Outline † Tendons and

A. Bone Details † Ligaments

†

Videos→ Medicosis Perfectionalis – Functions of bones

Notes→ via transcript ♪ Mechanical functions

† Gives framework
† Supports body weight
Bone Introduction
† Attachment for muscles and ligaments.
Video → Bone Structure & Function
♪ Protective functions
Notes → Transcript
† Protects internal organ
 Brain in skull
– Intro
 Spinal cord inside vertebral column
♪ Hardest form of connective tissue.
 Lungs and heart in rib cage
♪ Rigid
♪ Metabolic functions
♪ Rich in calcium.
† Bones mineral made of →
♪ Vascular unlike cartilages (which are avascular) 
 Calcium
show great regenerative abilities after fractures
especially in young.  Phosphate

– Background † Maintain homeostasis of Ca2+ & PO4

♪ Types of tissues in human body → four † Background → 2 hormones important

† Nerve tissue  PTH

† Muscle tissue  Calcitonin

† Epithelium. † PTH

† Connective tissue  ↑ serum Ca level by increasing

 Bones are connective tissue. ž Ca2+ absorption in GIT

– Embryology ž Ca2+ reabsorption in DCT of kidney

♪ All connective tissue of the body is derived from ž Bone resorption → release Ca2+ into blood.
mesoderm.  ↓ serum phosphate by secreting PO43- in PCT
♪ Mesenchyme → undifferentiated connective tissue ž Mn → P for PTH – P for Paradox
of embryo is called mesenchyme. † Calcitonin
♪ Connective tissue includes  ↓ both serum Ca2+ & PO43-
† Bones  Mn → C for Calcitonin – C for Common.
† Cartilages  Mn 2 → L in calcitonin.
† Muscles ♪ Hematopoiesis
 † Contain stem cells
† All red blood cells, white blood cells and ♪ Diaphysis → compact bone.
platelets derived from stem cells. ♪ Epiphysis → cancellous bone.
– Growth † Primary center of ossification diaphysis
♪ During adolescence → epiphyseal plate facilitate † Secondary center of ossification → epiphysis →
growth via endochondral ossification. mcq.
♪ Fractures that involve epiphyseal cartilage plate in  Mn → Partial denture.
children who are growing results in discrepancy in

growth – example uneven forelimbs.
– Covering
♪
♪ Bone → covered by periosteum
– Parts of Bone
† Cartilage → covered by perichondrium
♪ Bone is made of
† Tendon → covered by peritendinium
† Diaphysis
† Muscle → covered by perimysium
 shaft
† Nerve → covered by perineurium
† Epiphysis
– Types of bones
 articular end
♪ 2 bones exists in humans
† Metaphysis
† Woven Bone
 Region where the epiphysis joins the
† Lamellar Bone
diaphysis.
– Woven Bone
 In growing bone this is where the epiphyseal
plate is present. ♪ Def → weak immature bone in which collagen
fibers are randomly oriented
♪ Exists in →
† Embryonic skeleton
† Healing Fractured bone callus

– Lamellar Bone

♪ Lamellar bone is the bone present in adults.

♪ Lamellar bone is of 2 types depending on the
structure.
† Compact → aka cortical bone
† Cancellous → aka spongy aka trabecular
♪ Both compact bone and cancellous bone are
 collectively known as lamellar. † Spongy bone → ↑ in flexibility + active type in
– Differences between compact & cancellous bone. remodeling / turnover

♪ Cavity  Is bone type associated with osteoporosis.

† Compact bone → no 

† Spongy → yes – Cells in Bone

♪ Strength ♪ Osteoblasts

† Compact >>> spongy † Lay down bone.

♪ Flexibility † Origin → mesenchymal stem cells within

marrow
† Spongy > compact
† 20% will become osteocytes.
♪ Location
♪ Osteoclasts
† Compact →
† break down old or damaged bone
 In outer cortex of bone
† Origin → monocyte / macrophages lineage.
 Full diaphysis (i.e., shaft of bone) to provide
strength  osteoclasts are macrophages of bone.

† Spongy † multinucleated like activated macrophages.

 Beneath cortex † When osteoclasts are dissolving bones → they

leave some bony cavities called Howship’s
 Epiphysis →
lacunae.
ž More in epiphysis than compact bone to
 Howship’s lacunae → def → bony cavities in
ease articulation.
bone undergoing resorption by osteoclasts.

