CHEMICAL COMPOSITION OF BONE

1. Organic matrix (30%)

2. Bone salts (70%)
a. Calcium and phosphate
b. Magnesium, sodium , potassium and carbonate ions are also present among the bone
salts (they are believed to be conjugated to the hydroxapatite crystals rather than
organized into distinct crystals)
*Bone matrix is composed of 35% organic and 65% inorganic which comprises of calcium and
phosphate. Other parts of the matrix are protein, carbohydrate –protein complexes and ground
substances. Water comprises 5-8% of the matrix (from Pathophysiology, The Biologic basis fro
diseas in Adults and children 7th ed, pg 1515)

BONE GROWTH AND REPAIR

1. The bone adjust its strength in the proportion to the degree of bone stress, so the result is,
the bone thickens when subjected to heavy loads
2. The shape of the boen can be rearranged for proper support of mechanical forces by
deposition and resorption of bone in accordance with stress patterns
3. Old bones becomes brittle and weak, so, new organic matrix is needed as the old
organic matrix degenerates
Stages of bone healing (repair)
1. Hematoma formation: (occurs w/in hours)
- if vessels have been damaged that will lead to hemorrhage
- Fibrin and platelets form a meshwork that is the initial framework for healing with
the help of hematopoietic growth factors such as platelet-derived growth factor and
TGF-β
2. Procallus formation: (w/in days)
- Fibroblasts, capillary buds, and osteoblasts move into the wound to produce
granulation tissue called procallus
- Cartilage (precursor of bone) and types I, II, and III collagen are formed
- Enzymes and growth factors, such as insulin and insulinlike growth factors, plus bone
morphogenic protein and osteogenin, aid in this stage of healing.
 3. Callus formation: (w/in weeks)
- Osteoblasts in the procallus form membranous or woven bone (callus)
- Phosphate and calcium deposition happens
4. Callus replacement: (w/in years up to 4yearsin some cases)
- Osteoblasts continue to replace the callus with lamellar bone or trabecular bone
5. Remodeling:
- The periosteal and endosteal surfaces of the bone are remodeled to the size and shape
of the bone before injury
- Final stage of healing, or remodeling, is vital because bone that has not been
remodeled does not have good mechanical properties for weightbearing and mobility.
*Factors that affects the speed of healing
1. Severity of the bone disruption
2. type and amount of bone tissue to be replaced
3. blood supply and oxygen content at the site
4. presence of growth and thyroid hormones, insulin, vitamins, and other nutrients
5. the presence of systemic disease
6. the effects of aging
7. effectiveness of treatment, including immobilization and the prevention of
complications such as infection

EFFECTS OF EXERCISE AND DECONDITIONING ON THE MSK SYSTEM

1. Muscle bulk and strength slowly decline with aging, although not to a pathologic degree.
The bone remodelling cycle takes longer to complete, and the rate of mineralization
slows.
2. Exercise
- improves muscle strength
- helps increase bone mineral density
- improves balance, coordination, lean body mass, and mobility
3. Deconditioning is due to prolonged bed rest
- Levels of deconditioning
a. Mild: difficulty w/ maximal activity (swimming, running or exercising
 b. Moderate: difficulty w/ normal activity (walking down the street, shopping )
c. Severe: difficulty w/ minimal activity and self-care
- Effect in MSK
a. Muscle weakness and atrophy
 pathologic reduction in normal size of muscle fibers after prolonged
inactivity from bed rest, trauma (casting), or local nerve damage
 The effects of muscular deconditioning associated with lack of physical
activity may be apparent in a matter of days
 Oxidative stress from lack of muscle activity causes decreased protein
synthesis and increased proteolysis, leading to muscle atrophy
 Normal individual on bed rest loses muscle strength from baseline level
at a rate of 3% per day
b. Development of contractures (develops d/t muscle inaction that will lead to
calcium pump failure in the presence of ATP  muscle shortening)
c. Disuse osteoporosis (mechanical forces stimulate normal bone remodelling;
Bone loss in an immobilized or paralyzed extremity, the reduction of skeletal
mass in astronauts in a zero gravity environment for prolonged periods, and the
higher bone density in athletes exemplify the role of physical activity in
preventing bone loss.)

Sources:
Pathophysiology, the Biologic basis for disease in adults and children, 7th ed
Guyton’s Medical Phyhsiology 13th ed
Robbins and Cotran pathologic basis of disease 9th ed
Harrison Internal Medicine 19th ed