Bone is contiuously destroyed and reformed throughout our life (see Wolff's Law). Old bone is removed (resorption) by osteoclasts and new bone is created (formation) by osteoblasts. During childhood and the beginning of adulthood bone formation exceeds bone resorption so that bones become larger, heavier and denser.

The bone mass actually increases roughly until the age of 20 to 25 where it reaches its maximum value known as the Peak Bone Mass. The higher the peak bone mass is, the lower the risk of osteoporosis is. Peak bone mass is, to some extent, predetermined by genetics but there are other factors which can have an influence. These include sex hormones and lifestyle choices such as diet, exercise, smoking and alcohol. Bone mass then remains stable for a few years (for women, till about 45 years old) whereby there is an equilibrium between bone formation and resorption. After a certain age, bone mass starts to decrease. For women, this bone loss starts a few years before menopause and becomes more and more important until death.

As mentioned previously, bone grows in response to mechanical stress and this is often referred to as adaptive remodelling. Therefore, if the mechanical stresses increase to the point that tissue deformation (strain) is high, then more bone will be formed until strain reaches a normal level. Similarly, if mechanical stresses decrease to the point that strain is low then bone resporption will occur until strain reaches a normal level.

Consider then the example of a structural scoliosis whereby there is a lateral curvature of the spine. The curvature will probably become worse with time due to structural changes because stresses will have been concentrated differently to that of the optimum spine. If small, regular changes can be made to the mechanics of the spine to bring it closer to the alignment of the optimum spine then stress concentrations will change, thereby allowing bone to change shape and for the spine to straighten over time. This could be further improved by exercises which help to stress the spine more, thereby further encouraging adaptive remodelling.

Following logically from this, correcting the mechanics of the spine is especially important at an early age in order to provide the best chance of working towards the optimum spine. Therefore, what is needed is a preventative treatment to optimise the mechanical properties of the spine.