Spaceflight osteopenia: Difference between revisions

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Spaceflight osteopenia refers to the characteristic bone loss that occurs during spaceflight. Astronauts lose an average of more than 1% bone mass per month spent in space.^[1] There is concern that during long-duration flights, excessive bone loss and the associated increase in serum calcium ion levels will interfere with execution of mission tasks and result in irreversible skeletal damage.^[2]

History

Bone loss has been observed during spaceflight since at least as early as Gemini in the 1960s. Although most early measurements of the amount of bone loss were not reliable, they did show bone loss in Gemini, Soyuz 9, Apollo, Skylab, Salyut 7, Mir, and the International Space Station.^[3] William E. Thornton, an astronaut and physician, was one of the biggest proponents of exercise as a way of preventing bone loss.^[4]

Cause

Bone remodels in response to stress in order to maintain constant strain energy per bone mass throughout.^[5] To do this, it grows more dense in areas experiencing high stress, while resorbing density in areas experiencing low stress. On Mars, where gravity is about one-third that of earth, the gravitational forces acting on astronauts' bodies would be much lower, causing bones to decrease in mass and density.^[6]

Average bone loss of 1–2% was recorded in astronauts on Mir each month.^[2] This is in comparison to 1–1.5% bone loss in the elderly per year, and 2–3% in postmenopausal women.^[7]

Countermeasures

Since Gemini, exercise has been tried as a way of preventing bone loss, but it has not been shown to be successful. This may be in part due to lack of adequately designed studies (no controlled study had been done as of 2005, either in space or using bedrest as an attempt to simulate conditions which lead to bone loss). It is not known whether a different exercise regiment (perhaps including larger loads than past ones) would be effective.^[4]

Bone is difficult to regain once it is lost. Data from immobilization studies and from patients with spinal cord injuries support this.^[8] Spaceflight data suggest this as well.^[9] This suggests that bone loss prevention over postflight bone recovery is an important factor in countermeasure success.

Increasing dietary calcium and vitamin D is a standard countermeasure for osteoporosis.^[4] Clay is reportedly used by NASA for retaining calcium.^[10]

A variety of drug remedies currently used or proposed for osteoporosis may work for spaceflight, including hormone therapy (estrogen or progestin), selective estrogen receptor modulators, bisphosphonates, teriparatide, and others. Whether they can provide the same benefits for spaceflight as they do for osteoporosis is not yet known.^[4]

References

^ Kelly, Scott (2017). Endurance: A Year in Space, a Lifetime of Discovery. With Margaret Lazarus Dean. Alfred A. Knopf, a division of Penguin Random House. p. 174. ISBN 9781524731595. If I don't exercise six days a week for at least a couple of hours a day, my bones will lose significant mass - 1 percent each month ... Our bodies are smart about getting rid of what's not needed, and my body has started to notice that my bones are not needed in zero gravity.
^ ^a ^b "Space Bones". NASA. October 1, 2001. Archived from the original on October 6, 2001. Retrieved 2012-05-12.
^ Dupzyk, Kevin (November 20, 2018). "What ISS Taught Us In the Past 20 Years". Popular Mechanics. In space, astronauts lose bone density more quickly than they do on Earth. (In fact, all that extra calcium their bodies were flushing initially caused problems for the ISS's water purification system.)
^ ^a ^b ^c ^d Peter R. Cavanagh; Angelo A. Licata & Andrea J. Rice (June 2005), "Exercise and pharmacological countermeasures for bone loss during long-duration space flight", Gravitational and Space Biology, 18 (2): 39–58, PMID 16038092
^ Ali Marzban (January 1, 2008). "Different approaches of remodeling of bone to predict bone density distribution of proximal femur". Archived from the original on April 19, 2014. Retrieved 2013-02-23.
^ "Trip to Mars Will Challenge Bones, Muscles: Former Astronaut calls for More NASA Research on Exercise in Space". American College of Sports Medicine. April 12, 2006. Retrieved 2013-02-23.
^ "Lost in Space: Bone Density". NASA. Retrieved 2013-02-23.
^ Wilmet, E.; Ismail, A. A.; Heilporn, A.; Welraeds, D.; Bergmann, P. (November 1995). "Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section". Spinal Cord. 33 (11): 674–677. doi:10.1038/sc.1995.141. ISSN 1476-5624. PMID 8584304.
^ Long-Term Follow-Up of Skylab Bone Demineralization (Report).
^ Ubick, Suzanne; Mud, Mud, Glorious Mud, The Magazine of the California Academy of Sciences, Apr. 3, 2008