♪ Osteocytes
† Actual bone cells
– Note → To activate osteoclasts we need to activate
osteoblasts
♪ Rx → osteoblasts will activate osteoclast via RANK
ligand.

– Types of bone
♪ Functional unit
♪ Adult bone is composed of
† Compact bone → osteon
† Compact bone
† Spongy bone → trabeculae
 Usually in shaft or diaphysis as well as
♪ Significance
† Spongy bone
† Compact bone → ↑ in strength – bear weight
 Usually here at proximal and distal ends i.e.
 Epiphysis. ♪ Then tropo-collagen
– Composition ♪ Then collagen fibrils
♪ Composition of both Bones and cartilages includes ♪ Then collagen fibers
† Matrix † Histology video
† Cells † Haversian system, check out my video called
† Minerals. bone histology

♪ Matrix → ♪ Type 1 collagen fibers are in your bones. This is an

example of post-translational modification of
† Organic (unmineralized part)
collagen. Pause and review. So here's my
† Composed of
wonderful bone, here is compact bone, here is
 Collagen type 1 → main components cancellous or trabecular or spongy bone, here is an
 GF epiphyseal cartilage plate and an articular cartilage,
 Other components both of which are high-align cartilage. Inside your
bone there is wonderful haversian system. If you
ž Osteocalcin
want to learn more about h. Osteoclast has same
ž Osteonectin
origin as macrophage or monocyte. All of these
ž Fibronectin cells are analogous. Monocytes in blood,
ž Osteopontin macrophages or histocytes in tissue, cupfor cells in
♪ Cells → liver, microglia in nervous system, and osteoclasts
in bones. How does
† Osteoblasts
– Bone heal
† Osteoclasts
♪ Bone heal by a process known as bone remodeling
† Osteocytes.
♪ Osteoclasts to break down old bone and osteoblasts
♪ Minerals →
to lay down new bone with matrix and minerals.
† Inorganic i.e., calcified.
♪ Bone healing 4 stages
† Called hydroxyapatite crystals
† Inflammation
† hydroxyapatite crystals made of
† Hematoma formation ( clot formation)
 Calcium
† Hard Callus formation
 Phosphate.
† Remodeling
ž If i break your bone it can release some
 Mn → Indus Hospital Human resources
calcium and phosphate into bloodstream
 Clot formation → first (visible) sign → mcq.
ž Growth requires calcium
 In bone healing there is no granuloma
ž Vitamin d regulates calcium levels.
formation → mcq.
– Synthesis of collagen
– Factors that affect peak bone mass
♪ Start in rough endoplasmic reticulum → pre-pro
♪ Some people have strong bones and other have
collagen
weak bones
♪ Then pro collagen – triple helix structure
♪ Factors
† Vitamin c for hydroxylation of proline and lysine
† Gender
residue.
 M>F
† Substance necessary for bone regeneration →
Vit C → mcq. † Race
 Rx → Hydroxylation of proline into  Black > White
hydroxyproline → essential component of † Genetics
collagen.  Osteoporosis is Familial
 † Hormones
 ↑ Sex hormones → ↑ the bone density
 ↑ GH → → ↑ the bone density
† Diet
 ↑ Ca intake → ↑ the bone density
myeloma,
 Nutritional deficiency
 Iatrogenic → long term steroids
 Physical causes → Prolonged immobilization
– when your body doesn't move it atrophies

† Exercise. ♪

 ↑ bone density Classification of Bones

– Clinical.
Video → Bone Structure & Function
♪ Inflammation of bone → osteitis. Notes → Transcript
† Inflammation of cartilage → chondritis.
† Inflammation of muscles → myositis.
– According to development bones can develop by
† Inflammation of tendon → tendonitis.
♪ intramembranous ossification
† Inflammation of site of insertion of tendon into
♪ intra cartilaginous ossification
bone → enthesitis.
† Discussed in last.
♪ Decreased calcium
– According to shapes
† Def → decreased calcium in minerals of bone.
♪ long bones
 In children → Rickets
♪ short bones
 In adults → osteomalacia
♪ flat bones,
† Cause → in both
♪ irregular bones
 ↓ Ca + ↓ Vit D
♪ pneumatic bones
♪ Osteoporosis
♪ sesamoid bones aka sesamoid structures.
† Def →
 Normal bone mineralization – normal calcium
– According to structure two types of bones
 Defect in matrix → not minerals,
♪ Compact bone
 Bone resorption rate >>> bone deposition
♪ Cancellous bone
rate.
† Both compact and Cancellous bone are
 Result in essence → Reduced bone density →
collectively known as lamellar bone, which is
mcq
normal bone in adults.
† Osteoporotic bone leads to →
 ↑ bone pores
Classification according to Shapes
 ↓ bone mass
– Long Bones.
 ↑ fractures
♪ Location
† Common in old age → especially in post-
menopausal women. † Upper limbs

♪ Cause of Osteoporosis † lower limbs.

