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Unfocused Extracorporeal Shock Waves Induce Anabolic Effects in Rat Bone
O.P. van der Jagt, MD1; T.M. Piscaer, MD1; W. Schaden2; J. Li, PhD3; N. Kops1; H. Jahr, PhD1; J.C. van der Linden, PhD1; J.H. Waarsing, PhD1; J.A.N. Verhaar, MD, PhD1; M. de Jong, PhD1; H. Weinans, PhD1
1 Departments of Orthopaedics (O.P.v.d.J., T.M.P., N.K., H.J., J.C.v.d.L., J.H.W., J.A.N.V., and H.W.) and Nuclear Medicine (M.d.J.), Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for O.P. van der Jagt: o.vanderjagt@erasmusmc.nl
2 AUVA Trauma Center Meidling, Kundratstrasse 37, 1120 Vienna, Austria
3 Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, a research grant in excess of $10,000 from the Dutch Technology Foundation STW. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Tissue Regeneration Technologies).

Investigation performed at the Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jan 05;93(1):38-48. doi: 10.2106/JBJS.I.01535
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Extracorporeal shock waves are known to stimulate the differentiation of mesenchymal stem cells toward osteoprogenitors and induce the expression of osteogenic-related growth hormones. The aim of this study was to investigate if and how extracorporeal shock waves affected new bone formation, bone microarchitecture, and the mechanical properties of bone in a healthy rat model, in order to evaluate whether extracorporeal shock wave therapy might be a potential treatment for osteoporosis.


Thirteen rats received 1000 electrohydraulically generated unfocused extracorporeal shock waves to the right tibia. The contralateral, left tibia was not treated and served as a control. At two, seven, twenty-one, and forty-nine days after administration of the shock waves, in vivo single-photon-emission computed tomography (SPECT) scanning was performed to measure new bone formation on the basis of uptake of technetium-labeled methylene diphosphonate (99mTc-MDP) (n = 6). Prior to and forty-nine days after the extracorporeal shock wave therapy, micro-computed tomography (micro-CT) scans were made to examine the architectural bone changes. In addition, mechanical testing, microcrack, and histological analyses were performed.


Extracorporeal shock waves induced a strong increase in 99mTc-MDP uptake in the treated tibia compared with the uptake in the untreated, control tibia. Micro-CT analysis showed that extracorporeal shock waves stimulated increases in both trabecular and cortical volume, which resulted in higher bone stiffness compared with that of the control tibiae. Histological analysis showed intramedullary soft-tissue damage and de novo bone with active osteoblasts and osteoid in the bone marrow of the legs treated with extracorporeal shock waves. Microcrack analysis showed no differences between the treated and control legs.


This study shows that a single treatment with extracorporeal shock waves induces anabolic effects in both cancellous and cortical bone, leading to improved biomechanical properties. Furthermore, treatment with extracorporeal shock waves results in transient damage to the bone marrow, which might be related to the anabolic effects. After further examination and optimization, unfocused extracorporeal shock waves might enable local treatment of skeletal sites susceptible to fracture.

Clinical Relevance: 

Unfocused extracorporeal shock waves might in the future be used to increase bone mass and subsequently reduce the fracture risk.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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