[1] Kelly, Scott (2017). Endurance: A Year in Space, a Lifetime of Discovery. With Margaret Lazarus Dean. Alfred A. Knopf, a division of Penguin Random House. p. 174. ISBN 9781524731595. If I don't exercise six days a week for at least a couple of hours a day, my bones will lose significant mass - 1 percent each month ... Our bodies are smart about getting rid of what's not needed, and my body has started to notice that my bones are not needed in zero gravity.

[NASA-2] "Space Bones". NASA. October 1, 2001. Archived from the original on October 6, 2001. Retrieved 2012-05-12.

[3] Dupzyk, Kevin (November 20, 2018). "What ISS Taught Us In the Past 20 Years". Popular Mechanics. In space, astronauts lose bone density more quickly than they do on Earth. (In fact, all that extra calcium their bodies were flushing initially caused problems for the ISS's water purification system.)

[cavanagh-4] Peter R. Cavanagh; Angelo A. Licata & Andrea J. Rice (June 2005), "Exercise and pharmacological countermeasures for bone loss during long-duration space flight", Gravitational and Space Biology, 18 (2): 39–58, PMID 16038092

[Marzban-5] Ali Marzban (January 1, 2008). "Different approaches of remodeling of bone to predict bone density distribution of proximal femur". Archived from the original on April 19, 2014. Retrieved 2013-02-23.

[ACSM-6] "Trip to Mars Will Challenge Bones, Muscles: Former Astronaut calls for More NASA Research on Exercise in Space". American College of Sports Medicine. April 12, 2006. Retrieved 2013-02-23.

[7] "Lost in Space: Bone Density". NASA. Retrieved 2013-02-23.

[8] Wilmet, E.; Ismail, A. A.; Heilporn, A.; Welraeds, D.; Bergmann, P. (November 1995). "Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section". Spinal Cord. 33 (11): 674–677. doi:10.1038/sc.1995.141. ISSN 1476-5624. PMID 8584304.

[9] Long-Term Follow-Up of Skylab Bone Demineralization (Report).

[10] Ubick, Suzanne; Mud, Mud, Glorious Mud, The Magazine of the California Academy of Sciences, Apr. 3, 2008

