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Mechanical influences on bone development in children

Children's Hospital, University of Cologne, Kerpener Strasse 62, D-50924 Cologne, Germany

(Correspondence should be addressed to E Schoenau; Email: eckhard.schoenau{at}uk-koeln.de)

This paper was presented at the 5th Ferring International Paediatric Endocrinology Symposium, Baveno, Italy (2008). Ferring Pharmaceuticals has supported the publication of these proceedings.

This review focuses on methodological concepts in the evaluation of skeletal muscle function and on adaptation. It is now thought that the critical property of bone is strength rather than weight, and that control of bone strength is mainly exercised through the effect of the mechanical loads brought to bear on bone. Muscle contraction places the greatest physiological load on bone, and so the stability of bone must be adapted to muscle strength (the functional muscle–bone unit). The described suggestions and recommendations outline a new concept: bone mass and strength should not be related to age. There is now more and more evidence that bone mass and strength should be related to muscle function. Thus analyzed, there is no such entity as ‘peak bone mass’. Many studies are presently under way to evaluate whether these novel approaches increase the sensitivity and specificity of fracture prediction in an individual. Furthermore, the focus of many bone researchers is shifting away from bone mass to bone geometry or bone strength and their relationship with the driving muscle system.