This post examines whether low intensity whole body vibration therapy is appropriate for the treatment of osteoporosis. It also presents the health risks associated with high intensity whole vibration platforms. If you are considering a whole body vibration platform, I encourage you to read this article in its entirety.
Table of Contents
- 1 Low Intensity Vibration Therapy for Osteoporosis
- 2 Marodyne Disclosure Statements & Price Discount
- 3 Vibration Therapy Recommendations
- 4 Chapter 1: High Intensity Whole Body Vibration Versus Low Intensity Vibration
- 5 Chapter 2: How Low Intensity Vibration Works and Improves Bone Health
- 6 Chapter 3: Using a Low Intensity Vibration Platform
- 7 Chapter 4: Review of Key Research in Whole Body Vibration for Osteoporosis and Bone Density
- 8 Exercise Recommendations for Osteoporosis
- 9 Summary of Original Article
- 10 Conclusion
- 11 About Dr. Clinton Rubin
- 12 References
- 13 Osteoporosis Guidelines
Low Intensity Vibration Therapy for Osteoporosis
The article is based on three hours of interview I had in late 2020 with Dr. Clinton Rubin, a leading researcher and world expert in the field of whole body vibration therapy.
Dr. Rubin is a SUNY Distinguished Professor of Biomedical Engineering and Director of the Center for Biotechnology at Stony Brook University in Stony Brook, New York. Dr. Clinton is the most cited researcher in the area of vibration therapy.
Late 2020, I also approached Juvent, a manufacturer of whole body vibration platforms, to discuss this same topic. I was unable to get my questions answered to my satisfaction.
By the time you finish reading the whole article you will understand:
- Why you should immediately stop using a high intensity whole body vibration platform.
- The benefits of low intensity vibration therapy and how it complements exercise.
- How bone is formed and maintained throughout life.
- The importance of frequent exercise on bone health.
Marodyne Disclosure Statements & Price Discount
Before we start, I need to disclose any potential conflicts of interest regarding Marodyne, the manufacturer of a low intensity vibration platform specifically designed for osteoporosis.
First, Dr. Rubin is a founder of Marodyne Medical and inventor of many of the patented technologies found in the Marodyne product.
Second, I have no financial interest in Marodyne Medical. However, they do compensate me with a small commission for platforms purchased by readers of this post.
Marodyne Price Discount for Readers
If you have an interest in the product, you can contact Marodyne and they will get back to you to address any questions you have.
If you decide to purchase the device, they will give you a discount on the purchase price.
Vibration Therapy Recommendations
I constantly search for the best therapy options to treat my clients’ bone health. I only recommend something to my clients when I see peer-reviewed scientific research (published in established journals) indicating the efficacy of the modality.
Exercise, specifically exercise that is targeted and safe, is proven to improve the health of your bones (as well as improve you overall physical and mental health). People should exercise to their maximum capacity in order to avoid the onset of frailty.
I believe, after researching the area of whole body vibration, that low intensity vibration (LIV) therapy is an effective and appropriate modality for many people with osteoporosis. Research conducted by Dr. Clinton Rubin, as well as the certification and approval by the European Union as a non-drug preventative tool for osteoporosis, indicates it efficacy.
When I Recommend Low Intensity Vibration Therapy
The following are the circumstance when I recommend low intensity vibration therapy.
- LIV can act as a surrogate to exercise when you exercise to your maximum capacity but, due to other factors (for example, time or physical constraints), you are unable to gain or maintain your bone density.
- You manage to exercise once a day but you have trouble fitting in a second exercise activity (such as a walk or workout). In that case, time on the LIV can act as your second workout.
- If you are fragile — for example, you get recurrent metatarsal fractures (the long bones in your feet), recurrent sprains or strains — then LIV can be used either alone or in conjunction with exercise.
- Bad weather, rain, snow, or heat regularly stop you from getting out for some form of exercise every day.
- Past injuries limit your loading and lifting capacity, thereby restricting your ability to do exercise appropriate for your bone health.
- Co-morbidities such as chronic heart or lung disease, arthritis, chronic pain limit your access to regular exercise.
In addition, LIV can be used to pre-stimulate your cells and optimize the benefit of your exercise session. In this case you would stand on the platform 2 to 5 hours before you plan to exercise. You can also stand on the platform 2 to 5 hours after exercise, as well.
Limitations of Low Intensity Vibration Therapy
LIV is not a silver bullet or panacea, nor does it relieve you of your responsibility to follow the proper exercise program and eat right. There are no guarantees in medicine, whether the proposed solution is a drug or a device.
Your goal should be to make sure your skeleton outlives you. It would be wonderful if you can keep your skeleton in the form it was from its first day of use. You succeed if the quality and quantity of your bone stay the same, and thus reduce your risk of fracture. Gaining bone is a bonus, but avoiding resorption is essential.
Low intensity vibration therapy does not replace exercise. It will not make your muscles stronger or more flexible, nor does it improve your cardiovascular system (heart and lungs).
Finally, LIV therapy does have a positive impact on your balance, however, you can achieve many of your balance goals with a well designed (and less expensive) balance exercise routine.
Chapter 1: High Intensity Whole Body Vibration Versus Low Intensity Vibration
The series of interviews I conducted with Dr. Rubin provide the reader with an up-to-date, comprehensive and accessible discussion on the efficacy of whole body vibration, and in particular, low intensity vibration (LIV), for the treatment and prevention of osteoporosis.
With that in mind, let us move onto my three interviews with Dr. Rubin which I conducted in December of 2020. The first video, below, identifies the difference between high intensity whole body vibration platforms and low intensity vibration platforms, with a special emphasis on the safety risks of one platform over another.
Whole Body Vibration Platforms and Low Intensity Vibration Platforms
In the first interview, below, we discuss the difference between the whole body vibration platforms (you can find at gyms and clinics or purchase on Amazon) and low intensity vibration platforms. LIV has been the focus of Dr. Rubin’s work. The section that follows after the embedded interview presents much of the content of the video.
A good place to gain an understanding of the difference between high intensity and low intensity vibration is with a benchmark. Let’s examine that next.
Low and High Intensity Vibration Measured in G
The best benchmark is earth’s gravitational field, referred to as G. One G is what keeps all of us planted firmly on earth so that we do not float away.
Low intensity vibration, in the context of this discussion, are mechanical signals that are below the acceleration of one G.
If you are accelerating up and down, let’s say in an elevator or on a vibrating plate, it means you don’t actually leave the surface because the acceleration isn’t sufficient to lift you off the ground.
Acceleration greater than one G is high magnitude vibration.
One of the great risks of high magnitude vibration (found in whole body vibration platforms with signals over one G) is that they can cause harm, and in some cases quite significant harm to the user. Let’s discuss that next.
Health Risks of High Intensity Whole Body Vibration Platforms
You can find high intensity vibration platforms, like the Power Plate, in some gyms, clinics, and other facilities.
If you are told to bend your knees when you stand on the device, that is a tell-tale sign that the platform uses high magnitude vibration.
Danger #1: Don’t Stand Straight on a High Intensity Whole Body Vibration Platform!
The reason you have to bend your knees is because the transmission of the mechanical signal will propagate through your body and cause harm. The jarring vibrations can move right through your axial (spine) and appendicular (arms and legs) skeleton into your head, and could possibly cause damage to your brain.
A study conducted by a team of Finnish researchers and published in the Journal of Bone and Mineral Research (1) in 2009 illustrates the safety issues related to high intensity whole body vibration platforms.
Four healthy men between the ages of 24 and 47 volunteered to stand on a whole body vibration platform while the research team measured the results. According to the study: “the frequency and amplitude (the vibration amplitude denotes the peak displacement of the platform [in mm] from its middle position) of the whole body vibration platform were adjustable from 5 to 3000 Hz and from 0 to 19 mm.”
The subjects were told to “stand with normal erect position (knees slightly bent) on the platform. The subjects wore no shoes and used similar cotton socks to avoid external between‐subject variance in damping.”
