Continuing periosteal apposition I: Documentation, hypotheses, and interpretation

Abstract

Continuing periosteal apposition (CPA) of small amounts of new lamellar bone, leading to absolutely larger size, has been identified in a number of adult cranial and postcranial bones. This paper reviews 42 studies published since 1964 that have found both significant and nonsignificant age-related change in various skeletal size dimensions, e.g., length, diameter, width, and area. Also considered are four hypotheses that have, or may be, postulated for the occurrence of CPA. To date, however, these hypotheses (cohort effect, mechanical compensation, bone repair and/or mechanical response potential, and heterochrony) have not been rigorously tested, hence remain speculative. An important interpretive problem that befalls the investigation of CPA is its small effect size (i.e., the magnitude of change between observations), since most studies have restricted sample sizes. This problem is illustrated by power analysis of three reviewed studies that reported nonsignificant age-related change. The analysis indicates that these studies had very little likelihood of finding a statistically significant result, i.e., a low probability of rejecting the null hypothesis stipulating no size change with age. This finding has implications for interpreting CPA and for distinguishing between the statistical and biological significance of this phenomenon.

Limb bone bilateral asymmetry: variability and commonality among modern humans

“…Relative to other measures within elements, diaphyseal breadths consistently exhibit the most asymmetry, absolute and directional, followed by lengths and articular dimensions. In part, the increased asymmetry in external diaphyseal breadths may be due to the potential for continuing subperiosteal expansion of long bone cortices throughout life, after cessation of growth in length (and presumably articular size) (Garn et al, 1967;Lazenby, 1990;Heaney et al, 1997;Ahlborg et al, 2003). Thus, diaphyseal breadth asymmetry may increase in adults relative to length and articular asymmetry.…”

RETRACTED: The periosteum

“…At present, most evaluations of change in bone size in humans are small and cross-sectional and are subject to limited power and cohort effects, 69,77,106,107 but some longitudinal studies support the increase in bone size with age. 12,13,69 Mechanical events have usually been assumed to underlie the observation that bone size can increase in adults. 70 One attractive model posits that gradual endosteal bone loss with aging leads to cortical thinning and thus more bending stress on the outer surface of bone, in turn leading to the stimulation of periosteal bone apposition as a biomechanical compensation.…”

“…70 One attractive model posits that gradual endosteal bone loss with aging leads to cortical thinning and thus more bending stress on the outer surface of bone, in turn leading to the stimulation of periosteal bone apposition as a biomechanical compensation. 13,69 On the other hand, periosteal expansion also seems to occur in early adulthood, at a time when endosteal resorption has not begun, suggesting that events at the periosteum don't only reflect mechanical influences. 69 Moreover, less loaded bones (metacarpal, skull) also experience periosteal expansion in adults.…”

“…13,69 On the other hand, periosteal expansion also seems to occur in early adulthood, at a time when endosteal resorption has not begun, suggesting that events at the periosteum don't only reflect mechanical influences. 69 Moreover, less loaded bones (metacarpal, skull) also experience periosteal expansion in adults. Although likely important, the relative role of mechanical forces in the determination of periosteal responses are unknown.…”

Periosteal Thickness around the Femoral Neck: a cadaveric study

“…Periosteal apposition is also thought to occur with age, as a compensatory mechanism to increased mechanical stress [16,17]. Since the femoral neck experiences high compressive stress inferiorly through a lifetime of walking, quiescent periosteal tissue may be induced to resume bone apposition [18].…”