The finding Emricasan supplier that axial loading stimulates peak LY2090314 chemical structure strain magnitude-related increases in bone formation in some regions, but not others, is compatible with previously reported findings in the ulna [34]. One possible explanation for such variability in response at different regions within a single bone is that the osteogenic stimulus is more closely related to components of the strain regimen such as strain gradients than to peak surface strain magnitude [35]. As shown in Fig. 1a, the longitudinal curvature of the tibia’s proximal region deviates from the axis of loading while the proximal region is better aligned to that axis. Thus, strain gradients at the distal site would be lower than the proximal site due to less bending. It must

always also be born in mind Androgen Receptor Antagonist clinical trial that the bulk strain estimates, derived from strain gauges and predicted by FE analysis, do not necessarily reflect the actual strains in the matrix around osteocyte lacunae. These strains are heterogeneous and may be much higher than the applied macroscopic strains [36, 37]. However, we have no reason

to believe from the immunocytochemistry that, at the level of the osteocyte, there was any heterogeneity with a distribution which could account for differences in the regional response. There are a number of possible explanations for why there is a lack of consistent association between surface bone strain, sclerostin downregulation, and local new bone formation. One is that osteocytes respond directly in their sclerostin regulation to aspects of the strain regimen with different osteogenic potential (such as strain gradients and possibly their derivative fluid flow [35]) that are not reflected in the surface strain recordings. Bupivacaine More

likely in our view is that osteocytes respond directly to their local strain environment, including strain gradients, etc., but that they regulate their sclerostin production after sufficient processing of this initial strain-related stimulus to distinguish between osteogenic and non-osteogenic responses. Differential regulation of sclerostin and osteogenesis in the primary and secondary spongiosa has also previously been reported following intermittent parathyroid hormone (PTH) treatment. Similarly to the effect of loading, intermittent PTH resulted in greater suppression of sclerostin [38] and increased bone gain [39] in the secondary than in the primary spongiosa. This would support the hypothesis that in trabecular as well as cortical bone, loading-related changes in osteocyte sclerostin suppression are associated with the osteogenic response to loading. If this were the case, it suggests that osteocyte sclerostin suppression is a feature of the early (re)modeling control stimulus resulting from interactions within bone cells between a number of pathways whose activity can be altered by mechanical strain. The downregulation of sclerostin would then be indicative of an early osteogenic response to strain rather than a consequence of strain itself.