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+{{Short description|Bone loss caused by microgravity}}
-'''Spaceflight osteopenia''' refers to the characteristic [[bone loss]] that occurs during [[spaceflight]].  [[Astronaut]]s lose an average of more than 1% bone mass per month spent in [[outer space|space]]. There is concern that during long duration flights, excessive bone loss and the associated increase in serum [[calcium]] iron levels will interfere with execution of mission tasks and result in irreversible [[skeletal]] damage.<ref name=NASA>{{cite web |url=http://science.nasa.gov/headlines/y2001/ast01oct_1.htm |title=Space Bones |date=October 1, 2001 |author= |publisher=NASA |accessdate=2012-05-12 }}</ref>
+'''Spaceflight osteopenia''' refers to the characteristic [[Osteoporosis|bone loss]] that occurs during [[spaceflight]].  [[Astronaut]]s lose an average of more than 1% bone mass per month spent in [[outer space|space]].<ref>{{cite book | last = Kelly | first = Scott | author-link = Scott Kelly (astronaut) |  others = With Margaret Lazarus Dean | title = [[Endurance: A Year in Space, a Lifetime of Discovery]] | publisher = Alfred A. Knopf, a division of Penguin Random House | year = 2017 | page = 174 | isbn = 9781524731595 | quote = If I don't exercise six days a week for at least a couple of hours a day, my bones will lose significant mass - 1 percent each month ... Our bodies are smart about getting rid of what's not needed, and my body has started to notice that my bones are not needed in zero gravity.}}</ref> There is concern that during [[long-duration spaceflight|long-duration]] flights, excessive bone loss and the associated increase in serum [[calcium]] ion levels will interfere with execution of mission tasks and result in irreversible [[skeletal]] damage.<ref name=NASA>{{cite web |url=https://science.nasa.gov/headlines/y2001/ast01oct_1.htm |archive-url=https://web.archive.org/web/20011006181643/http://science.nasa.gov/headlines/y2001/ast01oct_1.htm |url-status=dead |archive-date=October 6, 2001 |title=Space Bones |date=October 1, 2001 |publisher=NASA |accessdate=2012-05-12 }}</ref>
 ==History==
-Bone loss has been observed during spaceflight since at least as early as [[Project Gemini|Gemini]] in the 1960s.  Although most early measurements of the amount of bone loss were not reliable, they did show bone loss in Gemini, [[Soyuz 9]], [[Apollo program|Apollo]], [[Skylab]], [[Salyut 7]], [[Mir]], and the [[International Space Station]].  [[William E. Thornton]], an astronaut and physician, was one of the biggest proponents of exercise as a way of preventing bone loss.<ref name="cavanagh">{{citation | url = http://gravitationalandspacebiology.org/index.php/journal/article/view/337/338#page=46 | title = Exercise and pharmacological countermeasures for bone loss during long-duration space flight | author = Peter R. Cavanagh, Angelo A. Licata, and Andrea J. Rice | journal = Gravitational and Space Biology | volume = 18 | issue = 2 | date = June 2005 | pages = 39–58 | pmid = 16038092 }}</ref>
+Bone loss has been observed during spaceflight since at least as early as [[Project Gemini|Gemini]] in the 1960s.  Although most early measurements of the amount of bone loss were not reliable, they did show bone loss in Gemini, [[Soyuz 9]], [[Apollo program|Apollo]], [[Skylab]], [[Salyut 7]], [[Mir]], and the [[International Space Station]].<ref>{{cite magazine | last = Dupzyk | first = Kevin | title = What ISS Taught Us In the Past 20 Years | magazine = Popular Mechanics | date = November 20, 2018 | url = https://www.popularmechanics.com/space/a25239320/iss-anniversary/ | quote = In space, astronauts lose bone density more quickly than they do on Earth. (In fact, all that extra calcium their bodies were flushing initially caused problems for the ISS’s water purification system.)}}</ref>  [[William E. Thornton]], an astronaut and physician, was one of the biggest proponents of exercise as a way of preventing bone loss.<ref name="cavanagh">{{citation | url = http://gravitationalandspaceresearch.org/index.php/journal/article/view/345 | title = Exercise and pharmacological countermeasures for bone loss during long-duration space flight |author1=Peter R. Cavanagh |author2=Angelo A. Licata |author3=Andrea J. Rice  |name-list-style=amp | journal = Gravitational and Space Biology | volume = 18 | issue = 2 | date = June 2005 | pages = 39–58 | pmid = 16038092 }}</ref>