During the trials, the amplitudes ranged between 0.05 mm to 3 mm, frequency ranged from 15 to as much as 90 hertz, and the resulting peak acceleration (measured in G) ranged from 0.04 to as high as 19.30 G. Duration on the platform was limited to between 30 to 60 seconds.
The research team stated that: “clinical vibration interventions can be divided either into sub‐G studies (platform peak acceleration <1 G, where G denotes Earth’s gravitational constant, or 9.81 m/s2 at sea level) or supra‐G studies (platform acceleration >1 G, reaching 10 G or more).”
For consistency purposes, the sub-G is the same as our low intensity vibration definition and the supra-G is the same as our definition of high intensity vibration.
Dr. Kiiski reported the following observations:
- “When the vibration platform reaches supra‐G (that is, high intensity vibration) levels, the body gets out of phase and is impacted tens of times per second, depending on frequency. It is noted that in a quasi‐static compressive testing, the failure load of an osteoporotic lumbar vertebral body can be as low as 1300 N34—only two to three times body weight (i.e., 2–3 G) of a frail individual.”
- “On the other hand, the vibration‐induced impacts, although high in magnitude, are very short in duration (∼10 ms), and may as such, not transfer enough energy to damage the vertebrae in their natural biomechanical environment. However, the mere possibility that the supra‐G vibration induced impacts could endanger fragile bones warrants concern. In particular, given the large number of repetitive high loads received during a typical vibration session, fatigue damage to the bone may not be totally excluded.”
- “Besides possibly jeopardizing fragile bones, influence of supra‐G vibration on aged cartilage tissue and other organs is not known.”
- “Regarding the safety further, the transmissibility of vibration to the upper body is known to increase with fully straight knees and whereas enhancing the stimulus for sub‐G vibration (that is, low intensity vibration) devices, this posture may increase the risk for supra‐G devices. Obviously, high transmission of vibration to the head should be avoided.”
The team concluded: “Although the attenuation of vertical vibration at higher frequencies is fortunate from the aspect of safety, amplitudes >0.5 mm may result in greater peak accelerations than imposed at the platform and thus pose a potential hazard for the fragile musculoskeletal system.”
The key take away is if you have bones (or other body parts) with any degree of fragility, it is in your best interest to avoid using a high intensity whole body vibration platform running at supra-G (or high intensity vibration) levels of intensity. And if you are forced to be on one, limit the duration to 16 seconds or less per day.
Danger #2: Retinal Detachment
There are reports of people experiencing detached corneas and retinas while standing on high magnitude whole body vibration devices. In least harmful cases, people complain of low back pain and other discomforts.
A case report published in 2020 by Dr. John Maggiano in BMC Ophthalmology (2) documents the case of a 59 year old male who sustained “temporal retinal tear, mild vitreous hemorrhage, and an inferior pre-retinal hemorrhage in the left eye” after using a high intensity whole body vibration platform.
The study points out that there have been other cases of “vitreous hemorrhage following whole-body vibration exercise. Both of these papers suggest a high probability of correlation between whole-body vibration training and subsequent vitreous hemorrhage.”
[Image courtesy of Wikimedia Commons. Artwork by Holly Fischer, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons]
Dr. Maggiano and his colleagues conclude by stating: “with the rise in popularity of whole body vibration training exercise, it is important for the medical and athletic community to be aware of possible associated ocular complications. We believe that high-force vibration training may cause retinal tears in susceptible persons.”
In another case report (3) entitled, Intraocular lens dislocation after whole-body vibration, published in the Journal of Cataract Refract Surgery in 2010, Dr. Vela and colleagues report on two individuals who experienced intraocular lens (IOL) dislocation as a result of using high intensity whole body vibration platforms.
The authors conclude that “patients with an underlying predisposition to IOL dislocation may be at increased risk when using [whole body] vibration machines. Cataract surgeons should be aware of this potential complication.”
While the number of people who have experienced damage to the eye as a result of standing on a high intensity whole body vibration platform is relatively small, you should still exercise caution before either using or purchasing one of these devices. The signal can propagate through your body and shake things that are loose and potentially cause irreversible damage to your health.
Danger #3: Damage to the Cochlea
A study published in 2013 demonstrated that there could be a linkage between high intensity whole body vibration and hearing loss. The study was conducted on rabbits and not humans (for obvious reasons). The researchers concluded that “whole-body vibration could cause cochlear damages in male rabbits, though vibration-induced auditory functional effects might be resulted as subsequent outcome of prolonged high level vibration exposures.”
Since publishing this post, a number of readers have contacted me about their health issues since using high intensity whole vibration plates. One reader, in particular, experienced tinnitus after using the LifePro Turbo Vibration Plate. While the link between her tinnitus and the usage of the plate is inconclusive, I encourage caution (actually, avoidance) when it comes to these devices.
Here is her email to me. I have left out her name to protect her identity.
First let me thank you for all the helpful information in your emails. I am an active 69 year old with osteoporosis, and your work is so very useful!
I am writing in regard to vibration plates.
I purchased a LifePro Turbo Vibration Plate in February of this year. (I realize it is not the same unit you and Dr. Rubin are using.) I purchased it [on Amazon] because I could not go to the gym during Covid, and thought it might make home workouts more interesting and useful. I also have mild neuropathy in my feet, and thought the plate might help with that also.
However, after using the plate at the lower levels for a few weeks, I developed tinnitus. I have been to an ENT (ear, nose and throat doctor) and been evaluated by an audiologist. They confirmed I have lost hearing at the very highest level of sound only, and my hearing is normal. I do not need hearing aids, nor would they help my tinnitus. I was told my tinnitus was caused by loud noise (misuse of ear buds) or my age.
I am now leery of using the plate. I have always easily been made dizzy. At first I thought dizziness would be a problem with the plate, but I got used to it; and was hoping continued use might help me with that issue. The audiologist said being easily made dizzy is controlled by an organ very close to the cochlea. Feeling dizzy easily is a sign there is a weakness in my auditory system. This was said by the audiologist who recommended I check with a physical therapist about the wisdom of continuing with the plate.
I know I need to protect my ears now more than ever. I must be careful of loud sounds etc. To be honest, I enjoyed using the plate and miss it.
However, the tinnitus is very distressing. I definitely do not want to make it any worse. I know the plate probably did not cause my tinnitus, but worry it may have exacerbated it.
My recommendation is that there are few benefits and far too many safety and health risks when using a high intensity whole body vibration platform.
International Standards Organization (ISO) 2631 Advisory on Work Place High Magnitude Vibration
High magnitude vibration is a pathogen. The International Standards Organization (ISO) advisory for human exposure to vibration, called ISO 2631, identifies the health risks associated with high magnitude vibration in the workplace.
The ISO publishes advisories for people who work on the floor of a manufacturing site, truck drivers or helicopter pilots.
In other words, if you had one of these high intensity whole body vibration platforms in your workplace, you would be prohibited from using it because of the ISO safety guidelines.
Manufacturers of whole body vibration platforms that exhibit high magnitude vibration and sell to consumers are not subject to these advisories because the devices do not find their way into work environments. In a different post I discuss whole body vibration therapy contraindications, however, the main problem with these platforms is the high intensity levels they use.
What is a Safe Level of Exposure to High Magnitude Vibration?
The amount of vibration exposure is determined by a combination of frequency (in cycles per second or hertz), intensity or magnitude (measured in G, as described above), and duration (amount of time on the device during a session).
The devices found in high-end gyms generate a G-force of around 8 G — at their low settings. As a reminder, that is eight times Earth’s gravitational force.
The G-force is around 15 G at the high settings for this class of device.
The ISO 2631 advisories (mentioned earlier) would say that these devices are safe for less than 16 seconds of exposure per day.
The consequences of exposing your body to these high magnitude signals (particularly if you’re osteoporotic or osteopenic — that is, you have low bone density at either your femoral neck or spine) is that you are increasing your susceptibility to fracture.
