Bones (~206 total) &Associated cartilages Ligaments and other connective tissues

Axial skeleton (80 bones) Bones of skull, thorax, and vertebral column
Appendicular skeleton (126 bones) Limbs and girdles that attach to the axial skeleton
-->Minerals resist compression and mechanical stress, providing bone with strength
-->Collagen resists tension and allows the bone to bend but not break, giving it resilience
Functions are support, store minerals & lipids, blood cell production, protections and leverage
Support. Bones, form the internal framework that supports the body and cradle its soft organs; the bones of the legs act as
pillars to support the body trunk when we stand, and the rib cage supports the thoracic wall. Protection. Bones protect
soft body organs; for example, the fused bones of the skull provide a snug enclosure for the brain, the vertebrae surround
the spinal cord, and the rib cage helps protect the vital organs of the thorax. Leverage Skeletal muscles, attached to bones
by tendons, use the bones as levers to move the body and its parts. Storage. Fat is stored in the internal cavities of bones;
bone itself serves as a storehouse for minerals, the most important of which are calcium and phosphorus; because most of
the body’s calcium is deposited in the bones as calcium salts, the bones are a convenient place to get more calcium ions for
the blood as they are used up. Blood cell formation. Blood cell formation, or hematopoiesis, occurs within the marrow
cavities of certain bones.

Bone Classification based on shape

Flat bones are thin, roughly parallel surfaces, they protect underlying soft tissues and provide surface area for
skeletal muscle attachment. Ex: cranial bones, sternum, ribs, scapulae
Sutural bones (Wormian bones) are irregular bones formed between cranial bones. sutural bonesumber, size,
and shape vary

Long bones are relatively long and slender. Ex: various bones of the limbs

Irregular bones have complex shapes with short, flat, notched, or ridged surfaces. Ex: vertebrae, bones of
pelvis, facial bones

Sesamoid bones (account for the # variation) are small, flat, and somewhat shaped like sesame seed. They
develop inside tendons of knee, hands, and feet. Individual variation in location and number which
accounts for some people have a different amount of bones. Ex: Patella
Short bones are small and boxy. Ex: bones of the wrist (carpals) and ankles (tarsals)
**Short, Irregular, and Flat Bones contain bone marrow in trabeculae but do not have a marrow cavity**

Bone Markings (surface features) are related to particular functions

Elevations/projections are located where muscle, tendon, and ligaments attachment. At joints they are
where adjacent bones articulate
Depressions/grooves/tunnels sites for blood vessels or nerves to lie alongside or penetrate bone

Head Expanded proximal end of abone that forms part of ajoint

Diaphysis (shaft) Elongated body of a longbone
Neck Narrow connection betweenthe head and diaphysis of abone
Elevations/projections
Crest: Prominent ridge
Condyle: Smooth, rounded articularprocess
Facet: Small, flat articular surface
Line: Low ridge, more delicate than a crest
Process: Any projection or bump
Ramus: Extension of a bone that makes an angle with the rest of a structure
Spine: Pointed or narrow process
Tubercle: Small, rounded projection
 Tuberosity: Small, rough projectionthat takes up a broad area
Trochanter: Large, rough projection
Trochlea: Smooth, grooved articularprocess shaped like a pulley

Depressions, grooves, and tunnels

Canal / meatus: Large passageway through a bone
Fissure: Elongated cleft or gap
Foramen: Small, rounded passageway for blood vessels or nerves to pass through bone
Fossa: Shallow depression or recess in bone surface
Sinus: Chamber within a bone, normally filled with air
Sulcus: Deep, narrow groove

Long bone features

Epiphysis: Expanded area at each end of the bone, it consists largely of spongy bone. The outer covering of
compact bone
Articular cartilage
Covers portions of epiphysis that form articulations

Metaphysis: Connects epiphysis to shaft

Diaphysis: Shaft of the bone, it contains the medullary cavity (marrow cavity). The medullary cavity is filled with
two types of marrow
Red bone marrow: involved in red blood cell production. Yellow bone marrow: Adipose tissue;
important as energy reserve
Diaphysis is covered by the Periosteum: Connective tissue covering the outside of the diaphysis
Endosteum: Connective tissue covering internal bone surfaces (medullary cavity, central canal, etc)
Epiphyseal Plate/Line (Growth Plate): Tissue in the metaphysis made of cartilage (youth) or bone (adult)