† Primary osteoporosis → unknown. ♪ Structure

† Secondary osteoporosis → are risk factors which
can contribute to osteoporosis and are metabolic
conditions such as
 Hyperparathyroidism
 Neoplastic syndrome such as multiple
† Each long bone has a
 Shaft also called diaphysis
 Two ends called epiphysis
† Inner layer → made of cancellous bone.
† Outer layer → made of compact bone.
 † Cross section of long bone is triangular → compact bone.
 3 borders – Pneumatic bones

 3 surfaces ♪ Pneumo means air.

† pneumonia → disease of lung → lung filter air.
† Air between two plural surfaces→
pneumothorax.
† Artificial pumps that use air → pneumatic
devices.
♪ Pneumatic bones → bones filled with air
† OR Bones in skull that contain cavities known as
paranasal sinuses.
♪ Structure
† Outer cortical bone
† Inner cancellous layer ABSENT – replaced by
air-filled space.
† Function of sinuses →
 Reduce skull weight,

– Short bones  Increase voice resonance.

♪ Location  Humidify warm inspired air

† Carpus of hand (wrist bones) ♪ Sinuses are lined by mucosa epithelium

† Tarsus of foot. – Sesamoid bone

♪ Structure ♪ Nodules of bone or fibrocartilage that develop in

certain tendons when they rub against convex bony
† No shaft in short bones,
surface
† Very thin outer shell → compact bones.
♪ Function → protect from excessive friction.
† Major inner part → cancellous bones
♪ Example
– Flat bones
† patella
♪ All start with s
† Fabella.
† Skull bones
† pisiform bone
† Sternum
† Scapula.
♪ Structure Blood Supply Of Bone
† Thin Outer layer → compact bone.
Video → Blood Supply of Bone & Haversian system
† Between outer layers → cancellous bone
Notes → Transcript
 known as diploe.
– Irregular bones.
– Haversian system
♪ Includes
♪ Blood supply of bone inside haversian system.
† Hip bone
♪ Haversian system discussed next
† Vertebrae
– Arterial supply of long bones →
† Some skull bones
† From 4 sources
♪ Structure
 Nutrient
† Cancellous bone covered by a thin shell of
  Epiphyseal
 Metaphyseal
 Periosteal
♪ Nutrient Artery
† Enters into shaft of bone via nutrient foramen.
† Supplies medulla of bone and bone marrow
inside shaft.
♪ Epiphyseal Arteries
† Supplies epiphysis (ends) of long bone → mcq
† Both compact and spongy
♪ Metaphyseal arteries.
† Supply metaphysis.
 Arise from nutrient artery interiorly,
 Arise from muscular arteries exteriorly.
† Metaphyseal arteries in children are end arteries
→ do not anastomose.
  osteomyelitis in children is irreversible →
leads to bone death.
 Especially important in sickle cell disease.
 Cause occlusions and thromboses inside
vessels. – Venous drainage of bone
 Blockage of metaphyseal arteries → bone ♪ Follow arteries,
necrosis.
♪ Take same name
† In adults, metaphyseal arteries anastomose → 
– Lymphatic drainage of brain
osteomyelitis less severe in adults.
♪ Like brain bones no lymphatics.
♪ Periosteal arteries
– Nerve supply of bone.
† Supply cortex of bone
♪ Includes
† Periosteal arteries are important to heal bone
† Somatic supply
after fracture.
† Autonomic supply.
– Arterial supply of short bones
♪ Somatic supply
♪ Only two arteries
† Recall → Somatic nervous system 2 arms
† Nutrient artery
 Somatic motor
† Periosteal artery.
 Somatic Sensory
† Somatic sensory supplies bone & periosteum
 Periosteum → very rich supply
 This is why – Bone marrow biopsy procedures
are very painful.
♪ Autonomic
† Sympathetic fibers supply
† Are Vasomotor fibers
† Follow arteries
 † Bring about vasoconstriction / vasodilation of
these arteries.
– Clinical

