Extended Outline

Chapter 7 Bone Tissue

I. Tissues and Organs of the Skeletal System (pp. 214216) A. Osteology is the study of bone; the skeletal system is composed of bones, cartilages, and ligaments joined tightly to form a strong, flexible framework for the body. (p. 214) B. The skeleton has at least six functions. (p. 214) 1. Support: The bones support the body and its structures. 2. Protection. Bones enclose and protect organs. 3. Movement. The action of muscles on bones produces movement. 4. Electrolyte balance. The skeleton stores calcium and phosphate and releases them as needed. 5. Acidbase balance. Bone tissue buffers the blood by absorbing or releasing alkaline salts such as calcium phosphate. 6. Blood formation. Red bone marrow is the major producer of blood cells, both red and white. C. Bone, or osseous tissue, is a connective tissue in which the matrix is hardened by mineral deposition, a process called mineralization or calcification; bones also include blood, bone marrow, cartilage, nervous tissue, and other connective tissue. (p. 214) D. Bones are classified into four groups according to their shapes and corresponding functions. (pp. 214215) (Fig. 7.1) 1. Long bones are conspicuously longer than wide. a. Long bones serve as rigid levers that are acted upon by skeletal muscles to produce body movements.. b. Examples are the humerus of the arm, the radius and ulna of the forearm, the femur of the thigh, the tibia and fibula of the leg, and the metacarpals, metatarsals, and phalanges of hands and feet. 2. Short bones are nearly equal in length and width. a. They have limited motion and glide across one another. b. Examples are the carpal (wrist) and tarsal (ankle) bones. 3. Flat bones enclose and protect soft organs and provide broad surface for muscle attachment. a. Most are not truly flat, but conspicuously curved; they all have a relatively broad, thin, sandwich-like structure.

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b. Examples are most cranial bones and the ribs, sternum, scapula, and hipbones.

4. Irregular bones have shapes that do not fit into the preceding categories. a. Examples include the vertebrae and some skull bones, such as the sphenoid and ethmoid. E.. The general features of bones can be observed in a typical long bone; flat bones have variations due to their shape. (pp. 215216) (Fig. 7.2) 1. Much of a long bone is composed of an outer shell of dense, white osseous tissue called compact (dense) bone. 2. The cylinder of compact bone encloses a space called the medullary cavity or marrow cavity, which contains bone marrow. 3. At the ends of the bone, the central space is occupied by osseous tissue called spongy (cancellous) bone; spongy bone is always enclosed by compact bone. 4. The skeleton is about three-quarters compact bone and one-quarter spongy bone by weight. 5. The principle feature of a long bone are its shaft (diaphysis) and an expanded head at each end (epiphysis). a. The diaphysis provides leverage. b. The epiphysis is enlarged to strengthen the joint and provide added surface area for attachment of tendons and ligaments. 6. The joint surface where bones meet is covered with a layer of hyaline cartilage called the articular cartilage, which enables a joint to move easily. 7. Blood vessels penetrate into the bone through tiny holes called nutrient foramina. 8. Externally, a bone is covered with a sheath called the periosteum, which has a tough outer fibrous layer of collagen and an inner osteogenic layer of bone forming cells. a. Some collagen fibers of the outer layer are continuous with tendons that bind muscle to bone. b. Other collagen fibers of the outer layer penetrate into the bone matrix as perforating (Sharpey) fibers. c. The osteogenic layer is important to bone growth and fracture healing. 9. The internal surface of a bone is lined with endosteum, a thin layer of reticular connective tissue, with cells that dissolve osseous tissue and others that deposit it. 10. In children and adolescents, an epiphyseal plate of hyaline cartilage separates the marrow spaces of the epiphysis and diaphysis. (Fig. 7.2a, Fig. 7.12) a. The epiphyseal plate is a zone where bones can grow in length. b. In adults, the epiphyseal plate is depleted, and the bones cannot grow longer. 11. The cranium is a typical flat bone, with a sandwich-like arrangement in which two layers of compact bone enclose a middle layer of spongy bone. (Fig. 7.3)

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a. The spongy layer is called diploe; a moderate blow can fracture the outer layer of compact bone, but the diploe may absorb the impact, leaving the inner layer unharmed. b. Both surfaces of a flat bone are covered with periosteum, and the marrow spaces are lined with endosteum.