Vascular features Growth and maintenance require blood supply

Nutrient artery / vein commonly one of each per bone
Nutrient foramen is a tunnel providing access to marrow cavity
Metaphyseal artery / vein carry blood to/from metaphysis, it connect to epiphyseal arteries/veins
Blood supply and innervation of the periosteum
Smaller vessels supply superficial osteons (compact bone units)
Lymphatic vessels collect lymph from bone and osteons
Sensory nerves innervate diaphysis, medullary cavity, and epiphyses. sensory nerves allow nervous system
control of cellular activity
Bone Cells
Osteogenic cells (osteoprogenitor cells) are unspecialized bone stem cells derived from mesenchyme producing
cells that differentiate into bone producing cells (osteoblasts). Osteogenic cells are important in fracture
repair. Osteogenic cells are located in the inner lining of periosteum, Osteogenic cells line the endosteum in
medullary cavity and they are found lining passageways containing blood vessels. only bone cells that divide.
Osteoblasts Produce new bony matrix (osteogenesis or ossification). Osteoblasts produce unmineralized matrix
(osteoid). Osteoblasts assist in depositing Ca2+ salts to convert osteoid to bone.
Osteocytesare mature osteoblasts that are surrounded by matrix. Osteocytes are unable to divide. They maintain
protein and mineral content of surrounding matrix. They are located in pockets called lacunae in bone
Osteoclasts remove and remodel bone matrix. Osteoclasts release acids and proteolytic enzymes to dissolve matrix
and release stored minerals, the process is called osteolysis . Derived from fusion of monocytes (WBCs)

BONE TISSUE
Bone matrix extracellular protein fibers and a ground substance.
Collagen fibers Account for ~1/3 bone weight. Collagen fibers provide flexibility
 Calcium salts accounts for ~2/3 bone weight. they provides rigidity

Calcium phosphate interacts with calcium hydroxide to form crystals of hydroxyapatite salts
Incorporates other salts (calcium carbonate, CaCO 3) and ion

Compact Bone
Although compact bone looks solid, a microscope reveals that it is riddled with passageways that serve as
conduits for nerves and blood vessels.
 Osteon (Haversian System). The structural unit of long bone is called the osteon, it is an elongated cylinder parallel to
the long axis of the bone, like a weight bearing (hollow) pillar. Each osteon consists of smaller matrix formations that
are oriented around the canal, called lamellae. These formations are always oriented in different directions, resisting the
twisting of bones.
 Canals running through the core of each osteon and contain blood vessels and nerve fibers that serve the osteon’s cells.
 Osteocytes occupy lacunae at the junctions of the lammelae, and play a role in bone reformation.
Each matrix tube=lamella. Made up of layers of lamella. *Alternating patterns of collagen fibers provide protection
against torsion stresses**
Osteon (Haversian System). The structural unit of long bone is called the osteon, it is an elongated cylinder parallel
to the long axis of the bone, like a weight bearing (hollow) pillar. Each osteon consists of smaller matrix formations
that are oriented around the canal, called
Central Canal Osteon center containing vessels & nerves
Concentric Lamellae Osseus (bone) tissue produces in concentric rings around the central canal
Lacunae Spaces between lamellae; filled with osteocytes
Canaliculi Canals connecting lacunae and the central canal. They bring nutrients in and waste out
Perforating Canals Canals connecting central canals to one another
Periosteum Connective tissue surrounding compact bone its the outermost layer, it has a fibrous outer layer and
cellular inner layer o Isolates/protects bone from surroundings o Anchors blood vessels/nerves to surface . Provides
osteoprogenitor cells and osteoblasts for bone growth (appositional) and fracture repair
STRUCTURE OF COMPACT BONE
Osteons: functional unit
Circumferential lamellae: Outer and inner osseous tissue layers
Interstitial lamellae: Osseous tissue filling spaces between osteons
Spongy bone
Spongy bone: looks like a poorly organized, even haphazard, tissue. However the trabeculae in spongy align
precisely along lines of stress and help the bone resist stress. These tiny bone struts are as carefully positioned
as the cables on a suspension bridge. No osteons are present, but nutrients can reach the cells easily through the
capillaries of the trabecular bone.