♪ Osteomyelitis.
† Myelo means → core of bone i.e. Bone marrow.
† Is inflammation of bone + bone marrow.
† Cause → ♪ Lamellae that runs along periosteum + along
 Most common cause bacterial infection, endosteum which lines inner spongy bone tissue is
circumferential lamellae.
† Recall → if infection affect metaphyseal arteries
in children, they are end arteries. → do not ♪ Located between concentric lamella is interstitial
anastomose → lead to bone death. lamellae.

Structure of Bones
♪ Video Bone (Microscopic Structure, Haversian
system, and bone tissue remodeling)
♪ Notes → Transcript
♪

ϫ Structure of bone
– In adults 2 types of bones
– Canaliculi → small canals that extend in many
♪ Compact bone directions from lacunae connecting to other lacunae
♪ Cancellous bone and central canal.
– Structure of Compact bone ♪ They provide for intercellular communication and
♪ Compact bone surrounds cancellous bone passageway for delivery of nutrients to osteocyte
♪ Compact bone has a unique cylindric appearance. cells.

♪ These cylinder-shaped structures are called osteons ♪ There are also transverse canals (Volkman’s canal)
or haversian systems. which connect central canals to one another and
these canals also house nerves and blood vessels.
♪ In middle of osteons → central haversian canal runs
lengthwise through bone.
† It houses nerves and blood vessels of the bone.
♪ Bone is laid down in form of layers and this is why
multiple layers surround a single canal.
♪ Multiple layers together are called lamellae.
♪ Between layers osteocytes are present in their
spaces called lacunae.
† Osteocytes maintain bone matrix.
♪ Cylinder shaped layers of osteons is called
concentric lamellae.

– Structure of Cancellous bone
♪ Has no osteons as it has a lattice like appearance of
crisscrossing branches called trabeculae.
♪ Trabeculae are comprised of endosteum
surrounding parallel lamellae composed of bone
matrix,
♪ Similar to compact bone → osteocytes in lacunae
♪ Canaliculi extending out from lacunae provide a
passageway for nutrients to reach osteocyte cells.
♪ Recall bone composed of matrix and minerals.
– Calcium homeostasis
♪ Calcium homeostasis depends on
† PTH
† Calcitonin → from thyroid gland
† Vit D
♪ Parathyroid hormone → one purpose in life, raise
calcium level in your blood.
† Does this by three mechanisms
ž Absorption
 resorption
 Reabsorption
† ↑ serum Ca2+ level by increasing
 Ca2+ absorption in GIT
2+
 Ca reabsorption in DCT of kidney

2+
Bone resorption → release Ca into blood.
† ↓ serum phosphate by secreting PO43- in PCT
 Mn → P for PTH – P for Paradox
♪ Vit D
† Mn → PTH is daddy of Vit D – explained ahead.
♪ Functions of Vit D →
†
2+
↑ serum Ca level by increasing
 Ca2+ absorption in GIT
 Ca2+ reabsorption in DCT of kidney
† Unlike father, Vit D learn from mistakes of
previous generation → ↑ PO43- too
 ↑ serum PO43- level by increasing
ž PO43- absorption in git
ž PO43- reabsorption in pct of kidney
† PTH essential for vitamin D synthesis
 PTH stimulate enzyme 1  hydroxylase in
kidney essential for conversion of 25 OH vit
d3 into 1,25 di OH vit D3
 Mn → PTH daddy of vitamin D
♪ Calcitonin
† ↓ both serum Ca2+ & PO43-
 ↓ serum Ca by ↑ bone formation
 ↓ serum PO43- by ↑ bone formation
† Bone crystal of Ca2+ & PO43-
 Mn → C for Calcitonin – C for Common.
 Mn 2 → L in calcitonin – L for Low
– Pathology
♪ PTHrP → mcq
† Malignant Ectopic overproduction of PTHrP →
binds to PTH receptors →
† ↑ serum Ca2+ + ↓ serum PO43-
† CF →
 Hypercalcemia → most common metabolic
disorder in this malignancy.
– Primary Vs Secondary Hyperthyroidism.
♪ Primary → Pathology is within thyroid gland
† produce ↑ T3 & T4 without stimulation from
TSH
♪ Secondary →
† ↑ T3 & T4 due to ↑ TSH.
† due to a secondary disease, Initially → serum
Ca2+ ↓ & serum PO43- ↑
† Cause
 CKD
 CKD leads to Primary Vit D deficiency
† ↓ Vit D serum levels.
† Recall PTH essential for Vit D Synthesis + Vit D
plays a role ion Ca homeostasis.
† ↓ Vit D → ↑ PTH + ↑ TSH
† PTH → ↑ serum Ca2+ + ↓ serum PO43.
 † ↓ platelets → thrombocytopenia
Bone Marrow
† ↑ platelets → thrombocytosis or
Video → Red Bone Marrow vs Yellow Bone Marrow
thrombocythemia
Notes → Transcript
† ↑ Lymphocytes → leukocytosis
– two types of bone marrow
† ↓ Lymphocytes → leukopenia
† red marrow
† Pancytopenia → deficiency of all 3 blood lines.
† yellow marrow
♪