II. Histology of Osseous Tissue (pp. 217221) A. Bone, a connective tissue, consists of cells, fibers, and ground substance; there are four principle types of bone cells. (pp. 217219) (Fig. 7.4) 1. Osteogenic cells are stem cells that give rise to most other bone cells; they are found in the endosteum, the inner layer of the periosteum, and the central canals. 2. Osteoblasts are bone-forming cells; they are roughly cuboidal or angular and form a single layer on the bone surface under the endosteum and periosteum. (Fig. 7.9) a. Osteoblasts are nonmitotic (do not divide), so differentiation of osteogenic cells is the only way new osteoblasts are generated. b. Osteoblasts synthesis the soft matter of the bone matrix, which then hardens by mineral deposition; stress and fractures stimulate osteogenic cells to multiply and generate osteoblasts. c. Osteoblasts secrete the hormone osteocalcin, which stimulates insulin secretion by the pancrease, increases insulin sensitivity in adipocytes, and limits growth of adipose tissue. 3. Osteocytes are former osteoblasts that have become trapped in the bone matrix they deposited. a. These cells reside in cavities called lacunae, connected by slender channels called canaliculi. i. Osteocytes have slender, fingerlike cytoplasmic processes that reach into canaliculi to contact neighboring osteocytes; some also contact osteoblasts. ii. Neighboring osteocytes are connected by gap junctions, allowing the passage of nutrients, wastes, and chemical signals. b. Osteocytes function to resorb or deposit bone matrix, contributing to the homeostatisis of bone density and blood concentrations of calcium and phosphate ions c. Osteocytes are also strain sensorswhen a load is applied to a bone, osteocytes are stimulated to secrete signals that may contribute to adjustments in bone shape and density to adapt to stress. 4. Osteoclasts are bone-dissolving cells found on the bone surface.

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a. Osteoclasts develop from bone marrow stem cells that give rise to blood cells; thus, they have an independent origin from osteogenic cells, osteoblasts, and osteocytes. b. Each osteoclast is formed by the fusion of several stem cells, so they are unusually large. i. An osteoclast typically contains 3 or 4 nuclei, but sometimes up to 50. c. The side of the cell facing the bone surface has a rufled border that increases surface area and the efficiency of bone resorption. d. Osteoclasts often reside in pits called resportion bays (Howship lacunae) that they have etched into the bone surface. e. Bone remodeling results from the combined action of osteoclasts and osteoblasts.

B. The matrix of osseous tissue is about one-third organic and two-thirds inorganic matter. (pp. 218219) 1. The organic matter includes collagen and proteincarbohydrate complexes. 2. The inorganic matter is about 87% hydroxyapatite, a crystallized calcium phosphate salt, 10% calcium carbonate, and lesser amounts of magnesium, sodium, potassium, fluoride, sulfate, carbonate, and hydroxide ions; certain elements behave like bone minerals and can contaminate bone. Insight 7.1 Bone Contamination 3. Bone is in a class of materials called a compositea combination of two structural materials; in this case, they are a ceramic and a polymer. a. The polymer is collagen, and the ceramic component is the hydroxyapatite and other minerals. b. When bones are deficient in calcium salts (the ceramic component), they are soft and bend easily; an example is in the childhood disease rickets. c. The protein component give bone flexibility, and without it, a bone is excessively brittle (as in osteogenesis imperfecta, or brittle bone disease). (Table 7.3) d. The ratio of minerals to collagen varies in different parts of the skeleton in response to tension and compression. C. Compact bone is studied using slices that have been dried, cut with a saw, and ground to translucent thinness, revealing details of the matrix. (p. 219) (Fig. 7.5) 1. These histological sections show onionlike concentric lamellae arranged around central (haversian or osteonic) canal and connected to each other by canaliculi. a. A canal and its lamellae constitute an osteon (haversian system).

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b. In longitudinal section, the osteon is a cylinder; osteons are connected by transverse or diagonal passages called perforating (Volkmann) canals.