Spongy bone is bone material deep to compact bone; projects into medullary cavity. Lamellae do not grow
parallel
Trabeculae is an open network of struts and plates deep to compact bone. No blood vessels in matrix. Nutrients
reach osteons through canaliculi open to trabeculae surfaces
Red bone marrow is found between trabeculae, red bone marrow produces blood cells
Bone Growth
Ossification: Production of osseous tissue
Appositional Growth-WIDTH
Interstitial Growth- LENGTH

Appositional Bone Growth

Deeper lamellae recycled and replaced by osteons. Osteoclasts remove matrix at inner surface to enlarge
medullary cavity
 Periosteum (fascia) Wraps the superficial layer of compact bone. There are two layers: a fibrous outer layer
and a cellular inner layer
Functions
Isolates bone from surrounding tissues. Provides a route for blood and nervous supply and
actively participates in bone growth and repair
Perforating fibers are protein fibers tying periosteum to osseous tissue

Endosteum Connective tissue. Incomplete layer lining medullary cavity. Active during bone growth, repair,
remodeling
Where layer is incomplete, exposed matrix is remodeled by osteoclasts and osteoblasts. Osteoclasts in shallow
depressions called osteoclastic crypts (Howship’s lacunae)

Ossification: bone formation • Bone first appears between weeks 6-8 of gestation. A child has more bones than adults as
some bones fuse throughout post-natal development, resulting in 206 adult bones. Intramembranous ossification produces
flat ones of skull, parts of clavicle and mandible with fibrous tissue as a precursor cell. o Mesenchyme formed from
mesoderm condenses into a sheet of soft fibrous tissue with no nerve and blood supply. o Capillaries come into the tissue
with osteogenic cells and form a network of soft trabeculae, and this marks the transition between precursor to bone. o
Osteoblasts gather on the trabeculae to form osteoid tissue i.e. uncalcified bones Osteoclasts break up the bone and
remodel by forming an outer and inner layer of compact bones while the middle is left as spongy bone. Remaining
mesenchyme on the surface gives rise to periosteum . Endochondral ossification produces long bones and most others
from hyaline cartilage. Mesenchyme formed from hyaline cartilage takes the shape of a long bone and a signal causes an
increase in metabolic activity in the centre of diaphysis at the primary centre where chondrocytes grow and multiply.
Nutrient artery enters the foramen, invading primary centre with osteogenic cells. o Bones first appear in the primary
centre before extending towards the epiphyses as cartilage is progressively replaced by bone. It is simultaneously formed
in periosteal and endosteal layers while medullary cavity is remodelled. Epiphyses start to ossify as diaphysis keep
growing, and secondary centres appear at the epiphyses. o Epiphyseal arteries and osteogenic cells invade the epiphysis
and deposits osteoblasts which erodes cartilage and causes it to ossify. o Larger bones undergo ossification longer by
starting early but finishing late, e.g. femur . During ossification, metaphyseal and epiphyseal arteries are end arteries as
they cannot communicate with each other due to the absence of blood vessels in the epiphyseal growth plate. This is
clinically important as these regions have no collateral supply of blood, and damage to the end artery results in complete
loss of blood supply and necrosis (death)
Once ossification is completed, the two can anastomose and make contact.

Endochondral Ossification
-Process of turning cartilage into bone
Initial skeleton of embryo formed of hyaline cartilage. The cartilage is used as small model. The Cartilage
expands and is slowly replaced, bone grows in diameter and length
Steps in endochondral ossification
1. Cartilage model enlarges.
Chondrocytes near center of shaft enlarge, enlarged chondrocytes die and disintegrate and disintegration
leaves cavities within cartilage.Blood vessels grow around the edge of the cartilage model. Cells of
perichondrium convert to osteoblasts and osteoblasts form superficial layer of bone along the shaft
-Blood vessels penetrate cartilage and enter central region, entering fibroblasts differentiate into osteoblasts.
Primary ossification center: Spongy bone production begins. Bone formation spreads along the shaft
toward both ends
- Growth & remodeling, in this step the medullary cavity is created. Osseous tissue of the shaft thickens.
Cartilage near the epiphyses is replaced by shafts of bone. Bone grows in length and diameter
-Capillaries and osteoblasts migrate into the epiphyses
Create secondary ossification centers
Epiphyses fill with spongy bone. Articular cartilage remains exposed to joint cavity. Epiphyseal cartilage
separates epiphysis from diaphysis

