BONE AND JOINTS

Rashidah A. Guro, MD, DPSP

 BONE FUNCTION
• Support
• Protection (protect internal organs)
• Movement (provide leverage system for skeletal
muscles, tendons, ligaments and joints)
• Mineral homeostasis (bones act as reserves of
minerals important for the body like calcium or
phosphorus)
• Hematopoiesis: blood cell formation
• Storage of adipose tissue: yellow marrow
BONE ANATOMY
Diaphysis: long shaft of bone
Epiphysis: ends of bone
Epiphyseal plate: growth plate
Metaphysis: b/w epiphysis and
diaphysis
Articular cartilage: covers
epiphysis
Periosteum: bone covering (pain
sensitive)
Sharpey’s fibers: periosteum
attaches to underlying bone
Medullary cavity: Hollow
chamber in bone
- red marrow produces blood cells
- yellow marrow is adipose
Endosteum: thin layer lining the
medullary cavity
• BONE – specialized connective tissue
composed of calcified intercellular material,
the bone matrix and the 3 cell types.
 OSTEOBLASTS
• Synthesis of the organic
components of bone matrix,
consisting of type I collagen
fibers, proteoglycans, and several
glycoproteins including
osteonectin.
• Deposition of the inorganic
components of bone
• Osteoblasts are located
exclusively at the surfaces of
bone matrix, usually side by side
in a layer somewhat resembling a
simple epithelium
• Osteoblast activity is stimulated
by parathyroid hormone (PTH).
OSTEOCYTES
 OSTEOCLASTS
• Osteoclasts are very large,
motile cells with multiple
nuclei.
• In areas of bone
undergoing resorption,
osteoclasts lie within
enzymatically etched
depressions or crypts in
the matrix known
as resorption
bays (formerly
called Howship lacunae).
 BONE MATRIX
• Inorganic material represents about 50% of the dry
weight of bone matrix.
• Hydroxyapatite is most abundant, but bicarbonate,
citrate, magnesium, potassium, and sodium are also
found.
• Significant quantities of amorphous (noncrystalline)
CaPO4 are also present.
• The surface ions of hydroxyapatite are hydrated and a
layer of water and ions forms around this crystal.
• This layer, the hydration shell, facilitates the exchange
of ions between the crystal and the body fluids.
PERIOSTEUM AND ENDOSTEUM
TYPES OF BONES
 Microscopic Examination
• Primary Bone Tissue
• Primary bone is the first
bone tissue to appear in
embryonic
development and in
fracture repair.
• It is characterized by
random disposition of
fine collagen fibers and
is therefore often called
woven bone.
 Microscopic Examination
• Secondary Bone Tissue
– is the type usually found in
adults.
– It characteristically shows
multiple layers of calcified
matrix (each 3–7 m thick) and
is often referred to as
lamellar bone.
– Lacunae with osteocytes are
found between the lamellae,
interconnected by canaliculi
which allow all cells to be in
contact with the source of
nutrients and oxygen in the
osteonic canal.
• Bone remodeling is continuous throughout
life and involves a combination of bone
synthesis and removal.
• In healthy adults 5–10% of the bone turns
over annually.
 Osteogenesis
• Intramembranous • Endochondral
ossification ossification
– which osteoblasts – which the matrix of
differentiate directly preexisting hyaline
from mesenchyme and cartilage is eroded and
begin secreting osteoid replaced by osteoblasts
producing osteoid.
Endochondral Ossification
 Bone Growth, Remodeling, & Repair

• Bone growth is generally associated with partial resorption of

preformed tissue and the simultaneous laying down of new bone
(exceeding the rate of bone loss). This process permits the shape of
the bone to be maintained as it grows.
• The rate of bone remodeling (bone turnover) is very active in young
children, where it can be 200 times faster than that in adults.
• Bone remodeling in adults is a dynamic physiologic process that
occurs simultaneously in multiple locations of the skeleton and is
not always related to bone growth.
• Because it contains osteoprogenitor stem cells throughout the
endosteum and periosteum and has an extensive blood supply,
bone has an excellent capacity for repair and regeneration.
 Metabolic Role of Bone
• The skeleton serves as the calcium reservoir and contains 99% of
the body's total calcium in crystals of hydroxyapatite. The
concentration of calcium in the blood and tissues is generally quite
stable because of a continuous interchange between blood calcium
and bone calcium.
• The principal mechanism for raising blood calcium levels is the
mobilization of ions from hydroxyapatite crystals to interstitial fluid.
This takes place mainly in cancellous bone.
• The action of two key hormones on cells in bone regulates the
process of calcium mobilization from hydroxyapatite.
– Parathyroid hormone raises low blood calcium levels. Osteoclast
activity is inhibited by another hormone,
– Calcitonin which is synthesized by the parafollicular cells of the thyroid
gland. This slows matrix resorption and thereby gradually lowers blood
calcium levels.
 Nutritional Deficiencies and Bone Remodeling

• Calcium deficiency in children causes rickets, a disease

in which the bone matrix does not calcify normally and
the epiphyseal plate becomes distorted by the normal
strains of body weight and muscular activity.
• Calcium deficiency in adults gives rise to osteomalacia,
which is characterized by deficient calcification of
recently formed bone and partial decalcification of
already calcified matrix.
• Osteoporosis, frequently found in immobilized patients
and in postmenopausal women, is an imbalance in
skeletal turnover so that bone resorption exceeds bone
formation.
 Hormones Acting on Bone Tissue

• Growth hormone (GH or somatotropin), which

stimulates the liver to produce insulin-like
growth factor-1 (IGF-1 or somatomedin). IGF
has an overall growth effect, especially on the
epiphyseal cartilage.
– Pituitary dwarfism
– Gigantism.
– Acromegaly
 Bone Tumors

• Osteosarcoma
• Metastases
 JOINTS
• DIARTHROSES • SYNARTHROSES
– Synostoses
– Synchondroses
– Syndesmoses