This is equivalent to standing on your desk and then jumping off 30 times a second.
When you have poor bone quality and you use high magnitude vibration devices for any length of time (beyond 16 seconds, that is), then you are putting your bone health at risk.
High and Low Intensity Vibration and Real World Applications
In his lab and during clinical trials, Dr. Rubin never goes above 1 G of force. In fact, all of his studies are usually around 0.7 G (or seven tenths of gravitational field) or lower.
In the clinic, the research team usually stays around 0.4 G (or less than half of our gravitational field).
For comparison purposes with real life applications, when you walk down the street, you strike your heel against the sidewalk. The gravitational impact of that is around 1.2 G.
When you run, you apply about 2 G of force.
When you use a high magnitude vibration device (at it’s low settings), you are subject to a force of 8 G. That is concerning.
A similar comparison between running and low intensity vibration is more comforting. Again, when you run, you experience 2 G of force to your heel strike. While standing on a low intensity vibration device, it generates a relatively safe 0.4 G of force. That is more agreeable!
Safe Duration Limits for Low Intensity Vibration
If one applies the same standards set by ISO 2631 to low intensity vibration devices (using 0.4 G), it’s considered safe to use for between four to eight hours of exposure per day.
Conclusion and Recommendation
I recommend you avoid high intensity whole body vibration platforms. The health risks far outweigh any potential benefits.
A number of readers have asked me if they change the frequency setting on their high intensity vibration platform so that it is 30 hertz will it make the platform safe to use. Frequency is just one variable. Another is displacement. The most important is the intensity and the problem is that it is unlikely that changing the frequency to 30 hertz will bring the device you have into the safe zone.
In my opinion, high intensity whole body vibration platforms should, like cigarettes, come with a warning label. At a minimum, they should be subject to independent study verifying their health benefits and gauging health risks.
Chapter 2: How Low Intensity Vibration Works and Improves Bone Health
In this chapter, I cover in detail how low intensity vibration works (right down to the stem cells in your bone marrow) and discuss how it can improve your bone health.
This discussion is based on the second video interview, below, I did with Dr. Rubin. The sections that follow the video discuss the video content.
How Low Intensity Vibration Improves Bone Health
Your muscular skeletal system is an adaptive system. If you lead a sedentary lifestyle or are chronically inactive, then you are not regularly loading your muscular skeletal system.
The result: your muscular skeletal system will begin to waste away — almost immediately.
In other words, you need to “use it or lose it” when it comes to your bones.
Research shows that if you are inactive for a 24 hour period, your system recruits cells that start to break down tissues instead of loading or building them up. People who do not challenge their system for an extended period, either through choice or forced inactivity (such as through bedrest) experience an accelerated decline in bone mass.
As an example, we achieve peak bone mass around the age of 35, and both men and women lose around 2-3% bone per decade after that — if they do not consciously do activity to mitigate the loss. Post menopausal women can lose between 2 to 3% (or as much as 5%) per year — an accelerated loss in bone (due to hormonal decline).
Astronauts, Athletes and Bone Health
Astronauts, on the other hand, shed as much as 2% of bone mass per month while in space, despite being well trained athletes in peak condition.
Why is this loss happening? What’s the difference between an astronaut and us?
The reason is that the astronauts, while in space, are not subject to G — Earth’s gravitational field that loads the bone.
The “use it or lose it” phenomenon acts in the opposite direction, as well.
Some of our greatest tennis players, Serena or Venus Williams, are good examples of “use it”. Professional tennis players have about 30-35% more bone in their playing arm compared to the arm that simply throws the ball up into the air.
The cells in and around your bone are able to perceive the mechanical challenges and respond to them. As you begin to exercise more and more, the cells pick up this signal, and build up not only bone density (the amount of bone you have) but also bone quality.
Bone quality is the way that the bone is put together. To understand bone quality, we need to discuss two key types of bone, cortical and trabecular bone.
First, there is cortical bone. An example of cortical bone is that dense, hard bone on your shin.
Second, towards the ends of the bone is trabecular bone (that is surrounded by a protective shell of cortical bone). The trabecular bone is more metabolically active and is the first to diminish as we age. We have more trabecular bone in our vertebrae and in the neck of the femur, which is why those areas tend to be where osteoporotic fractures occur.
Think of trabecular bone as struts of bone — equivalent to the scaffolding that holds a building up. As these struts begin to break down —with age, disuse, or disease — the trabeculae, which are all interconnected, begin to break away.
It is very difficult to reconnect the struts after they have broken down — even with the intervention of anabolic therapy (FORTEO or Evenity, for example). Although pharmaceutical intervention may build up bone density, there still may be a loss of bone quality.
Maintain Bone Density and Bone Quality
We want to figure out how to maintain our skeleton as long as possible. In other words, how can we keep the skeleton vibrant and healthy. It’s much, much easier to maintain a healthy skeleton than to lose it and try to build it back.
The Role of Cells in Maintaining Bone Density and Quality
Bone is a very live, viable tissue.
It’s actually the only tissue in the body that can heal without leaving a scar.
The bone is remarkably sophisticated. There are the bone forming cells, the osteoblasts, and there are the bone eating cells, the osteoclasts.
There are also cells called osteocytes, which are cells inside the bone. Osteocytes are derived from osteoblasts, interconnected throughout the bone tissue, and are surrounded by new bone during bone formation.
There are cells on the surface of the bone called the periosteum and endosteum.
Bone Marrow: The Source of Bone Health
Dr. Rubin’s research indicates that the bone marrow, encased within the bone, plays a vital role in the health of your bones.
There are two types of stem cells in your bone marrow relevant to our discussion on bone health, hemapoietic stem cells (HSC) and mesenchymal stem cells (MSC).
Hemapoietic Stem Cells (HSC)
The hemapoietic stem cells (HSC) are critical to your immune system — your B and your T cells. The hemapoietic stem cells are the progenitors for your immune system. They are the agents that become the T and the B cells, which fight disease.
These multi potential progenitors can differentiate (or grow up) into different things. They can grow up into B cells, T cells, or they can go on to become macrophages, such as osteoclasts — the bone eating cells. During their lifetime, the hemapoietic stem cells within the bone marrow have to decide what they want to eventually become.
Mesenchymal Stem Cells (MSC)
The other interesting stem cells in the bone marrow are called the mesenchymal stem cells (MSC). These are cells that can grow up to become bone cells, cartilage cells, tendon cells, or ligament cells (as illustrated below).
However, mesenchymal stem cells can also become fat cells, called adipocytes.
The mesenchymal stem cells and hemapoietic stem cells reside in the marrow waiting for signals to indicate what type of cells they should become.
The signals that tell these stem cells what to do when they grow up include growth factors, cytokines (small proteins secreted by cells), and a variety of other indicators.
However, researchers have determined that these cells are also responsive to mechanical signals. As Dr. Rubin states: “mechanical signals can cause fate selection in your stem cells.”
Mechanical Signals and Bone Formation
A key question is: what type of mechanical signals will tell the stem cells in your bone marrow to grow up and become bone, and muscle, and ligament, and tendon — and not become fat?
If you have a cell population that’s mechanically responsive, the question is what mechanical parameters are best suited to stimulate a response, or in the case of bone cells, to stimulate bone formation?
When you walk briskly or run, how is force generated to your bone from your muscle? The answer lies in the way the muscles contract.
Muscle Contraction as a Mechanical Signal
Muscles contract at a clock speed, measured in hertz. If you lift up a weight, a coffee cup, or any other weight, your muscles in your arm (and supporting areas) contract at one cycle per second (depending how fast you lift the item).
Your muscles, as they contact and pull together, are an inefficient motor. As a muscle pulls and contracts, it is unstable and begins to shake.