Interstitial Growth (length)

Epiphyseal plate
 Chondrocytes produce cartilage on epiphyseal side
Osteoblasts replace cartilage with bone on diaphyseal side
Epiphyses are pushed away by continued production of new cartilage
Articular Cartilage
Chondrocytes produce cartilage on superficial side
Osteoblasts replace cartilage on epiphesyal sie
Epiphysis continues to push distal and proximal ends

At puberty, hormones stimulate increased bone growth, and epiphyseal cartilage is replaced. Osteoblasts
produce bone faster than chondrocytes produce cartilage. Epiphyseal cartilage narrows until it disappears,
this process is called epiphyseal closure and it leaves epiphyseal line in adults
Intramembranous Ossification
Begins when stem cells differentiateinto osteoblasts within embryonicor fibrous connective tissue, normally
occurs in deeper layersof dermis. Bones called dermal bones ormembrane bones
Ex: roofing bones of skull, lower jaw, collarbone, sesamoid bones (patella)
Steps of intramembranous ossification
Mesenchymal cells cluster and differentiate into osteoblasts.Secrete osteoid matrix.Osteoid matrix becomes
mineralized and forms bone matrix. The location in tissue where ossification begins is ossification
center
Bone grows out in small struts (spicules). Osteoblasts become trapped in pockets and mature into osteocytes.
Mesenchymal cells produce more osteoblasts
Blood vessels enter area. Bone spicules meet and fuse, Blood vessels get trapped in developing bone
Continued deposition of bone by osteoblasts close to blood vessel, results in spongy bone with interwoven blood
vessels
Remodeling around blood vessels produces osteons of compact bone. Connective tissue around bone organizes
into fibrous layer of the periosteum. Osteoblasts near bone surface remain as cellular layer of
periosteum
Intramembranous ossification in development
Begins during the eighth week of embryonic development, visible ossification centers and progressing bone
formation at 10 weeks. At 16 weeks, most of the bones of the adult skeleton can be identified

Minerals
Inorganic ions contributing to the osmotic balance of body fluids, they are vital in many physiological processes
Calcium
Most abundant mineral in body, it makes up about 99% deposited in skeleton.

Used in a variety of physiological functions : Muscle contraction. Blood coagulation. Nerve conduction

[Ca2+] variation > +/- 30–35% affects neuron/muscle function

Normal daily fluctuations are <10%

Calcium Blood concentration controlled by…

Intestines Absorb calcium and phosphate under hormonal control
Bones - Osteoclasts erode matrix and release calcium. Osteoblasts use calcium to deposit new matrix
Kidneys- Varying levels of calcium and phosphate loss in urine under hormonal control

Hormonal control of blood levels…

Parathyroid Hormone (PTH)
Increases low blood calcium levels, it is secreted by parathyroid glands
It's responses are the following: Stimulates kidneys to produce another hormone (Calcitriol)
Kidneys
 Phosphate OUT, Calcium IN Synthesize vitamin D
Intestines
Increased vitamin D stimulates intestines to absorb calcium
Bones
Stimulates osteoclast differentiation. Bone remodeling favors osteoclasts
Calcitonin
Decreases high calcium blood levels
Secreted from Clear cells in the thyroid gland
Responses
In bones:Osteoclasts inhibited, osteoblasts encouraged. Bone remodeling favors osteoblasts
In intestines:Calcium absorption decreased with decreasing PTH and calcitriol
In kidneys:Inhibits calcitriol release and calcium reabsorption
Fracture
Crack or break due to extreme mechanical stress. Most heal as long as blood supply and cellular parts of
periosteum and endosteum survive. The repair involves four steps.
Fracture Repair
Fracture hematoma formation
Large clot closes injured vessels, this develops within several hours.
Callus formation
Internal callus
Network of spongy bone, unites inner edges of fracture
External callus
Composed of cartilage and bone, stabilizes outeredges of fracture
Spongy bone formation
Cartilage of external callus replaced by spongy bone
Bone fragments and dead bone are removed and replaced
Ends of fracture held firmly in place

