Remodelling of living bone induced by dynamic loading and drug delivery—Numerical modelling and clinical treatment

Remodelling is a dynamic process occurring during growth and it includes sensing of environmental changes, tissue resorbance, i.e. the removal of existing old bone, and formation of new tissue. The biomechanical remodelling process is relatively well formulated for bones and can be divided into three stages: (1) bone resorption based on the osteoclast activity, (2) bone deposition based on the osteoblast activity and (3) bone growth control established on RANK/RANKL/OPG pathway—RANKL/OPG balance. The main driving force of remodelling process is a dynamic loading (cyclic compression and expansion, e.g. walking or running), which strongly influences the rate of chemical reactions. The evolution from the homogeneous density distribution to the corticalis and cancellous bone formation is shown. An inevitable influence of a dynamic mechanical loading and osteoprotegerin (OPG) concentration is demonstrated. Deformations were calculated by commercial code ANSYS. The clinical experience indicates that the dynamic loading (above the threshold level 1500–2500microstains/s), especially walking with a characteristic time approximately 1s, influences the whole process of bone remodelling after a time period of approximately 3 months. The numerical simulation shows that the concentration of the new bone and the bone elastic constants substantially depend on history and intensity of the loading, drug delivery and nutrition.