Scientists have found that muscles shake at a clock rate of between 20 to 50 cycles per second. Whether you’re an average walker walking around the block, or you are Usain Bolt running the 100 metre dash at the Olympics, the force generated by your muscle is not only contracting at one cycle per second, it’s doing so by pulling together and shaking as it does so.
Low intensity vibration tries to provide a surrogate for that muscle shaking.
Low Intensity Vibration and Bone Cell Formation
Dr. Rubin’s research has found that not only are bone cells responsive to one cycle loads (also referred to as displacements), they’re also very, very sensitive to very small, high frequency, high cycles per second stimulation.
A bone cell could either wait for that one cycle per second load (from your walking or lifting) or it could respond to what it’s always seeing, which are your muscles contraction and vibration (at between 30 and 50 hertz).
That vibration is transmitted to the bone and the bone cells. The bone cells see a predominant signal during the day of 30 to 50 cycles per second of muscle shaking or vibrating.
Low intensity vibration stimulates the bone cells to think that they’re challenged by running a sprint in the Olympics.
The fact is that we are not running the 100 metre dash at the Olympics. However, by standing on this device, as low intensity as it is, as far as the bone cell is concerned, the effect is actually quite large.
The 30 cycles per second (30 hertz) clock rate at the displacement (0.4 G) on the low intensity vibration platform causes an intensity that’s actually anabolic — or is a stimulus to bone cells. The muscle vibration at 30 cycles per second on the low intensity vibration platform is a surrogate for high intensity exercise.
The combination of the vibration (at that clock rate) and the displacement (at 0.4 G) is a signal to the cells in the bone marrow to grow into bone formation cells (osteoblasts) instead of fat.
Bone Cell Recruitment and Bone Formation
Dr. Rubin’s research found that bone cells grow more and more responsive to frequency. If you want to build bone, back to the anabolic therapies we discussed earlier on this post, you can either try to activate the quiescent, or the sleeping bone cells on the surface of your bone, to tell them to wake up and start forming bone, or you can recruit more bone cells to that task.
Where do you get more bone cells from?
You get them from the bone marrow where the progenitor population (progenitor cells are early descendants of stem cells) reside.
Dr. Rubin found that you can activate the bone marrow population (before they turn into fat) through low intensity vibration.
If you could drive your mesenchymal stem cells (MSEs) and make them commit to become bone cells, then there are more bone cells to make bone. And this is good.
Further, Dr. Rubin found that when his team stimulated the MSEs to become bone, they didn’t become fat.
Turning on a Light Switch: Activating Bone Cells
Dr. Rubin compares the process of activating the stem cells in the marrow to turning on a light switch as you enter a room. Once you turn on the light switch, no matter how much you push the light switch, the lights don’t become brighter.
The same principle applies to the bone cells. You just need the right combination of mechanical signals to turn them on.
How often do you need to “turn on” your bone marrow cells? Dr. Rubin advises you do this at least once per day. We explore why we should do that in the next section where we explore the cytoskeleton.
Frequency Matters: The Cytoskeleton and Bone Formation
The cytoskeleton is a network of protein microfilaments, microtubules and intermediate filaments found in the cytoplasm of all cells (as illustrated below). Just like you have a skeleton, a cell has a skeleton too. If you examine a cytoskeleton under the microscope, the cytoskeleton looks a little scrawny.
However, if you can add a growth factor or if you mechanically load the cell, the cell adapts. This causes the cytoskeleton to become more robust — this is what we want to happen.
The problem is that 24 hours later, that cytoskeleton loses that gain. The cytoskeleton goes back to being couch potato.
To gain back what you had yesterday, you have to load that cell again. In fact, you have to load your body everyday to see sustained results.
The Cytoskeleton and the Light Switch Analogy
As it turns out, however, going back to the light switch analogy, you don’t need to load it very long.
If you have the right signal, it will turn on the light switch within five minutes of an exercise period. Exercising for an hour doesn’t turn the light switch on any more for your bones.
The trick is to find the right exercise to stimulate the bone marrow cells and do that activity several times per day, rather than one long period over one hour.
If you mechanically stimulate those cells, the cytoskeleton becomes stronger. However, if you keep doing it in real time, over the course of let’s say an hour, the cytoskeleton doesn’t become more robust, it’s adapted to its challenge.
If you stop stimulating the cell, and you wait for one to three hours to pass, and you stimulate them again before the cytoskeleton moves back to its dormant state, the cytoskeleton itself adapts again, and again, and again.
As an additional bonus, not only does the cell have a more robust cytoskeleton, there are more elements of it to perceive mechanical signals. More elements leads to more cell activity — almost like compound interest on your money.
The Advantage of Youth
A young and healthy body does not need these sort of signals. A young person does not need to stand on a low intensity vibration device because their cells are already stimulated through active exercise.
However, this rule does not apply if you are inactive and lead a sedentary life — even if you’re 25 years old.
No matter your age, if you’re inactive, your cells descend into a place where they’re going to have difficulty responding to mechanical signals. The marrow drive those stem cells to become fat — and that is not good.
When bone marrow fills up with fat, it begins to displace all of the cells that are key to your immune system and your regenerative capacity.
You want to keep the skeleton you have healthy and to avoid trying to rebuild it. Keep your marrow happy and healthy, because not only is it important to osteoporosis, it’s important to your overall health and well being.
How Frequently Should You Use a Low Intensity Vibration Platform?
Dr. Rubin recommends that you use the low intensity vibration platform at least once per day to keep the cells from descending into a dormant state, but then to try and ratchet up the sensitivity of the cells by doing it several times per day.
He and his research team have found in their clinical trials with mice, cells and people, that if they “buzz” (his term for vibration) their subjects two or even three times per day, the outcomes are even more robust.
Interestingly, they do not buzz for an hour per day and instead they buzz for five minutes at a time, separated by what’s called a refractory, or a rest period. They find that the whole adaptive system becomes more responsive when they implement this “buzz, rest, buzz again” protocol.
The problem is that in the lab it’s very easy to buzz cells (or mice) three to five times a day because they are captive and are forced to comply.
It is more difficult for humans to incorporate this into their daily routine. He suggests people buzz two times per day, once in the morning while they are brushing their teeth and once in the evening while they are washing dishes.
Relationship Between Fat and Bone Cells
Dr. Rubin states that when you apply mechanical stimulation to build up bone, you avoid building up fat. They have shown this phenomenon not only in cells but also mice. Mechanical stimulation is applied to drive the stem cells to become bone, which, in turn, produces a lot less fat cells.
He has shown that in mice and rats that have been fed a high fat diet, where the control mice become morbidly obese, that the “buzz rodents” not only have significantly less fat, they have significantly more bone.
Will humans experience similar results? The next section examines the research in this area.
Does Low Intensity Vibration Improve Bone Health in Humans?
Dr. Rubin describes a study (5) on the use of low intensity vibration therapy (low-level, high frequency mechanical signals) on osteopenic and osteoporotic young women done at the Keck School of Medicine in Los Angeles. The study was led by Vincente Gilsanz.
In the study Gilsanz recruited young osteopenic women, between the ages of 16 and 20, in the lowest quartile of bone mineral density, with at least one fracture due to low bone mass.
The conditions of why they were osteopenic could have been genetics, an eating disorder, or poor lifestyle choices. All participants had a history of at least one skeletal fracture.
In that study, the research team were able to show that after one year, the young women that were on the sham device (i.e., not using low-level, high frequency mechanical signals) continued to lose bone. In addition, they gained fat, both in their thoracic cavity, and throughout their body.
Dr. Gilsanz and Dr. Rubin were able to show that the women who stood on the device for at least two minutes per day (in general between two and 10 minutes per day) markedly and significantly increased bone not only in their femur and their thigh bones, but also in their spine.
The women who stood on the device for two to ten minutes per day built up significantly more muscle, paraspinous musculature, trabecular bone in the vertebrae, and cortical bone in the femur, than the women in the control group or those who did not comply with the minimum time using the low intensity vibration.