Compact bone formation

Spongy bone replaced by compact bone
Remodeling over time eliminates evidence of fracture
Closed / simple No break in skin and is only seen on x-rays
Open / compound project through the skin, more dangerous due to: Infection and uncontrolled bleeding

Transverse fractures
Break shaft perpendicular across long axis
Spiral fractures
Produced by twisting stresses, the break is spread along length of bone
Displaced fractures
Produce new and abnormal bone arrangements
Nondisplaced fractures retain normal alignment
Compression fractures
Occur in vertebrae subjected to extreme stresses, they are often associated with osteoporosis
Greenstick fractures
One side of shaft broken, one side bent. Greenstick fractures generally occur in children, whose long
bones have yet to fully ossify
Comminuted fractures
Shatter affected area producing fragments
Epiphyseal fractures
Occur where bone matrix is calcifying. A clean transverse fracture of this type heals well
If not monitored, breaks between epiphyseal plate and cartilage can stop growth at site
Pott’s (bimalleolar) fracture
Occurs at ankle and affects both medial malleolus and lateral malleolus
 Colles fracture
Break in distal radius

Bone Growth Abnormalities

Shortened Bones
Inadequate Growth Hormone
Pituitary failure, reduced epiphyseal cartilage activity; abnormally short bones. It is rare in United States
due to treatment with synthetic growth hormone
Gigantism
Disorder causing lengthened bones . It is caused by overproduction of growth hormone before puberty.
Pituitary tumor most common
treatment includes surgery, radiation, or medications suppressing growth hormone release
addional facts are that individuals with this abnormality can reach heights of over 2.7 m (8 ft. 11 in.). Puberty
often delayed
Acromegaly
Overproduction of growthhormone after epiphysealplates close. Bones get thicker, not longer
Especially those in face, jaw,and hands. Alterations in soft-tissue structure changes physical features
Achondroplasia
Epiphyseal cartilage of long bones grows slowly, replaced by bone early in life. Short, stocky limbs result
but trunk is normal size.
No effects on sexual or mental development.
Lengthened Bones
Marfan syndrome
Inherited metabolic condition in which excessive cartilage formation at epiphyseal cartilages, results in
very tall person with long, slender limbs. Affects other connective tissues throughout the body and
commonly causes cardiovascular problems
Congenital talipes equinovarus (clubfoot) Inherited developmental abnormality that affects 2 in 1000 births, boys
roughly twice as often as girls. It may affect one or both feet. Abnormal muscle development distorts growing
bones, feet turn medially and are inverted
Treated with casts or supports
Fibrodysplasia ossificansprogressiva (FOP) Gene mutation that causes bone deposition around skeletal muscles.
Bones develop in unusual places, called heterotopic (hetero, place) or ectopic (ektos, outside) bones. There is
no effective treatment.
RickettsSoftening/weakening of bones due to low hydroxyapatite, decreased hardness, no decrease in strength
(collagen). Bones under excess stress begin to bow, rare to be genetic causes prolonged/extreme Vitamin D
deficiency and decreases calcium absorption.
Treatment includes Vitamin D & Calcium Supplements
Aging
Osteopenia Inadequate ossification leading to loss of bone mass
Osteoporosis Bone loss sufficient to affect normal function
Bone Density Testing is done with multiple scanning technologies
Central test – measures hip and/or vertebrae
Peripheral test – measures arm, leg, finger, heel, etc.

T-score: A measurement of how dense the bone is compared to a helathy 30-year old.
-1.0 = above normal
-1.0 to -2.5 = osteopenia
-2.5 or lower = osteoporosis

Osteoporosis causes 8.9 million fractures per year. One fracture every 3 seconds
1 in 3 women (>50) will have an osteoporotic fracture. 1 in 5 men (>50) will have an osteoporotic fracture
 Hip fractures 75% women, 25% are men. 20-24% mortality rate within 12 months (women fair better than
men)
Treatment Diet, Medications, Movement / Stress, Limiting risk of fracture