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Mechanical usage window of bone. MESr, MESm, and MESp are the remodeling, modeling, and pathological mechanical thresholds, respectively. Below the MESr, biochemical stimuli are required to drive adaptation. Within MESr–MESm, mechanical loading is the dominate force. Below the MESp, mechanical loading is reversible, whereas above the MESp, irreversible damage may occur. (Adapted from Frost HM. Bone's mechanostat: a 2003 update. Anat Rec A Discov Mol Cell Evol Biol 2003;275:1080–1101.)
