Bone Bioelectricity and Bone-Cell Response to Electrical Stimulation: A Review

It is hypothesized that bone cells can sense mechanical force in the extracellular network via an electrical signal. This has led to the use of electrical stimulation (ES) to improve fracture repair and mitigate bone loss. Although overlap exists in bone maintenance and fracture healing mechanics, the processes involved in both are very different, resulting in dissimilar behaviors from the cells. Osteocytes are the most abundant cell type in bone tissue, and their basic structure and lineage are fairly well understood, but much debate is present regarding their behavior, with even less known about their behavior in electrical environments. A wide range of research exists on cell behavior under different types of ES, but it is difficult to draw conclusions due to the large variance in stimulation parameters, cell types, and origins (locations and species). By exploring behavior of multiple bone-cell types under different forms of ES, as well as mechanical stimulation through fluid flow, we can determine more about cell reactions to stimuli. In turn, a better understanding of cell response has the potential to improve and broaden therapeutic applications of ES for bone healing and bone loss mitigation, and enhance outcomes for osseointegration into implantable medical devices. These require greater understanding of the bone cellular environment from an electrical perspective as well as cellular responses to ES.