♪ Red marrow
♪

† hematopoietic → synthesize all blood cells

Periosteum
 red blood cells
 white blood cells Video → Periosteum of bone
 platelets Notes → Transcript
† hematopoiesis includes making all blood cells →
red blood cells white blood cells and platelets – Def → Dense fibro-cellular membrane covering
† Constitutes all bone marrow in fetus up to 2 exterior bone surface in all places except at joints
years of age. (which are protected by articular cartilage).
† Location – Made of two layers

 Newborn baby → All the born marrow – red ♪ Outer fibrous layer →
bone marrow. † Very dense
 Newborn till Puberty→ almost all bone † Very strong
marrow – red bone marrow. ♪ Inner cellular layer →
 After puberty → hematopoiesis stops in long † Elastic
and peripheral bones.
† ↑ vessels –
 Around age 18 or 20, hematopoiesis is limited
† ↑ nerve endings,
to
– Functions
ž axial skeleton
♪ Protects bone → (has very high number of nerve
ž proximal ends of humerus and femur.
endings)
ž (axial = central bones → skull, clavicle,
† Somatic sensory NS supplies bone &
sternum, scapula, vertebral column, ribs,
periosteum.
pelvis)
† Periosteum  very sensitive to pain.
♪ yellow marrow
♪ Provides a surface for attachment of muscles and
† not hematopoietic
ligaments.
† inactive red bone marrow
♪ Some cells of periosteum differentiate into
† Only in cases of ↑ demand such acute osteoblasts .
Hemorrhage or blood loss yellow bone marrow
† Osteoblasts are the cells that have a direct role in
has capacity to re-activate and convert to red
activate osteoclasts.
bone marrow.
† Combined activity of both heal bone after
† Location →
fractures.
 Remainder bones (other than those of active
♪ Periosteal artery supplying the periosteum also has
reb bone marrow)
branches to bone →  nourish bones.
♪ Terminologies

† ↓ RBCS → anemia
† ↑ RBCs → polycythemia
 ♪ Bone → Vascular
Ossification in Bones
♪ Cementum → Avascular.
Video → Intramembranous vs Intracartilagenous
♪
Ossification
♪
Notes → Transcript
♪

♪
– Intramembranous,
♪
♪ bone is derived directly from embryonic
mesenchymal membrane. ♪

♪ Which arises from mesoderm. So, mesoderm will ♪

give you bone directly, ♪

♪ Since direct process → Ossification (process of †

creating bone) is rapid.

♪ Location
† only in few bones →
 Part of mandible
 Clavicles
 Flat bones of skull (skull includes both
cranium & facial bones)
– Intra cartilaginous

♪ a cartilage model of the bone forms from mesoderm

♪ Cartilage is hyaline cartilage → mcq.
♪ then cartilage dies.
♪ remnants of cartilage will lay down new bone.
♪  indirect process
♪ Since indirect → bone formation takes longer.
♪ Location
† All the remaining bones of the body form by
endochondral ossification.
♪

ϫ Pearls
– ALP raised in bony lesions and used as a tumor
marker.
– Decreased mineral density of Bone

♪ Bone mineral density ↓ due to malnutrition (

♪ Most commonly affected → pregnant patient
(multipara → is a woman who has had more than
one off-spring)
♪ CF → Generalized bone pain
♪ Cause → defiency of Vit D (as per medicall not
confirmed)
– Bone vs Cementum