Sclerostin, the protein product of the Sost gene, is a potent inhibitor of bone formation. Among bone cells, sclerostin is found nearly exclusively in the osteocytes, the cell type that historically has been implicated in sensing and initiating mechanical signaling. The recent discovery of the antagonistic effects of sclerostin on Lrp5 receptor signaling, a crucial mediator of skeletal mechanotransduction, provides a potential mechanism for the osteocytes to control mechanotransduction, by adjusting their sclerostin (Wnt inhibitory) signal output to modulate Wnt signaling in the effector cell population. We investigated the mechanoregulation of Sost and sclerostin under enhanced (ulnar loading) and reduced (hindlimb unloading) loading conditions. Sost transcripts and sclerostin protein levels were dramatically reduced by ulnar loading. Portions of the ulnar cortex receiving a greater strain stimulus were associated with a greater reduction in Sost staining intensity and sclerostin-positive osteocytes (revealed via in situ hybridization and immunohistochemistry, respectively) than were lower strain portions of the tissue. Hindlimb unloading yielded a significant increase in Sost expression in the tibia. Modulation of sclerostin levels appears to be a finely tuned mechanism by which osteocytes coordinate regional and local osteogenesis in response to increased mechanical stimulation, perhaps via releasing the local inhibition of Wnt/Lrp5 signaling.Low bone mass and poor bone structure are two major risk factors for osteoporotic fracture (1, 2). A simple yet effective means to enhance bone mass and architecture is through mechanical stimulation of the resident bone cell population (3, 4). Mechanical loading (e.g. exercise) improves bone mass and strength by stimulating the addition of new bone onto surfaces experiencing high strains, whereas surfaces that experience small strains largely remain quiescent. This phenomenon occurs both across the skeleton (limb bones adapt to locomotive loading, whereas nonbearing bones (e.g. skull) do not) and within a loaded bone (tension/compression surfaces undergo bone formation, whereas surfaces straddling the neutral bending axis do not). The cellular mechanisms involved in directing new bone formation to the high strain regions of a loaded bone are unclear, but elucidation of these mechanisms would provide an attractive target for pharmaceutical intervention aimed at mimicking the adaptive response to loading (5).Despite these gaps in our understanding, significant progress has been made in delineating some of the basic mechanisms of mechanotransduction in bone, in large part because of the creation of genetically engineered mice. A key finding in this arena is the requirement for Wnt signaling through Lrp5 (the low density lipoprotein receptor-related protein 5) in mechanically induced bone formation. We reported recently that mice engineered with a loss-of-function mutation in Lrp5 recapitulate the low bone mass phenotype observed in humans with inactivating mutations of LRP...

Bone is a dynamic tissue that is constantly renewed. The cell populations that participate in this process--the osteoblasts and osteoclasts--are derived from different progenitor pools that are under distinct molecular control mechanisms. Together, these cells form temporary anatomical structures, called basic multicellular units, that execute bone remodeling. A number of stimuli affect bone turnover, including hormones, cytokines, and mechanical stimuli. All of these factors affect the amount and quality of the tissue produced. Mechanical loading is a particularly potent stimulus for bone cells, which improves bone strength and inhibits bone loss with age. Like other materials, bone accumulates damage from loading, but, unlike engineering materials, bone is capable of self-repair. The molecular mechanisms by which bone adapts to loading and repairs damage are starting to become clear. Many of these processes have implications for bone health, disease, and the feasibility of living in weightless environments (e.g., spaceflight).

The human skeleton is affected by mutations in Low-density lipoprotein Receptor-related Protein 5 (LRP5). To understand how LRP5 influences bone properties, we generated mice with inducible Lrp5 mutations that cause high bone mass and low bone mass phenotypes in humans. We conditionally-induced Lrp5 mutations in osteocytes and found that bone properties in these mice were comparable to bone properties in mice with inherited mutations. We also conditionally-induced an Lrp5 mutation in cells that contribute to the appendicular skeleton, and not to the axial skeleton, and we observed bone properties were altered in the limbs, and not in the spine. These data indicate that Lrp5 signaling functions locally and suggest increasing LRP5 signaling in mature bone cells as a strategy to treat human low bone mass disorders, such as osteoporosis.

Exercise is a very effective way to strengthen bones, particularly during childhood and adolescence. A collection of studies from the clinic and laboratory have provided new insights into how bone building effects of exercise can be maximized. From the available data we have calculated an "osteogenic index" for exercises.