 ==Cause==
-Bone remodels in response to stress in order to maintain constant strain energy per bone mass throughout.<ref name=Marzban>{{cite web |url=http://iris.lib.neu.edu/cgi/viewcontent.cgi?article=1003&context=mech_eng_theses |title=Different approaches of remodeling of bone to predict bone density distribution of proximal femur |date=January 1, 2008 |author= Ali Marzban |accessdate=2013-02-23 }}</ref>  To do this, it grows more dense in areas experiencing high stress, while resorbing density in areas experiencing low stress.  On Mars, where gravity is about one-third that of earth, the gravitational forces acting on astronauts' bodies are much lower, causing bones to decrease in mass and density.<ref name=ACSM>{{cite web |url=http://www.spaceref.com/news/viewpr.html?pid=19543 |title=Trip to Mars Will Challenge Bones, Muscles: Former Astronaut calls for More NASA Research on Exercise in Space |date=April 12, 2006 |author= |publisher = American College of Sports Medicine |accessdate=2013-02-23 }}</ref>
+Bone remodels in response to stress in order to maintain constant strain energy per bone mass throughout.<ref name=Marzban>{{cite web |url=http://iris.lib.neu.edu/cgi/viewcontent.cgi?article=1003&context=mech_eng_theses |archive-url=https://web.archive.org/web/20140419202723/http://iris.lib.neu.edu/cgi/viewcontent.cgi?article=1003&context=mech_eng_theses |url-status=dead |archive-date=April 19, 2014 |title=Different approaches of remodeling of bone to predict bone density distribution of proximal femur |date=January 1, 2008 |author=Ali Marzban |accessdate=2013-02-23 }}</ref>  To do this, it grows more dense in areas experiencing high stress, while resorbing density in areas experiencing low stress.  On Mars, where gravity is about one-third that of earth, the gravitational forces acting on astronauts' bodies would be much lower, causing bones to decrease in mass and density.<ref name=ACSM>{{cite web |url=http://www.spaceref.com/news/viewpr.html?pid=19543 |title=Trip to Mars Will Challenge Bones, Muscles: Former Astronaut calls for More NASA Research on Exercise in Space |date=April 12, 2006 |publisher = American College of Sports Medicine |accessdate=2013-02-23 }}</ref>
-Average bone loss of 1-2% was recorded in astronauts on Mir each month.<ref name="NASA"/>  This is in comparison to 1–1.5% bone loss in the elderly ''per year'', and 2–3% in postmenopausal women.<ref>{{cite web |url=http://www.nasa.gov/audience/foreducators/exploringmath/algebra1/Prob_BoneDensity_detail.html|title=LOST IN SPACE: BONE DENSITY |publisher = NASA|accessdate=2013-02-23 }}</ref>
+Average bone loss of 1–2% was recorded in astronauts on Mir each month.<ref name="NASA"/>  This is in comparison to 1–1.5% bone loss in the elderly ''per year'', and 2–3% in postmenopausal women.<ref>{{cite web |url=http://www.nasa.gov/audience/foreducators/exploringmath/algebra1/Prob_BoneDensity_detail.html|title=Lost in Space: Bone Density |publisher = NASA|accessdate=2013-02-23 }}</ref>
 ==Countermeasures==
+[[File:TVIS treadmill.jpg|thumb|right|Astronaut [[Sunita Williams|Sunita "Suni" Williams]] bungeed to the [[Treadmill with Vibration Isolation Stabilization|TVIS treadmill]] aboard the [[International Space Station]].]]
-Since Gemini, exercise has been tried as a way of preventing bone loss, but it has not been shown to be successful. This may be in part due to lack of adequately designed studies (no controlled study had been done as of 2005, either in space or using bedrest as an attempt to simulate conditions which lead to bone loss). It is not known whether a different exercise regimen (perhaps including larger loads than past ones) would be effective.<ref name="cavanagh"/>
+Since Gemini, exercise has been tried as a way of preventing bone loss, but it has not been shown to be successful. This may be in part due to lack of adequately designed studies (no controlled study had been done as of 2005, either in space or using bedrest as an attempt to simulate conditions which lead to bone loss). It is not known whether a different exercise regiment (perhaps including larger loads than past ones) would be effective.<ref name="cavanagh"/>
