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What are the functions of the skeleton?

  • Enables movement by providing a site for muscle attachment. 
  • Protects the vital organs. 
  • Provides structural support. 
  • Storage of minerals (Ca2+, PO43-, Mg).
  • Haematopoiesis - blood cell formation in the bone marrow. 


Describe the structure of bone.

  • Collagen fibre framweork in a mucopolysaccharide-rich semisolid 'ground substance'.
    • This gives bone tensile strength. 
  • Hardened by precipitation of calcium phosphate (hydroxyapatite) crystals within matrix. 
    • This gives bone compressional strength.
    • Cartilage is similar to bone but is not calcified. 
  • Structural strength near reinforced concrete but lighter.
  • Made of osteoblasts, osteoclasts and osteocytes. 
  • Supplied by blood vessels and nerves.
  • Contains bone marrow. 


Describe the structure of a long bone.

  • Epiphysis (head)
    • Flared bone at the end
    • Articular surface 
    • Covered by hyaline cartilage
  • Diaphysis (shaft) 
    • Hollow cylinder
    • Contains bone marrow in marrow cavity
      • RBC formation
    • Nurtient foramen for main blood supply to the bone
  • Periosteum
    • Fibrous connective tissue sheath covering external surfaces. Cells include:
      • Fibroblasts - synthesise collagen.
      • Mesenchymal cells - can differentiate into osteoblasts and chondroblasts.
      • Osteoclasts


What two things must be in balance for bone mineral density to be maintained?

Osteoblast activity (building bone) and osteoclast activity (destroying bone). 


Describe the 2 main types of bone.

  • Trabecular / cancellous bone
    • Spongy and porous
    • Gives supporting strength to the ends of the weight bearing bone.
  • Cortical bone
    • Solid
    • Bone on the outside forms the shaft of the long bone. 
    • Provides stiffness and strength


Describe how trabeculae are laid down and what their function is.

  • Trabeculae are laid down along lines of stress.
  • They allow distribution of stresses on the bone. 


Why are horizontal trabeculae important?

They are important for strength.


Describe the blood supply to and from long bones.

  • Haversian canals carry blood along the long axis of the bone.
  • Volkmann's canals carry blood perpendicularly.
  • Majority of cells in very close contact to blood vessels (micrometers away), but, not all cells are in direct contact with blood supply (osteocytes). 


What is the functional unit of cortical bone?

An osteon


Describe the structure of compact bone in detail.

  • Haversian canals carry blood along the bone. 
  • Cells are arranged in concentric circles (like onions). 
  • Inside each layer are collagen fibres. 
  • Fibres in each layer can be orientated differently - very flexible. 
  • Structure requires calcium hydroxyapatite to add strength and harden it. 
  • These components make bone neither too brittle nor too flexible. 


What is the functional unit of trabecular bone?

A trabecula


Describe the structure of trabecular bone in detail.

  • Fewer lamellar layers in the 'spongy' trabecular region.
  • Less coordinated (weaker and more flexible) than compact bone. 
  • More open, less dense, site of haemopoiesis in bone marrow. 
  • Bone surface area of trabecular bone is far more accessable. 

  • These are sites of easy access (easy exchange).


Describe the composition of bone matrix.

  • Organic matrix:
    • Mostly protein fibres - collagen 
      • Collagen is highly organised in parallel arrangement (in cotrtical and trabecular bone). 
    • Crystallised mineral salts
      • Hydroxyapatite Ca10(PO4)6(OH)2\
    • Water


Describe some common disorders of bone matrix.

  • Rickets
    • Caused by vitamin D deficiency
    • This results in failure of Ca2+ absorption as vitamin D enables calcium absorption
  • Scurvy 
    • Caused by vitamin C deficiency 
    • This leads to a lack of collagen


What is an osteoblast?

Describe its structure.

  • Bone forming cell
  • Covers the surface of bone, forming an osseous matrix in which it becomes enclosed as an osteocyte. 
  • Mononucleate cells, derived from osteoprogenitor cells that line the surface of bone. 
  • When stimulated to form bone, it will deposit organic matrix (collagen) then hydroxyapatite. 
  • Some become entombed during this process = maturation to osteocytes. 


What is an osteoclast?

Describe its structure.

  • A large, multinucleated cell derived from haematopoietic cells, in response to mechanical stresses and physiological demands they resorb bone matrix by demineralisation. 
  • Multinucleate - several cells fuse together.
  • They form a 'sealing zone' on bone. 
  • They release H+ and hydrolytic enzymes to dissolve the mineral, liberate calcium and break down the extracellular matrix. 
  • Regulated by hormones (eg. estrogens) and osteoblasts.


What is an osteocyte?

Describe its structure.

  • A bone cell.
  • Trapped 'retired' osteoblasts.
  • Mature bone cells embedded in lacunae, relatively inactive. 
  • Maintain bone matrix through cell-to-cell communication (via projections in canaliculi) and influence bone remodelling. 
  • Mechanosensing cells


What are osteoprogenitor cells?

Stem cell population which gives rise to osteoblasts, among other cells. 


What controls the equilibrium between osteoblast and osteoclast activity?

  • Signalling between the different cells in bone and the action of hormones:
    • Calcitonin decreases the activity of osteoclasts
      • This causes decreased blood calcium levels.
    • Parathyroid hormone (PTH) increases the activity of osteoclasts.
      • This causes release of calcium. 


Describe the trabecular bone remodelling cycle.

  • Can be either to deal with microdamage, or scheduled repair or turnover.
  • Has a role in regulating calcium. 


Describe cortical bone remodelling.

  • Osteoclasts reabsorb bone.
  • Osteoblasts lay down new matrix, eventually get surrounded and become...


Describe how bone is remodelled throughout life.

  • Bone mass and density can increase:
    • Caused by excessive mechanical stimulation.
  • Bone mass and density can decrease:
    • Non-weight bearing (immobilisation)
    • Sex-hormone deficiency (eg. menopause)
    • Endocrine / nutritional disorders
  • Wolff's law
    • Bone adapts to the load under which it is placed. 
    • Weight-bearing exercise, orthodontic braces


What happens to bone during menopause?

  • Bone dissolution is greater than bone formation in menopause so bone density decreases. 
  • Decrease in bone density can result in fractures. 


What happens to trabecular bone during osteoporosis?


Describe the age-related changes in bone mass in both males and females. 


What are the modifiable risk factors for osteoporosis?

  • Lifestyle
    • Increased weight-bearing exercise
    • Adequate calcium intake
    • Avoidance of excess alcohol
    • Avoidance of smoking 
    • Fall prevention


What are the non-modifiable risk factors for osteoporosis?

  • Biological sex
  • Age (but not everyone gets osteoporosis)
  • Family history
  • Race
  • Previous fractures give high risk of another


How does bone develop from the fetus to the adult?

  • First, a cartilage model is laid down. 
    • Formed by chondrobasts.
    • Reshaped by chondrocytes. 
  • Replaced by bone - this is ossification.
    • Endochondral ossification in long bones.
    • Intramembraneous ossification in flat bones.
  • Bone growth begins in the shaft during fetal life. 


Describe fetal endochondral ossification.

  • Ossification begins in the diaphysis. 
  • Primary ossification centre is active before birth. 


Describe the endochondral ossification which occurs after birth.

  • A secondary ossification centre develops in the epiphysis.
  • After birth bone begins to develop in the ends of the bone.