They also had significantly less fat in the thoracic cavity than the women who were the control group. That result made the research team realize that the mechanical stimulation is not just stimulating bone and muscle, it made them think about the recruitment process.
Dr Rubin realized that there is less fat because the mechanical stimulation is telling the stem cells to become bone and muscle. As we mentioned earlier, without stimulation, the MSC cells within the bone marrow become fat cells.
Vibration Therapy and a Younger Body
While these results are encouraging, the reader should note that a younger body is more responsive to stimulus (whether that be strength training, vibration therapy) than a body that is more advanced in age. As a result, the reader who is a post menopausal women cannot assume that the Gilsanz study implies that you will experience the same outcomes as the study partcipants.
The next study published in 2020 is more appropriate for that reader.
Bone Quality and Low Intensity Vibration Therapy
A paper published in December 2020 (6) by Dr. Felix Wehrli and Dr. Mary Leonard showed that the structure and the quality of bone in post menopausal women improved as a result of low intensity vibration.
The research team used high fidelity MRI (magnetic resonance imaging) to look at the structure and quality of bone. They showed that the quality of the bone in the active group, the post menopausal buzz group, improved, whereas the control group got worse, just as you would expect in a post menopausal group.
Further, they were able to demonstrate it an active group of these women that were buzzed, that their bone marrow actually improved to be more vital than the women in the control group, who had turned more towards fat.
Dr Rubin points out that once you allow your bone to become osteoporotic or your bone marrow to become composed of fat, it is more challenging to get your bone and marrow back to a healthy state. It is much easier to keep it healthy, rather than make it weak and try to make it better.
How Does Low Intensity Vibration Transmit Through the Body?
A low intensity vibration platform device delivers exceedingly small signals — about 120 microns in displacement.
However, this very subtle vibration has to transmit up through your knees, through your hip, to your spine in order to stimulate the bone marrow cells in each of those regions. How does this happen?
If 100% of the signal starts at the plate (as illustrated above at the base of the vibration platform), how much of it actually reaches your spine?
The signal leverages a phenomenon called the transmissibility function.
Viscoelastic Material and the Transmissibility Function
Before we explain transmissibility, we need to touch on the concept of viscoelasticity. Let’s start with something you can find in your kitchen — a sponge.
The common kitchen sponge is a viscoelastic material in terms of its material properties and the way it displaces and changes with frequency.
For example, if you take a kitchen sponge, fill it with water and squeeze it really slowly, the water will dribble down your arm. That’s because you’re slowly displacing the water out of the sponge.
If you take that same sponge and you slam it against the kitchen counter, the water explodes and goes everywhere. (If you do this experiment at home, you can blame science for the mess. But make sure you clean up everything, otherwise, your family members might be less than amused.)
Your muscular skeletal system is also a viscoelastic system and acts in a manner similar to the kitchen sponge.
With that in mind, how do those really small signals emanating from the base of your feet reach your spine?
How Signals Transmit
When you stand with your knees straight, your skeleton becomes a long rigid system. Higher frequency signals transmit (because of the transmissibility function, mentioned earlier) effectively up through your axial skeleton. The viscoelasticity quality of your skeletal system allows the signal to propagate through the skeleton.
However, that can change once you bend your knees. When this happens, the low intensity vibration signal no longer transmits as well as when you keep your knees straight. Once you bend your knees (a mini squat), the mechanical signal is lost to the muscles in your legs.
This is why you should not flex your knees while using a low intensity vibration device. You want the signal to propagate from your feet to your spine.
How much of the low intensity signal propagates through your skeleton?
When you stand straight on the device, the platform uses the skeleton as a transducer. It is very efficient. Under this circumstance, Dr. Rubin reports that about 80% of that mechanical signal is transmitted to your hip and spine at 30 cycles per second.
Clench Your Teeth Check
How do you know if the signal is transmitting to your upper torso? Dr. Rubin states: “If you stand on a low intensity vibration device, and you don’t clench your teeth, if you put them very closely together, you can feel them very slightly chatter a little bit. It’s a great way to make sure you device is working. As soon as you put your teeth together and feel them chatter, gently bend your knees and your teeth no longer chatter, because your skeleton is no longer transmitting the signal.”
Earlier in the post, Dr. Rubin discussed the risks associated with whole body vibration platforms that operate at high magnitude vibration levels. The alert reader is probably wondering about the transmissibility of signal through the skeletal system associated with these platforms. Let’s cover that topic next.
Whole Body Vibration Systems versus Marodyne LIV
In 2013, Dr. Rubin and colleagues at Harvard Medical School published a study (7) comparing a low intensity vibration platform (from Marodyne) with commercially available whole body vibration platforms from two manufacturers: Power Plate and Vibrafit.
The study measured the intensity of the vibration platform (measured in G forces) and had the subjects keep their knees straight and then bend their knees to reduce transmissibility.
While manufactures sometimes publish displacement (usually in millimetres or microns) and frequency, they often shy away from publishing intensity (in G forces) under different poses. (However, I have recently found a few manufacturers who promote their high intensity levels as a requirement for improving bone health!)
The research team used “skin and bite-bar mounted accelerometers, [to measure] transmissibility to the tibia and cranium … in six healthy adults standing on a programmable whole body vibration device as a function of frequency and intensity.”
Dr. Rubin and his team concluded “Vibration can have adverse effects on a number of physiologic systems. This work indicates that readily accessible [high magnitude] whole body vibration devices (Power Plate and Vibrafit, in this case) markedly exceed ISO-2631 guidelines for safety, and extreme caution must be practiced when considering their use.”
They further found that “transmissibility to the cranium was markedly attenuated by the degree of flexion in the knees.”
This probably explains why Power Plate recommends you flex your knees when you stand on their whole body vibration platform. Over time and extended use, a whole body, high intensity vibration platform will likely cause damage to your knees and other joints, as well as many other body parts including the brain and eyes.
Why a Frequency Rate of 30 Hertz?
Dr. Rubin and his team of researchers at SUNY Stony Brook found that the 30 hertz clock rate is the optimal frequency rate for vibration.
Why? It is related to the transmissibility function discussed earlier in this post.
Earlier in this post Dr. Rubin mentioned that muscle works between 20 and 50 Hz. However, there is a reason they actually drive the plate at 30 Hz and do not go above 30 Hz.
They found that at the 30 Hz clock rate (and just slightly above), the transmissibility function, the amount of signal from the floor to your hip and spine, is very efficient at 80%.
Above 30 Hz, at about 33 to 34 Hz, the transmissibility function drops off significantly and goes from 80% to around 50-40% signal effectiveness.
Dr. Rubin states that “it’s very, very important that, at least from our perspective, that we stay within this window of 30 Hz. Once you go above [that rate], the signal even though it’s potent biologically, if it doesn’t reach the spine, it’s of no consequence.”
In other words, the signal may reach your hips but will not reach your spine, and hence your spine will not benefit from the vibration.
How Does Low Intensity Vibration Therapy Work?
Low intensity vibration therapy compresses mechanical stimulation. For adults, standing on a low intensity vibration device for 10 minutes is equivalent to the muscle activity that occurs from eight hours of standing up tall.
The modality tricks the muscle, the marrow, and the bone cells into thinking that they are running a marathon, where in reality you are standing on a low intensity vibration plate.
As we age, our body systems begin to break down. Like it or not, an older body is not as responsive to mechanical stimulation as a younger person’s.
Low intensity vibration therapy assists that person (of advanced age) who is walking round the block two times per day, or playing tennis at the age of 70, but who’s system isn’t as responsive as that of a 25 year old.
Dr. Rubin’s experience is that low intensity vibration works independent, or in synergy with, people who are committed to exercise.
Chapter 3: Using a Low Intensity Vibration Platform
In this chapter we discuss the use of low intensity vibration for certain populations. This chapter is based on the third interview I had with Dr. Rubin. You can find that video below.
Again, the written copy below the video explains many the key issues that surfaced during our conversation.