+Bone is difficult to regain once it is lost. Data from immobilization studies and from patients with spinal cord injuries support this.<ref>{{Cite journal |last1=Wilmet |first1=E. |last2=Ismail |first2=A. A. |last3=Heilporn |first3=A. |last4=Welraeds |first4=D. |last5=Bergmann |first5=P. |date=November 1995 |title=Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section |journal=Spinal Cord |language=en |volume=33 |issue=11 |pages=674–677 |doi=10.1038/sc.1995.141 |issn=1476-5624|doi-access=free |pmid=8584304 }}</ref> Spaceflight data suggest this as well.<ref>{{Cite report |url=https://apps.dtic.mil/sti/citations/ADA107965 |title=Long-Term Follow-Up of Skylab Bone Demineralization. |language=en}}</ref> This suggests that bone loss prevention over postflight bone recovery is an important factor in countermeasure success.
-Increasing dietary [[calcium]] and [[vitamin D]] is a standard countermeasure for [[osteoporosis]].<ref name="cavanagh"/>  [[Clay]] is reportedly used by NASA for retaining calcium.<ref>[http://web.archive.org/web/20080403060558/http://research.calacademy.org/calwild/2005winter/stories/mud.html Ubick, Suzanne; ''Mud, Mud, Glorious Mud,'' The Magazine of the California Academy of Sciences, Apr. 3, 2008]</ref>
+Increasing dietary [[calcium]] and [[vitamin D]] is a standard countermeasure for [[osteoporosis]].<ref name="cavanagh" />  [[Clay]] is reportedly used by NASA for retaining calcium.<ref>[https://web.archive.org/web/20080403060558/http://research.calacademy.org/calwild/2005winter/stories/mud.html Ubick, Suzanne; ''Mud, Mud, Glorious Mud,'' The Magazine of the California Academy of Sciences, Apr. 3, 2008]</ref>
-A variety of drug remedies currently used or proposed for osteoporosis may work for spaceflight, including [[Hormone replacement therapy (menopause)|hormone therapy]] (estrogen and/or progestin), [[selective estrogen receptor modulator]]s, [[bisphosphonate]]s, [[teriparatide]], and others. Whether they can provide the same benefits for spaceflight as they do for osteoporosis is not yet known.<ref name="cavanagh"/>
+A variety of drug remedies currently used or proposed for osteoporosis may work for spaceflight, including [[Hormone replacement therapy (menopause)|hormone therapy]] (estrogen or progestin), [[selective estrogen receptor modulator]]s, [[bisphosphonate]]s, [[teriparatide]], and others. Whether they can provide the same benefits for spaceflight as they do for osteoporosis is not yet known.<ref name="cavanagh"/>
 == See also ==
@@ Line 22: / Line 26: @@
 **[[Space adaptation syndrome]]
 *[[Microgravity University]]
-*[[Vomit Comet]]
+*[[Reduced-gravity aircraft]]
+*[[Timeline of longest spaceflights]]
 ==References==

v t e Space medicine
Main areas	Artificial gravity Astronautical hygiene Bioastronautics Neuroscience in space Space exposure Space food Space nursing Space weather Weightlessness
Illness and injuries	Asthenization Ebullism Illness and injuries during spaceflight Medical treatment during spaceflight Space adaptation syndrome Space and survival Spaceflight osteopenia
Organizations	Aerospace Medical Association National Space Biomedical Research Institute Rubicon Foundation Space Nursing Society
Other topics	Adverse health effects from lunar dust exposure Cardiac rhythm problems during space flight Central nervous system effects from radiation exposure during spaceflight Effect of spaceflight on the human body Effects of sleep deprivation in space Epidemiology data for low-linear energy transfer radiation Sleep in space Health threat from cosmic rays Intervertebral disc damage and spaceflight List of microorganisms tested in outer space Psychological and sociological effects of spaceflight Radiobiology evidence for protons and HZE nuclei Reduced muscle mass, strength and performance in space Renal stone formation in space Spaceflight radiation carcinogenesis Team composition and cohesion in spaceflight missions Visual impairment due to intracranial pressure