1. Heredity—each person has a genetic potential for height, that is, a maximum height, with genes inherited from both parents. Many genes are involved, and their interactions are not well under- stood. Some of these genes are probably those for the enzymes involved in cartilage and bone pro- duction, for this is how bones grow.
2. Nutrition—nutrients are the raw materials of which bones are made. Calcium, phosphorus, and protein become part of the bone matrix itself.
Vitamin D is needed for the efficient absorption of calcium and phosphorus by the small intestine.
Vitamins A and C do not become part of bone but are necessary for the process of bone matrix forma- tion (ossification). Without these and other nutri- ents, bones cannot grow properly. Children who are malnourished grow very slowly and may not reach their genetic potential for height.
3. Hormones—endocrine glands produce hormones that stimulate specific effects in certain cells.
108 The Skeletal System
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Posterior fontanel Posterior fontanel
Mastoid fontanel Temporal bone
Sphenoid fontanel Mandible
Sphenoid bone Zygomatic bone Maxilla
Occipital bone
Occipital bone Frontal bone
Anterior fontanel
A B
C D
Figure 6–2. Infant skull with fontanels. (A) Lateral view of left side. (B) Superior view.
(C) Fetal skull in anterior superior view. (D) Fetal skull in left lateral view. Try to name the bones; use part A as a guide. The fontanels are translucent connective tissue. (C and D pho- tographs by Dan Kaufman.)
QUESTION:What is the difference between the frontal bone of the infant skull and that of the adult skull?
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B Epiphyseal disc
Chondrocytes producing cartilage
Bone
Cartilage
Epiphyseal disc
Cartilaginous model
Medullary cavity containing marrow
Bone collar and calcifying cartilage in ossification center
Secondary ossification center
Compact bone Compact bone
Spongy bone
Articular cartilage Medullary cavity and development
of secondary ossification centers
A
Osteoblasts producing bone
Figure 6–3. The ossification process in a long bone. (A) Progression of ossification from the cartilage model of the embryo to the bone of a young adult. (B) Microscopic view of an epiphyseal disc showing cartilage production and bone replacement.
QUESTION:The epiphyseal discs of the bone on the far right are closed. What does that mean?
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Box Figure 6–A Types of fractures. Several types of fractures are depicted in the right arm.
A fracture means that a bone has been broken.
There are different types of fractures classified as to extent of damage.
Simple (closed)—the broken parts are still in nor- mal anatomic position; surrounding tissue damage is minimal (skin is not pierced).
Compound (open)—the broken end of a bone has been moved, and it pierces the skin; there may be extensive damage to surrounding blood vessels, nerves, and muscles.
Greenstick—the bone splits longitudinally. The bones of children contain more collagen than do adult bones and tend to splinter rather than break completely.
Comminuted—two or more intersecting breaks create several bone fragments.
Impacted—the broken ends of a bone are forced into one another; many bone fragments may be created.
Pathologic (spontaneous)—a bone breaks with- out apparent trauma; may accompany bone disor- ders such as osteoporosis.
The Repair Process
Even a simple fracture involves significant bone damage that must be repaired if the bone is to resume its normal function. Fragments of dead or damaged bone must first be removed. This is accomplished by osteoclasts, which dissolve and reabsorb the calcium salts of bone matrix. Imagine a building that has just collapsed; the rubble must be removed before reconstruction can take place.
This is what the osteoclasts do. Then, new bone must be produced. The inner layer of the perios- teum contains osteoblasts that are activated when bone is damaged. The osteoblasts produce bone matrix to knit the broken ends of the bone together.
Because most bone has a good blood supply, the repair process is usually relatively rapid, and a sim- ple fracture often heals within 6 weeks. Some parts of bones, however, have a poor blood supply, and repair of fractures takes longer. These areas are the neck of the femur (the site of a “fractured hip”) and the lower third of the tibia.
Other factors that influence repair include the age of the person, general state of health, and
nutrition. The elderly and those in poor health often have slow healing of fractures. A diet with sufficient calcium, phosphorus, vitamin D, and protein is also important. If any of these nutrients is lacking, bone repair will be a slower process.
Several hormones make important contributions to bone growth and maintenance. These include growth hormone, thyroxine, parathyroid hormone, and insulin, which help regulate cell division, pro- tein synthesis, calcium metabolism, and energy production. The sex hormones estrogen or testos- terone help bring about the cessation of bone growth. The hormones and their specific functions are listed in Table 6–1.
4. Exercise or “stress”—for bones, exercise means bearing weight, which is just what bones are spe- cialized to do. Without this stress (which is nor- mal), bones will lose calcium faster than it is replaced. Exercise need not be strenuous; it can be as simple as the walking involved in everyday activ- ities. Bones that do not get this exercise, such as those of patients confined to bed, will become thin- ner and more fragile. This condition is discussed further in Box 6–2: Osteoporosis.