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FRACTURE RISK IN SPACEFLIGHT AND POTENTIAL TREATMENT OPTIONS

机译：航天和潜在治疗方案中的断裂风险

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Understanding the chronic effects of a microgravity environment on bone is essential, given that humans are now considering new long-distance spaceflight missions. With ambitions to send astronauts into deep space in the next few decades, it is important to note that the negative effects of long-duration spaceflight on bone may increase the risk of musculoskeletal injuries. As a result, management options for these types of injuries, particularly fractures, should be addressed prior to future deep-space missions. The objective of this study was to determine high-risk bone fracture areas after long-duration spaceflight, and identify management protocols for those fractures. A literature search was conducted for information on current fracture risk predictive models, and suggestions for treatment. It is well known that bone mineral density (BMD) decreases during long-duration spaceflight. This is likely the result of decreased load on bone in a microgravity environment, which leads to an uncoupling between bone resorption (increased) and bone remodeling (stable or decreased), also causing diminished bone fracture healing. While the risk of fracture in a microgravity environment is believed to be low, upon re-entering a gravity environment (such as the Earth, the Moon, or Mars), the potential risk for fracture increases. The Bone Fracture Risk Model (BFxRM) is an algorithm developed to determine the probability of fracture at a particular skeletal site in a given loading scenario. As predicted by this model, there is greater fracture risk of the lumbar spine, femoral neck, and wrist, especially with increased mission duration and subsequent physical activity once re-introduced to a gravity environment. While there are many viable suggestions for mitigating bone fracture risk, there are limited proven management options. Exercise is part of a fundamental long-duration spaceflight strategy to mitigate BMD loss, and BMD improvement with exercise has been augmented by the introduction of the advanced resistance exercise device (ARED) on the International Space Station. Additionally, studies have shown that supplementation with bisphosphonates has an additive effect for preventing bone loss. If a fracture were to occur, promising treatment options to improve bone fracture healing in space (in addition to standard management modalities such as splinting) include the use of low-magnitude, high-frequency vibration, as well as subcutaneous injections of parathyroid honnone coupled with low-intensity pulsed ultrasound. In conclusion, the best strategy for reducing musculoskeletal injuries for deep-space missions will be a combination of BMD loss reduction coupled with improvements in management protocols for potential fractures.
机译：鉴于人类现在正在考虑新的长途航天飞行任务，因此了解微重力环境对骨骼的慢性影响至关重要。出于在未来几十年内将宇航员送入太空的雄心，重要的是要注意长期太空飞行对骨骼的负面影响可能会增加肌肉骨骼受伤的风险。因此，在未来的深空任务之前，应对这些类型的伤害（尤其是骨折）的管理方案进行研究。这项研究的目的是确定长期航天飞行后的高风险骨折区域，并确定这些骨折的治疗方案。进行了文献搜索，以获取有关当前骨折风险预测模型的信息以及治疗建议。众所周知，在长时间的太空飞行中，骨矿物质密度（BMD）会降低。这很可能是微重力环境中骨骼负载减少的结果，这导致骨骼吸收（增加）和骨骼重塑（稳定或减少）之间的脱钩，还导致骨折愈合的减弱。尽管在微重力环境中破裂的风险被认为是低的，但是在重新进入重力环境（例如地球，月球或火星）时，潜在的破裂风险增加了。骨骨折风险模型（BFxRM）是一种算法，用于确定在给定的载荷情况下特定骨骼部位的骨折可能性。正如该模型所预测的那样，腰椎，股骨颈和手腕的骨折风险更大，特别是随着任务持续时间的增加和随后重新引入重力环境的后续体育活动。虽然有许多可行的建议可以减轻骨折的风险，但有限的行之有效的管理选择。锻炼是减轻BMD损失的基本长期航天策略的一部分，并且通过在国际空间站上引入先进的阻力锻炼装置（ARED）增强了锻炼对BMD的改善。另外，研究表明，补充双膦酸盐具有防止骨质流失的累加作用。如果发生骨折，改善空间骨折愈合的有前途的治疗选择（除了诸如夹板之类的标准管理方式之外）还包括使用低强度，高频振动以及皮下注射甲状旁腺激素联用低强度脉冲超声。总之，减少深空飞行任务肌肉骨骼损伤的最佳策略将是减少BMD损失以及改进对潜在骨折的管理方案。

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