, genetic constitution, concomitant disease, nutrient availability, and exposure to drugs all affect bone’s response to mechanical loading. Understanding the mechanostat and mechanobiological regulatory factors involved in mechanosensation and desensitisation is essential for our ability to control bone mass based on physiological loading, either directly through different exercise regimens, or by manipulating bone cells in a targeted manner using tailored site and individual specific stimuli including pharmaceuticals