It’s no secret that osteoporosis is a global epidemic. Every year, millions of people have to live with the limitations brought on by osteoporosis – including almost one million Australians.1 Globally, it is the leading cause of fractures to the hip, spine and wrist for individuals over the age of 50, with 30% of women and 20% of men in this age range predicted to experience an osteoporosis-related fracture in their lifetime2,3.
With both osteoporosis and the resulting fractures shown to be linked to a lower quality of life4, poor health status, impaired physical function and increased pain5, it is clear that simple and effective strategies to manage osteoporosis at every age are in critical need. With the Marodyne low-intensity vibration device gaining global popularity over the recent years due to being medically certified to prevent osteoporosis and osteopenia by slowing bone loss, here is an overview of its mechanism of action, evidence, and comparison to other preventative therapies to date.
Exercise for Osteoporosis
Weight Bearing Aerobic Workouts by Margaret Martin, Physical Therapist @ MelioGuide
Weight-bearing exercise is a key treatment and prevention method for both postmenopausal and age-associated osteoporosis.6 Incorporating various forms of physical activity into our daily lives is shown to improve muscle function and offset age-related muscle morphology changes.7 To best benefit from the results, the National Osteoporosis Foundation recommends skeletal loading with high and low-impact weight-bearing exercises for at least 30 minutes per day, 5–7 days a week.8 It is a promising non-invasive and non-pharmacological method of regulating both osteoporosis and osteopenia.
Unfortunately, intense physical activity is often not a realistic nor achievable approach for those aged over 50, or who have underlying musculoskeletal or metabolic conditions. In these instances, exercise may simply not be possible, or could cause further harm.
Medication for Osteoporosis
Fosamax (10mg), Fosamax Plus D (70mg)
Another common management tool for osteoporosis is through pharmacological interventions. While medicines such as Fosamax show promising results in helping reduce the prevalence of fractures, they are not without their limitations. Research has found osteoporosis medication to be associated with poor patient adherence9,10, leading to poor outcomes. A study examining the attitudes and treatment patterns of Australian GP’s in treating osteoporosis found that in over 80% of cases where patients ceased their medication, prescriptions were not being followed up or continued, placing these people at risk of further fractures and suggesting that osteoporosis was undertreated and underdiagnosed.11 In addition, adverse effects12,13, can accrue with long-term use of osteoporosis therapeutic medications14. This means that for our ageing populations, we need better treatment options to support healthy bone density.
Marodyne Liv For Osteoporosis
Marodyne LiV
The key component of exercise — mechanical signals — is what promotes the generation of bone and muscle and slows bone loss, while limiting formation and expansion of fat mass. It is also what has led to the formation of the new vibration strategy to treat osteoporosis through Marodyne.
The Marodyne LiV is a modern device that has been recognised by the Royal Osteoporosis Society as a safe and effective tool for the prevention of osteoporosis and the improvement of bone health. The mechanism of action behind the Marodyne is grounded in the principles of exercise, whereby the musculoskeletal system responds to ground-reaction forces, exposing bones to high and low frequency mechanical signals.
