Abstract
The finding that alterations in electrical potential play an important role in the mechanical stimulation of the bone provoked hype that noninvasive extremely low frequency pulsed electromagnetic fields (ELF-PEMF) can be used to support healing of bone and osteochondral defects. This resulted in the development of many ELF-PEMF devices for clinical use. Due to the resulting diversity of the ELF-PEMF characteristics regarding treatment regimen, and reported results, exposure to ELF-PEMFs is generally not among the guidelines to treat bone and osteochondral defects. Notwithstanding, here we show that there is strong evidence for ELF-PEMF treatment. We give a short, confined overview of in vitro studies investigating effects of ELF-PEMF treatment on bone cells, highlighting likely mechanisms. Subsequently, we summarize prospective and blinded studies, investigating the effect of ELF-PEMF treatment on acute bone fractures and bone fracture non-unions, osteotomies, spinal fusion, osteoporosis, and osteoarthritis. Although these studies favor the use of ELF-PEMF treatment, they likewise demonstrate the need for more defined and better controlled/monitored treatment modalities. However, to establish indication-oriented treatment regimen, profound knowledge of the underlying mechanisms in the sense of cellular pathways/events triggered is required, highlighting the need for more systematic studies to unravel optimal treatment conditions.
Highlights
It is well accepted that bone is a mechanosensory organ, which requires continuous strain to preserve its functional structure and prevent disuse bone loss
Med. 2019, 8, 2028 partly explained by our own study, which showed reactive oxygen species (ROS) formation caused by repetitive ELF-PEMF exposure (f = 16 Hz) induced expression and activity of antioxidative enzymes, for example, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and glutathione-disulfide reductase (GSR)
Treatment modalities have to be better defined in order to establish ELF-PEMF treatment in the clinical routine
Summary
It is well accepted that bone is a mechanosensory organ, which requires continuous strain to preserve its functional structure and prevent disuse bone loss (osteopenia or osteoporosis). Bassett and colleagues suggest collagen piezoelectricity as a potential underlying mechanism According to their theory, applied stress generates local potential gradients along the collagen fibers [3,4]. This mechanism, ascribed to the non-centrosymmetric nature of collagen, is well accepted for dry bJ.oCnlien.tMisesdu. IAnntehcedsoetsatlurdeipeso,rmts atihnalyt exletcretrmomelyaglnoewticfrefiqeuldesncfyosptuerleseddheeleaclitnrogmoafgpneertsicisfiteenldt sn(oEnL-Fu-nPioEnMfFrsa)chtuarvees bfueertnhaepr pfuliedle.d the interest in this area [7,8,9,10] In these studies, mainly extremely low frequency pulseEdLFel-ePcEtrMomFsargenperteicsefinetldass(uEbLcFla-sPsEoMf Fesle)chtraovme bageennetaicppfileiledds. B [T] or dB/dt [T/s] amplitude t t burst repetition period pulse repetition period. PEMF-signals use periodically repeated bursts consisting of a certain number of pulses, N, at a certain. Without knowing the exact search coil dimensions, the magnetic field amplitude cannot be derived from this value
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