Bone and its adaptation to mechanical loading: a review

Bone is a remarkable living material that comes in two forms with different porosities and different macrostructure, but with the same highly organised microstructure and nanostructure. As bone accumulates damage, it is removed and replaced. When the mechanical demands on bone increase the bone mass increases, while reductions in the loading leads to the removal of bone, thus bone can be considered a ‘smart material’. The ongoing replacement of old bone tissue by new bone tissue is called remodelling. Bone formation, repair and remodelling is controlled and produced by four types of cell, namely osteoblasts, osteoclasts, osteocytes and bone lining cells. Bone remodelling is regulated by signals to these cells generated by mechanical loading. Exactly how loads are transferred into bone, how the bone cells sense these loads and how the signals are translated into bone formation or removal is unknown. In this review, the structure of bone and the cells responsible for maintaining bone are described. The mechanisms that cause bone to adapt to mechanical loading have been investigated. The methods that have been employed in attempts to determine this mechanism are considered.