cannot comprehensively assess skeletal integrity [3]. High-resolution micro-tomographic techniques enable detailed pre- and post-mission evaluation of trabecular bone, but are not suitable for longitudinal monitoring [4]. Mesoscale experiments and simulations under modeled microgravity highlight the need to complement traditional morpho-geometrical measures with functional structural analyses [5,6]. Musculoskeletal deconditioning under microgravity analogues, such as bed rest, provides a critical model to investigate the coupled processes of bone loss and muscle atrophy driven by mechanical unloading and disuse, involving interconnected endocrine-metabolic, immune, and inflammatory pathways. However, current diagnostic tools offer only a partial view of the resulting functional impairment. METHOD To address these limitations, the Bone Elastic Structure (BES) test—a CE-marked software medical device— can be applied to assess trabecular bone elasticity, a functional parameter, independent of BMD, which responds earlier than cortical bone and BMD to physio-pathological unloading. The technology is based on in silico analysis [7], of ultra-low-dose X-ray images of the proximal epiphysis of the first phalanx of the hand and foot, enabling rapid, repeatable, and noninvasive monitoring sensitive to changes occurring within weeks (Fig.1). Figure 1: the BES TEST workflow This approach is integrated with a panel of non-standard biochemical markers of bone remodelling, muscle catabolism, and inflammation to capture bone–muscle interactions and individual variability in unloading responses. RESULTS BES TEST complements densitometry as a low-dose monitoring tool and has demonstrated applicability across multiple clinical settings: bone follow-up [8], rheumatology [9], and rare diseases [10], with reproducibility metrics consistent with current osteoporosis diagnostic standards (CV intra-operator = 0.06; inter-operator = 0.11) [11]. DISCUSSION Acquisition of hand radiographs in microgravity and simulated lunar gravity using ultra-portable digital X-ray systems has already been demonstrated [12]. The BES TEST can therefore contribute to multi-modal, longitudinal monitoring of bone and metabolic health during spaceflight, and its added value can be further validated through microgravity analogue studies in the near future. REFERENCES 1. DOI:10.1016/S8756-3282(98)00017-9 2. DOI:10.1359/JBMR.040307 3. DOI:10.3357/AMHP.EC06.2015 4. DOI:10.1016/j.jocd.2019.08.005 5. DOI:10.1016/j.jmbbm.2008.06.004 6. DOI:10.1016/J.JMBBM.2015.01.002 7. DOI:10.3970/mcb.2015.012.087 8. DOI:10.21741/9781644902431-45 9. DOI:10.23736/S0026-4806.19.06079-8 10. DOI:10.1016/j.matpr.2019.03.121 11. DOI:10.1177/09544062221133675 12. DOI:10.3357/AMHP.6286.2023
A Proposal for Monitoring of Bone Function in Microgravity and Analogues / Cosmi, F., Visai, L., Vico, L., Strigini, M., Emmi, G., Fischetti, F.. - (2026), pp. "-"-"-". (45th Annual Meeting of the International Society for Gravitational Physiology German Sport University, Cologne, Germany 25-29 May 2026).
A Proposal for Monitoring of Bone Function in Microgravity and Analogues
Francesca Cosmi
Primo
;Giacomo Emmi;Fabio FischettiUltimo
2026-01-01
Abstract
cannot comprehensively assess skeletal integrity [3]. High-resolution micro-tomographic techniques enable detailed pre- and post-mission evaluation of trabecular bone, but are not suitable for longitudinal monitoring [4]. Mesoscale experiments and simulations under modeled microgravity highlight the need to complement traditional morpho-geometrical measures with functional structural analyses [5,6]. Musculoskeletal deconditioning under microgravity analogues, such as bed rest, provides a critical model to investigate the coupled processes of bone loss and muscle atrophy driven by mechanical unloading and disuse, involving interconnected endocrine-metabolic, immune, and inflammatory pathways. However, current diagnostic tools offer only a partial view of the resulting functional impairment. METHOD To address these limitations, the Bone Elastic Structure (BES) test—a CE-marked software medical device— can be applied to assess trabecular bone elasticity, a functional parameter, independent of BMD, which responds earlier than cortical bone and BMD to physio-pathological unloading. The technology is based on in silico analysis [7], of ultra-low-dose X-ray images of the proximal epiphysis of the first phalanx of the hand and foot, enabling rapid, repeatable, and noninvasive monitoring sensitive to changes occurring within weeks (Fig.1). Figure 1: the BES TEST workflow This approach is integrated with a panel of non-standard biochemical markers of bone remodelling, muscle catabolism, and inflammation to capture bone–muscle interactions and individual variability in unloading responses. RESULTS BES TEST complements densitometry as a low-dose monitoring tool and has demonstrated applicability across multiple clinical settings: bone follow-up [8], rheumatology [9], and rare diseases [10], with reproducibility metrics consistent with current osteoporosis diagnostic standards (CV intra-operator = 0.06; inter-operator = 0.11) [11]. DISCUSSION Acquisition of hand radiographs in microgravity and simulated lunar gravity using ultra-portable digital X-ray systems has already been demonstrated [12]. The BES TEST can therefore contribute to multi-modal, longitudinal monitoring of bone and metabolic health during spaceflight, and its added value can be further validated through microgravity analogue studies in the near future. REFERENCES 1. DOI:10.1016/S8756-3282(98)00017-9 2. DOI:10.1359/JBMR.040307 3. DOI:10.3357/AMHP.EC06.2015 4. DOI:10.1016/j.jocd.2019.08.005 5. DOI:10.1016/j.jmbbm.2008.06.004 6. DOI:10.1016/J.JMBBM.2015.01.002 7. DOI:10.3970/mcb.2015.012.087 8. DOI:10.21741/9781644902431-45 9. DOI:10.23736/S0026-4806.19.06079-8 10. DOI:10.1016/j.matpr.2019.03.121 11. DOI:10.1177/09544062221133675 12. DOI:10.3357/AMHP.6286.2023Pubblicazioni consigliate
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