Is the Marodyne Low Intensity Vibration FDA Approved?
The Marodyne Low Intensity Vibration platform is approved for treatment of osteoporosis in the Europe Union (EU). The device is under review with Health Canada as a certified medical device. Marodyne is not approved in the US for the treatment of osteoporosis.
Low Intensity Vibration is something to consider in conjunction with (but not a substitute for) pharmacologic treatments for osteoporosis, as well as exercise and nutrition.
Marodyne Price Discount for Readers
If you have an interest in the product, you can contact Marodyne and they will get back to you to address any questions you have.
If you decide to purchase the device, they will give you a discount on the purchase price.
How Safe is Low Intensity Vibration for People with Joint Replacements?
In 2015 Dr. Rubin did a clinical trial with Dr. Doug Keil at Harvard University examining the effects of low magnitude mechanical stimulation to improve bone density in persons of advanced age (8).
The research team recruited a group of frail elderly people between 75 and 95. The majority of the study candidates had rods, and a mixture of total knee and total hip replacements.
The team found that there were no adverse events or loosening of rods during the use of the low intensity vibration platform. It is always a good idea to have a conversation you with your physician or your orthopeadic surgeon if you have had a joint replacement or have plates or screws before engaging in LIV treatment.
Is Low Intensity Vibration Safe for People with Compression Fractures?
Dr. Rubin has not studied compression fractures, and whether low intensity vibration is good or bad for them.
He does, however, mention a group in Hong Kong that has published work (9) on femoral neck fractures. This research team put their subjects on low intensity vibration devices and demonstrated that it can accelerate and augment healing.
In general, someone should wait the six to eight weeks after a new vertebral compression fracture before they exercise.
However, we should put low intensity vibration (LIV) therapy in context and compare it to walking down the street. The impact of your heel (or the impact strike) on the ground generates an acceleration of around 1.2 G, just above Earth’s gravitational field.
LIV is at 0.4 G. As a result, there is less of a mechanical challenge to the region of compression/repair compared to walking down the street.
How to Use a Low Intensity Vibration Platform
When standing on the low intensity vibration platform, Marodyne suggests you keep your knees straight but not locked. You should feel a gentle vibration up to your jaw.
The machine is set for a 10 minute session. The ten minutes duration has been shown to be long enough to turn on the MSCs. Beyond a 10 minute session you don’t benefit as much as if you would if you waited a few hours and repeat another 10 minutes later in the day.
Once you have “turned on the cells”, more vibration time does not increase their excitability. Remember, the minimum time period to keep the cells from turning into fat would be at least once every 24 hours.
Using the Marodyne 2 to 5 hours before you exercise would optimize your exercise session, on a cellular level.
For maximum benefit you would either exercise or stand on the Marodyne every few hours. Any opportunity for exercise or standing on the Marodyne for 10 minutes is an extra boost to your mesenchymal stem cells.
Will a Low Intensity Vibration Platform Improve Bone Density in Wrists and Arms?
Dr. Rubin has not studied the effect of a low intensity vibration platform on the upper extremity (wrists and arms), however, he would does not anticipate, based on his study of the transmissibility of the signal, that it reaches the upper extremity.
He did identify a group in Brazil that has used low intensity vibration in subjects who were wheelchair-bound. The researchers directly stimulated the upper extremity with vibration, with the result that the people can generate more power with their arms following use.
How Does Low Intensity Vibration Work With Bisphosphonates?
There is a study underway examining the effects, if any, of low intensity vibration in combination with bisphosphonates. The results have not been published so Dr. Rubin is unable to provide a definitive answer at this time.
Keep in mind that bisphosphonates stop the osteoclasts, the bone eating cells, from cleaning the bone. However, bisphosphonates do not stimulate the bone formation cells.
Low intensity vibration, on the other hand, is anabolic in that it stimulates bone. As a result, while you are buzzing bone to grow, you’re taking antiresorptive to stop the loss. There might be some synergy and benefit but we will not know until the study results are published.
Chapter 4: Review of Key Research in Whole Body Vibration for Osteoporosis and Bone Density
There is a large library of studies and meta-analyses done on the effects of whole body vibration on bone density and bone health. Unfortunately, a number of these studies have conflicting conclusions. They also vary dramatically in what they studied making comparisons of their results with other studies very difficult to interpret. Finally, clinical trials involving humans are very difficult to run (because they involve humans).
These contradictions, inconsistencies, and clinical challenges make the decision to use whole body vibration therapy confusing and frustrating for the general reader.
For reasons of brevity, I will not cover all the published studies. Instead I will discuss one study conducted at Toronto General Hospital, largely because it is fairly prominent in the minds of many people who follow this category. Along the way I will show that its conclusions are not completely applicable to the low intensity vibration approach presented in this article by Dr. Rubin.
Effect of 12 Months of Whole-Body Vibration Therapy on Bone Density and Structure in Postmenopausal Women
In a 12 month study on whole body vibration, published in 2011, Lubomira Slatkovska, Angela Cheung and colleagues concluded that “whole-body vibration therapy at 0.3g and 90 or 30 Hz for 12 months did not alter BMD (bone mineral density) or bone structure in postmenopausal women who received calcium and vitamin D supplementation.” (10)
Summary of Study Methods
The research team at Toronto General Hospital recruited “202 healthy postmenopausal women with bone mineral density (BMD) T-scores between 1.0 and 2.5 who were not receiving prescription bone medications.” The study participants were recruited primarily by using “posted flyers, word of mouth, and our postmenopausal health newsletter in the Greater Toronto Area.” Recruitment was conducted between October 2006 and November 2008.
One of the investigators “randomly assigned [the study participants] to 1 of 3 groups (allocated with a 1:1:1 ratio) by using a block-randomization scheme and sealed envelopes.”
Eligible participants were assigned to receive 1 of 3 interventions:
- 0.3g, 90-Hz WBV;
- 0.3g, 30-Hz WBV;
- or no WBV (control group).
Sham WBV was not provided to control participants because of limited funding; thus, participants knew whether they were in the control group.
The study participants were asked “to stand on a low-magnitude (0.3g) 90-Hz or 30-Hz WBV platform for 20 minutes daily or to serve as control participants; all participants received calcium and vitamin D.”
Independent assessors used “trabecular volumetric BMD and other measurements of the distal tibia and distal radius with high resolution peripheral quantitative computed tomography and areal BMD with dual-energy x-ray absorptiometry at baseline and at 12 months.”
How the Participants Used the Whole Body Vibration Platform
The research team “chose to examine low-magnitude (0.3g) WBV at 90 and 30 Hz because high-magnitude (greater than 1g) WBV has been shown to have deleterious effects in occupational settings. The International Organization for Standardization recommends its use for only short intervals or not at all in industries that use machinery involving vibration (ISO 2631).”
At the start of the study, participants were asked to stand on the platform for 20 minutes daily for 12 months at home. They were instructed to stand erect and with neutral posture at the neck, lumbar spine, and knees. In addition they were told to wear socks or stand barefoot and not use excessive foot or body movements.
Control participants were asked not to use WBV therapy.
At baseline and at 12 months, volumetric bone mineral density (trabecular, cortical, and total) and bone structure (cortical thickness and trabecular thickness, number, separation, and bone volume fraction) were measured at the distal tibia and distal radius. The investigators used high-resolution peripheral quantitative computed tomography (HR-pQCT). Areal BMD was measured at the femoral neck, total hip, and L1 to L4 lumbar spine with dual-energy x-ray absorptiometry (DXA).
Their “prespecified primary outcome was trabecular volumetric BMD (bone mineral density) at the distal tibia.” They selected this outcome “because trabecular bone tissue at a weight-bearing site closest to the oscillating plate was expected to have a greater response to WBV than other measurements or sites.”
Slatkovska and Cheung reported that “twelve months of WBV therapy at 90 or 30 Hz resulted in no significant change in either HR-pQCT or DXA bone outcomes compared with no WBV.”