Consider the normal daily bone strain of a healthy individual. Their bones will naturally be exposed to a few large mechanical events (for example, four loading events like lifting per day that are >2,000 με)15 as well as hundreds of thousands of daily events that are below 10 με16. These low magnitude events are generated by the dynamics of muscle contraction,17 which the Marodyne LiV induces without weight-bearing or exercise, so the user can still reap the multifactorial benefits including slowing bone loss and promoting bone formation.18,19,20
Marodyne LiV And Falls Prevention
Ageing also puts people at an increased risk of falls. Paired with the reduced bone density caused by osteoporosis, falls frequently lead to fractures21,22, in older patients. The Marodyne LiV has been shown to improve muscle strength and balance, reducing fall rates and the fractures sustained by those falls.23
Low-Intensity Vibration vs Whole Body Vibration
Low intensity vibration (LiV) has been found to promote the construction of healthy bone and muscle, and inhibit the formation of fat, improving bone outcomes in patients.24 Whole body vibration (WBV) between 20-90Hz in animals has been found to promote the generation of bone and muscle, preventing and reversing osteoporosis.25 Moreover, 30Hz vibrations have been shown to build bone and muscle in the hip and spine of young women with osteoporosis26, promote volumetric bone density in the proximal tibia of children with conditions such as cerebral palsy27, enhance bone quality in adolescents with idiopathic scoliosis28, and help protect balance control in those subject to chronic bed rest.29
WBV devices are currently accessible to the general public, often being a paid feature of gyms as the vigorous vibrations can stimulate the growth of muscles. While effective for those who are fit and strong, WBV machines can be seriously damaging to those with bone conditions like osteoporosis. This is where a purpose built LiV device is crucial. The specific LiV vibrations administered through a foot plate have also been found to reach and impact the axial skeleton, showing it as an effective way to prevent bone loss and prevent or reverse skeletal fragility in those with a spinal cord injury, where other non-pharmacological options are very limited.30
Doctor Clinton Rubin Ph.D., is a distinguished State University of New York professor and a global authority on vibration therapy, whole body vibration platforms and their impact. He recommends a minimum of 10 minutes per day, citing that the most important component for success is not duration, but consistency. Using the Marodyne LiV every single day is a more important factor than the time for which it is used. In fact, growing evidence suggests that the incorporation of multiple cycles of mechanical signals within a given day, separated by periods of rest, can increase the beneficial bone-building effects.31
Safety
The Marodyne LiV provides low-level, low acceleration vibration which is transmitted at a high frequency to the person standing on it. This type of vibration mimics the small high frequency contractions exerted by muscles onto the bone. It is safe to use at home or in-clinic and provides a safe and suitable therapy for those with weaker bones. Departing from the typical ‘more is better’ attitude to exercise and treatment, several groups have reported that small mechanical signals that are high frequency and low-intensity vibration are effective to construct bone,32,33 slow bone loss and suppress the formation of adipose tissue.34,35
A significant problem with the scientific literature of WBV is the availability of multiple devices from which clinical information has been collected. These devices deliver differing directionality (horizontal or vertical displacement), amplitudes (displacements resulting in gravitational force from <1-15g+), and frequency (5–90 Hz). Some devices (marketed as exercise or slimming devices), can increase muscle damage and generate unwanted rotational movements in joints. In contrast, low intensity vertical vibration devices are well tolerated and beneficial.36
Importantly, the key index of safety is not displacement or frequency, but rather the acceleration, or g-force experienced, which is derived from a product of displacement and frequency (for example, displacing 1 mm at 10 Hz results in 0.4g, but displacing 1 mm at 50 Hz increases acceleration to 10g).37
Many devices can provide both high (>1g) and low-magnitude (<1g) forces, but those marketed as exercise or weight loss tools generally deliver forces greater than 4g. Such devices are not appropriate for elderly or frail patients in whom the endpoint is improving bone strength38.
In contrast, the Marodyne LiV has been developed to deliver safe levels of acceleration for patients, to promote and optimise the synthesis of healthy bone mass. The Marodyne is easy to use, with smart technology that adjusts to the patient’s weight, mass, movement and balance to deliver even cycles of acceleration output at 0.4g to any user. The closed loop feedback continually monitors acceleration and will adjust displacement to maintain a safe acceleration of 0.4g.
Marodyne LiV Use in Children
Up to the age of 30 years, our bone mass is naturally built, after which we begin to slowly lose our bone mass and bone density. For children with metabolic, genetic, physical disability, disease or other limitations, they may be restricted in their ability to build good bone mass through exercise. With the bone mass acquired during childhood being a key determinant of adult bone health that prevent, effective strategies to support their bone health are needed.
