Lloyd SAJ, Travis ND, Lu T, Bateman TA. Development of a low-dose anti-resorptive drug regimen reveals synergistic suppression of bone formation when coupled with disuse. J Appl Physiol 104: 729-738, 2008. First published January 3, 2007 doi:10.1152/japplphysiol.00632.2007.-Safe and effective countermeasures to spaceflight-induced osteoporosis are required to mitigate the potential for mission-critical fractures and ensure long-term bone health in astronauts. Two anti-resorptive drugs, the bisphosphonate zoledronic acid (ZOL) and the anti-receptor activator of NF-B ligand protein osteoprotegerin (OPG), were investigated to find the minimum, comparable doses that yield a maximal increase in bone quality, while minimizing deleterious effects on turnover and mineralization. Through a series of five trials in normally loaded female mice (n ϭ 56/trial), analysis of trabecular volume fraction and connectivity using microcomputed tomography, along with biomechanical testing, quantitative histomorphometry, and compositional analysis, was used to select 45 g/kg ZOL and 500 g/kg OPG as doses that satisfy these criteria. These doses were then examined for their ability to mitigate bone loss following short-term unloading through hindlimb suspension (HLS). Seventy-two mice were prophylactically administered ZOL, OPG, or PBS and assigned to loaded control or 2-wk HLS groups (n ϭ 12 for each of 6 groups). Both anti-resorptives were able to preserve trabecular microarchitecture and femoral elastic and maximum force in HLS mice (ϩ30 -40% ZOL/OPG vs. PBS). In HLS mice, anti-resorptive dosing reduced resorption perimeter at the femoral endocortical surface by 30% vs. PBS. In loaded control mice, anti-resorptives produced no change in bone formation rate; however, reductions in bone formation rate brought about by HLS were exacerbated by anti-resorptive treatment, suggesting synergistic inhibition of osteoblasts during disuse. Refined anti-resorptive dosing will tend to target countermeasures to the period of disuse, resulting in faster recovery and less adverse effects for astronauts. spaceflight; osteoprotegerin; zoledronic acid; osteoporosis; bone loss; microcomputed tomography THE "VISION FOR SPACE exploration" has directed the National Aeronautics and Space Administration (NASA) toward human exploration of the Moon and Mars within the next 30 years (22). In addition to the many engineering challenges associated with such an undertaking, there are important biomedical issues that result from extended exposure to the space environment, including muscle atrophy (35), altered immune function (39), and metabolic disruptions (24). The risk of bone loss is also a major obstacle for the future of long-duration spaceflight (34,36).In microgravity, skeletal unloading causes increased bone resorption, which leads to long-term demineralization of loadbearing bones (34). Astronauts experience an average net loss of ϳ230 mg calcium/day (33). Bone loss at a rate of 0.5-2.0%/mo in load-bearing bones creates a risk of fractures during the mi...