They concluded: “12 months of low-magnitude (0.3g) WBV at either 90 or 30 Hz had no effect on BMD or bone structure in healthy, community-dwelling, postmenopausal women who received calcium and vitamin D supplementation, and is thus not recommended for preventing age related bone loss in this population.”
Interpretation of Results
The Cheung clinical study was a difficult study to do because it involved human subjects over a 12 month period. It also presented the research community with important information. They deserve applause for the work.
However, several issues need to be considered before applying the results of a clinical trial in 2011 to the low intensity vibration technology available in 2021.
No Bone Loss
First, the goal of most interventions for most people, whether it be exercise, pharmaceutical or vibration therapy, is to avoid continued bone loss. In other words “over time, maintaining is gaining”. In the Cheung study neither group (the two intervention groups and the control group) lost bone during the 12 month period. One would expect, at least, some decline in the control group over the 12 month period – but for some reason this did not happen.
One possible reason that all three of the groups did not experience bone loss, regardless of intervention, is that all of the groups exercised or were active during the 12 month period. This likely offset the effects of the vibration therapy. A careful read of the study shows that they recruited participants primarily by using “posted flyers, word of mouth, and our postmenopausal health newsletter in the Greater Toronto Area.”
I anticipate that the people on their postmenopausal health newsletter, for example, were motivated to improve their bone health and continued bone healthy activities, such as exercise. Further, the researchers did not tell the three study groups not to exercise or maintain activities that improved bone health for the 12 month study period.
Perhaps the study might have been more telling if they selected participants who were losing bone (to see if the vibration was effective or not in arresting bone loss) or if they ran the study for more than one year.
In their 2020 study, Wehrli and Leonard (5) state “previous studies that failed to demonstrate osteogenic effects of low-intensity vibration in healthy adults did so perhaps because the adults were already experiencing the stimulatory mechanical signals during normal ambulation or daily physical activity.”
Juvent Hertz Rate
Second, the research team used the Juvent vibration plate available in 2011. The 30 hertz clock rate that they used was actually running at 38 hertz.
Earlier in the post I mentioned how Dr. Rubin identified a sweet spot for vibration at around 30 hertz and above that rate the effectiveness dropped significantly. (Hence, the 90 Hz rate group was destined to underperform.)
If you can recall, Rubin and colleagues found that at the 30 Hz clock rate (and just slightly above), the transmissibility function, the amount of signal from the floor to your hip and spine, is very efficient at 80%. Above 30 Hz, around 33 to 34 Hz, the transmissibility function drops off significantly and goes from 80% to around 50-40% signal effectiveness.
Rubin and team also found that the 30 hertz rate is optimal to stimulate bone cell activity in the bone marrow.
Third, the primary outcome in the Cheung study was “trabecular volumetric BMD and other measurements of the distal tibia and distal radius.” They used “high-resolution peripheral quantitative computed tomography (HR-pQCT).” In addition, areal BMD was measured at the femoral neck, total hip, and L1 to L4 lumbar spine with dual-energy x-ray absorptiometry (DXA).
These measurements are far less sensitive than CT (used in other studies) and is not as versatile as MRI (magnetic resonance imaging). In the 2020 study at the University of Pennsylvania, Wehri and Leonard employed MRI to determine not just bone density but also bone quality. Further, there were able to examine bone marrow and determine that the marrow viability remained high.
As well, they found that the fat infiltration that is normally seen with aging, was suppressed. This indicates that the stem cells in the bone marrow were not been shoved out by adipocytes (fat cells). As we mentioned earlier in the post, bone marrow activity, in particular the fate of the stem cells, is a major contributor to bone health.
Effect of Low‐Intensity Vibration on Bone Strength, Microstructure, and Adiposity in Pre‐Osteoporotic Postmenopausal Women: A Randomized Placebo‐Controlled Trial
In late 2020, Dr. Felix Wehrli of the University of Pennsylvania and Dr. Mary Leonard of Stanford University, published Effect of Low-Intensity Vibration on Bone Strength, Microstructure, and Adiposity in Pre-Osteoporotic Postmenopausal Women: A Randomized Placebo-Controlled Trial, in the Journal of Bone and Mineral Research. (6)
The study was similar in format as the 2011 clinical study by Dr. Lubomira Slatkovska and Dr. Angela Cheung. However, there were a couple of key differences.
First, the Wehrli study was able to looked deeper into the bone with the use of and MRI (magnetic resonance imaging). This allowed them to determine not just bone density, it also gave them insight into the effects of low intensity vibration on bone quality and bone marrow activity.
Second, the configuration of the low intensity vibration was closer to that described by Dr. Rubin (in this article) and therefore is more indicative of the results one could see from the usage of a device such as the Marodyne LIV platform.
Summary of Study Methods
The research team enrolled its first and last randomized participants in April 2014 and October 2017, respectively. Follow-up study visits continued into 2018. Postmenopausal females aged 45 – 65 years were eligible for the study.
Subjects meeting the entry criteria at the screening visit were randomly allocated 1:1 to either an active low-intensity vibration or placebo device designed for home use.
Briefly, the device, which resembles a large bathroom scale, oscillates in the vertical direction at a frequency of 30 Hz with 0.3g acceleration, requiring a displacement of approximately 90 μm.
Participants were instructed to stand on the platform in a relaxed stance, with knees neither locked nor bent. They had to be either barefoot or wearing stockings for ten minutes daily over a 12-month period. The device is designed to induce the maximum possible amplitude of stimulation all the way up to the spine with a given vibrational load at the feet.
The distal tibia (3% up the tibia) was chosen as the primary site for bone microstructure and stiffness measurements because of the proximity to the external mechanical stimulus applied to the feet and because it is a site rich in trabecular bone.
All subjects underwent a series of imaging procedures involving MRI at the tibia and spine, DXA of the hip and spine, and peripheral quantitative computed tomography (pQCT) at the tibia, as described below.
For this randomized trial, a total of 415 women were telephone screened, of which 182 (44%) were eligible for a screening visit. Of these, 117 (64%) women completed the screening visit and 87 (74%) were eligible based on DXA, BMI, and lab criteria. Eighty (92%) were randomized, with 42 (52%) being given active devices and 38 (48%) being given placebo devices.
The two primary outcome variables examined were computationally quantified stiffness of the distal tibia bone obtained from MRI-derived bone structure, and independently, a measure of marrow metabolism, the vertebral bone marrow’s adiposity.
Additional secondary variables included DXA bone densities of the spine and hip, as well as pQCT measures at the distal tibia, and vertebral deformity.
This prospective, randomized, double-blinded, 12-month trial of ten minutes of daily low intensity vibration in pre-osteoporotic, postmenopausal women demonstrated beneficial effects on MRI-derived distal tibia stiffness, trabecular microstructure, and lumbar vertebral adiposity.
It should be noted that most previous studies that reported beneficial effects of low intensity vibration intervention involved cohorts with severely compromised bone quality at baseline. For example, vibration interventions have been found to be beneficial in patients with renal osteodystrophy , disabling conditions , idiopathic scoliosis , cerebral palsy , Crohn’s disease , Rett syndrome , child cancer survivors , and young women (15 – 20 years) with low BMD and a history of bone fracture .
These studies, taken together with the results of the present work, suggest that low-intensity vibration may be best suited for individuals with compromised bone quality lacking regular stimulatory cues.
Vibration therapy may thus serve as a potential surrogate for exercise.
Comparison with Other Research Studies
Previous studies that failed to demonstrate osteogenic effects of low-intensity vibration in healthy adults did so perhaps because the adults were already experiencing the stimulatory mechanical signals during normal ambulation or daily physical activity.
In contrast to other low-intensity vibration studies that relied mainly on bone density as the primary endpoint, Wehrli and Leonard used finite-element-derived whole-tibia stiffness as the primary outcome variable. This is a parameter that showed the most significant treatment effect compared to conventional measures of bone.