Low intensity vibration is shown to increase bone formation in children at risk, which has shown bone quality improvements of between 10.7% over the total body39 to 18% in the lower limbs.40 Low intensity vibration has been shown to be safe and efficient to use with overall positive benefits for children.41
Break Up With Osteoporosis
With LiV promoting increased bone mass and quality, contributing to bone strength and a reducing risk of fracture, in today’s market, Marodyne presents a simple, easy and effective solution for osteoporosis. It can be utilised by all age ranges, all physical abilities, without the need for repeat prescriptions or GP visits, and without strenuous or unmanageable exercise.
To purchase the device, or for any questions, please contact Marodyne LiV Australia on 1300 653 522 or at sales@rehacare.com.au.
[1] https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoporosis/contents/what-is-osteoporosis
[2] Wright, N. C. et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J. Bone Miner. Res. 29, 2520–2526 (2014).
[3] NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 285, 785–795 (2001).
[4] https://www.tandfonline.com/doi/full/10.1080/21556660.2019.1677674
[5] https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1268-y
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[8] https://cdn.nof.org/wp-content/uploads/2016/02/Exercise-for-Your-Bone-Health.pdf
[9] Siris, E. S. et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin. Proc. 81, 1013–1022 (2006).
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[11] https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01103-2
[12] https://pubmed.ncbi.nlm.nih.gov/30814687/
[13] Rossouw, J. E. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288, 321–333 (2002).
[14] Shane, E. et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J. Bone Miner. Res. 29, 1–23 (2014).
[15] https://www.sciencedirect.com/science/article/abs/pii/S0021929097000043
[16] https://www.sciencedirect.com/science/article/abs/pii/S0021929099002109?via%3Dihub
[17] https://academic.oup.com/biomedgerontology/article/54/8/B352/542716?login=false
[18] Wallace, B. A. & Cumming, R. G. Systematic review of randomized trials of the effect of exercise on bone mass in pre- and postmenopausal women. Calcif. Tissue Int. 67, 10–18 (2000).
[19] https://pubmed.ncbi.nlm.nih.gov/11811566/
[20] https://www.sciencedirect.com/science/article/abs/pii/S8756328201006895?via%3Dihub
[21] NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 285, 785–795 (2001).
[22] Wright, N. C. et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J. Bone Miner. Res. 29, 2520–2526 (2014).
[23] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458848/
[24] https://pubmed.ncbi.nlm.nih.gov/30814687/
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[33] Wren, T. A. et al. Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy. J. Pediatr. Orthop. 30, 732–738 (2010).
[34] David, V. et al. Mechanical loading down-regulates peroxisome proliferator-activated receptor gamma in bone marrow stromal cells and favors osteoblastogenesis at the expense of adipogenesis. Endocrinology 148, 2553–2562 (2007).
[35] Maddalozzo, G. F., Iwaniec, U. T., Turner, R. T., Rosen, C. J. & Widrick, J. J. Whole-body vibration slows the acquisition of fat in mature female rats. Int. J. Obes. 32, 1348–1354 (2008).
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[37] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458848/
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[39] Bianchi ML, Vai S, Morandi S, Baranello G, Pasanisi B, Rubin, C; Effects of Low-Magnitude High-Frequency Vibration on Bone Density, Bone Resorption and Muscular Strength in Ambulant Children Affected by Duchenne Muscular Dystrophy. ASMBR – American Society for Bone and Mineral Research, Oral Paper (2013)
[40] Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z; Low Magnitude Mechanical Loading Is Osteogenic in Children With Disabling Conditions. Journal of Bone and Mineral Research (2004)
[41] Matute-Llorente A, González-Aguero A, Gómez-Cabello A, Vicente-Rodríguez G, Casajús Mallén JA; Effect of Whole-Body Vibration Therapy on Health-Related Physical Fitness in Children and Adolescents With Disabilities: A Systematic Review. Journal of Adolescent Health (2014)