Previous studies have also demonstrated that MRI-based finite element analysis is sensitive to changes and differences in bone not captured by more traditional parameters focusing on bone volume and architecture.
Data presented in the Wehrli and Leonard study provides “compelling new evidence supporting the hypothesis that the intervention reduces lumbar bone marrow adiposity quantified by spectroscopic imaging. This, in turn, indicates enhanced commitment of mesenchymal stem cells toward the osteoblastic lineage via downregulation of the nuclear hormone receptor, PPARγ. The important results suggest “a reduction in the rate of marrow adipogenesis to some degree, thereby retaining or enhancing the capacity for osteoblastogenesis.”
Data from the study “suggest that exogenous stimulation in the form of low amplitude cyclical loading could be beneficial by slowing down postmenopausal bone loss in otherwise healthy women, especially those who might face barriers to regular exercise.”
While the treatment effects observed after one year of vibration therapy are modest, they are nevertheless highly significant, suggesting that the intervention at least stabilizes postmenopausal bone loss. The results also shed new light on the connection between osteogenesis and adipogenesis, from the perspective of intervention involving very low amplitude cyclical loading.
In summary, Wehrli and Leonard conclude that “the data suggest that low-intensity vibration treatment as a preventive strategy may have potential as a non-pharmacological alternative to antiresorptive and anabolic agents, without incurring adverse side effects.”
Exercise Recommendations for Osteoporosis
Exercise is an essential ingredient to bone health. If you have osteoporosis, therapeutic exercise needs to be part of your osteoporosis treatment program.
But what exercises should you do and which ones should you avoid? What exercises build bone and which ones reduce your chance of a fracture? Is Yoga good for your bones? Who should you trust when it comes to exercises for osteoporosis?
A great resource on exercise and osteoporosis is my free, seven day email course called Exercise Recommendations for Osteoporosis. After you provide your email address, you will receive seven consecutive online educational videos on bone health — one lesson each day. You can look at the videos at anytime and as often as you like.
- Can exercise reverse osteoporosis?
- Stop the stoop — how to avoid kyphosis and rounded shoulders.
- Key components of an osteoporosis exercise program.
- Key principles of bone building.
- Exercises you should avoid if you have osteoporosis.
- Yoga and osteoporosis — should you practice yoga if you have osteoporosis?
- Core strength and osteoporosis — why is core strength important if you have osteoporosis?
Enter your email address and I will start you on this free course. I do not SPAM or share your email address (or any information) with third parties. You can unsubscribe from my mail list at any time.
Summary of Original Article
In the original post, I carefully reviewed a meta-analysis published in 2018 (11) by a team of Spanish researchers led by Dr. Elena Marin-Cascales of the Universidad Católica de Murcia (UCAM) in Murcia, Spain.
The systematic review and meta-analysis evaluated ten “published, randomized controlled trials (RCTs) that investigated the effects of WBV (Whole Body Vibration) on total, femoral neck, and lumbar spine BMD in postmenopausal women and identified the potential moderating factors explaining the adaptations to such training”.
The team found a number of unexplained inconsistencies and conflicting outcomes between the studies. Unfortunately, the inconsistencies and conflicts made it difficult to draw clear conclusions from Dr. Marin-Cascales’ review on the effectiveness of whole body vibration on the treatment and prevention of osteoporosis.
The team made several recommendations regarding the use of whole body vibration therapy for osteoporosis including using high intensity vibration platforms that operate at acceleration levels of as much as 8 G.
It should not come as a surprise to the reader that I have significant reservations about this last recommendation, given the known safety issues related to high intensity whole body vibration platforms (described in detail above).
Exercise and movement play an essential role in the maintenance of your physical, mental and bone health. This article explains why you need to do frequent exercise to stimulate bone cell formation, all the way down to the marrow of your bones.
We covered how vibration can be both a pathogen (in whole body vibration high intensity platforms) and how it can be a surrogate to exercise in low intensity vibration platforms.
About Dr. Clinton Rubin
Clinton T. Rubin, Ph.D., is the SUNY Distinguished Professor of Biomedical Engineering, and Director of the Center for Biotechnology at Stony Brook University in Stony Brook, New York. Dr. Rubin’s research is targeted towards understanding the cellular mechanisms responsible for the growth, healing, and homeostasis of bone, and how mechanical stimuli mediate these responses through the control of mesenchymal and hematopoietic stem cell differentiation and proliferation, to establish non-drug treatment strategies for osteoporosis, obesity and diabetes.
When he’s not teaching, Dr. Rubin is busy researching cellular mechanisms that are responsible for maintaining bones’ health, how mechanical stimulus can help bone grow, and how to help it heal faster after a fracture.
Applications of Research
Dr. Rubin holds ~30 patents in the area of wound repair, stem cell regulation, and treatment of metabolic disease, and is a founder of Exogen, Juvent, Marodyne Medical, and Lahara Bio, which use physical signals to regulate biologic processes. He has published over 300 articles, has been cited ~33,000 times, with an H-index of 93. Unfortunately, some of those citations are used by companies that make unsafe whole body vibration machines.
His research has been put to very good use developing devices that give us non-drug treatment strategies. LIV stands for low intensity vibration and is a non-drug treatment strategy that builds bone. It’s been shown to successfully and safely build bone in persons diagnosed with osteopenia, osteoporosis, and low bone density caused by other diseases or co-morbidities.
He is a fellow of AAAS, NAI, ASBMR, BMES and AIMBE. Dr. Rubin received his AB degree from Harvard, and his PhD from Bristol University, U.K.
Dr. Rubin is a world authority on vibration therapy and whole body vibration platforms and their affect on health.
- Kiiski, J et al. Transmission of Vertical Whole Body Vibration to the Human Body. Journal of Bone and Mineral Research. First published: 04 December 2009.
- Maggiano, J., Yu, MC.M., Chen, S. et al. Retinal tear formation after whole-body vibration training exercise. BMC Ophthalmology 20, 37 (2020). https://doi.org/10.1186/s12886-019-1291-y
- Vela J, et al. Intraocular lens dislocation after whole-body vibration. Journal of Cataract Refract Surgery. 2010 Oct;36(10):1790-1. doi: 10.1016/j.jcrs.2010.07.001.
- Najarkola SAM, et al. Cochlear Damages Caused by Vibration Exposure. Iran Red Crescent Medical Journal. 2013 Sep; 15(9): 771–774. Published online 2013 Sep 5. doi: 10.5812/ircmj.5369
- Gilsanz V, Rubin C, et al. Low-level, high-frequency mechanical signals enhance musculoskeletal development of young women with low BMD. J Bone Mineral Research. 2006 Sep;21(9):1464-74
- Wehrli F, Leonard M, et al. Effect of Low‐Intensity Vibration on Bone Strength, Microstructure, and Adiposity in Pre‐Osteoporotic Postmenopausal Women: A Randomized Placebo‐Controlled Trial. J Bone Mineral Research. 13 December 2020.
- Muir J, Keil D, Rubin C. Safety and severity of accelerations delivered from whole body vibration exercise devices to standing adults. J Sci Med Sport. 2013 Nov;16(6):526-31. doi: 10.1016/j.jsams.2013.01.004. Epub 2013 Mar 1.
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- Chow et al. Low-magnitude high-frequency vibration (LMHFV) enhances bone remodeling in osteoporotic rat femoral fracture healing. J Orthop Research. 2011 May;29(5):746-52. doi: 10.1002/jor.21303. Epub 2010 Dec 23
- Slatkovska, Cheung et al. Effect of 12 Months of Whole-Body Vibration Therapy on Bone Density and Structure in Postmenopausal Women. Annals of Internal Medicine. November 15, 2011.
- Marin-Cascales E., et al. Whole body vibration training and bone health in postmenopausal women: A systematic review and meta-analysis. 2018 Aug;97(34):e11918.
For more information, check out my Osteoporosis Guidelines.