2. Collagen fibers are arranged in the matrix of a lamella in a helical pattern like threads of a screw. a. The helices coil opposite directions in adjacent lamellae. b. This alternation enhances the strength of the bone, similar to how plywood is made. c. Bones that undergo bending stress have loose helices, and those that are weight bearing, the helices are more tightly coiled. 3. About half a liter of blood per minute passes through the skeleton. a. Blood vessels and nerve enter the bone tissue through nutrient foramina on the surface and open into the perforating canals that connect with the central canals. b. The innermost osteocytes receive nutrients from these vessels and pass them along through gap junctions to neighboring osteocytes. c. Waste materials pass in the other direction and diffuse into the blood vessels. 4. Inner and outer boundaries of dense bone are arranged in circumferential lamellae that run parallel to the bone surface. 5. Interstitial lamellae are irregular regions that are the remains of old osteons that broke down as the bone grew and underwent remodeling. D. Spongy bone consists of a lattice of delicate slivers of bone called spicules and thin plates called trabecula; the term spongy refers to its appearance, not its hardness. (p. 219) (Fig. 7.5) 1. Spongy bone is permeated by spaces filled with bone marrow. 2. Central canals are not needed because osteocytes are never far from marrow spaces. 3. Spongy bone imparts strength while adding a minimum of weight. E. Bone marrow is a general term for soft tissue that occupies the marrow cavity of a long bone, the spaces in spongy bone, and larger central canals; the two kinds are red marrow and yellow marrow. (pp. 219221) 1. Red bone marrow (myeloid tissue) fills the marrow cavity of nearly every bone in children. a. Red marrow is often termed hemopoietic tissue because it produces blood cells, but it is actually composed of multiple tissues and acts as an organ in itself. 2. In adults, most red marrow turns to fatty yellow bone marrow. a. Yellow marrow no longer produces blood except in cases of severe or chronic anemia. b. In adults, red marrow is limited to the skull, vertebrae, ribs, sternum, part of the pelvic girdle, and the proximal heads of the humerus and femur.

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III. Bone Development (pp. 221xxx)

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A. The formation of bone is ossification or osteogenesis; the two methods of bone development in the human fetus are intramembranous ossification and endochondral ossification. (p. 221) B. Intramembranous ossification produces the flat bones of the skull and the clavicle; they develop within a fibrous sheet, and their development includes four stages. (p. 222) (Fig. 7.8) 1. Embryonic connective tissue (mesenchyme) condenses into a layer of soft tissue with a dense supply of blood capillaries. a. The mesenchymal cells enlarge and differentiate into osteogenic cells. b. Regions of the mesenchyme become a network of soft sheets called trabeculae. 2. Osteogeneic cells gather on the trabeculae and differentiate into osteoblasts. a. These osteoblasts deposit osteoid tissue, which is soft collagenous tissue similar to bone except for a lack of minerals. (Fig. 7.9) b. Osteoblasts go on to deposit minerals, producing a honeycomb of bony trabeculae; some trabeculae persis as permanent spongy bone while osteoclasts resorb and remodel others to form a marrow cavity. 3. Trabeculae at the surface continue to calcify until the spaces are filled in, converting spongy bone to compact bone; this process leads to the sandwich-like arrangement of mature flat bones. C. Endochondral ossification is a process by which bone develops from a preexisting model composed of hyaline cartilage; most bones of the body develop in this way, and the development includes six stages. (pp. 222224) (Fig. 7.10) 1. Mesenchyme develops into a body of hyaline cartilage covered with a fibrous perichondrium; the perichondrium produces chondrocytes and the cartilage model grows. 2. Eventually, the perichondrium starts producing osteblasts instead of chondrocytes and is known as a periosteum. a. The osteoblasts deposit a thin collar of bone around the middle of the cartilage model. b. Chondrocytes in the middle of the model enlarge to become the primary ossification center. c. The walls of matrix between the lacunae calcify, blocking nutrients from reaching the chondrocytes, which die; their lacunae merge into a single cavity in the middle of the model. 3. Blood vessels penetrate the bony collar and invade the primary ossification center; the hollowed-out center of the model becomes the primary marrow cavity. a. Stem cells introduced with the blood give rise to osteoblasts and osteoclasts.

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b. Osteoblasts begin depositing osteoid tissue, and the bony collar thickens and elongates toward the ends of the bone, along with a wave of cartilage death. c. Osteoclasts follow, dissolving calcified cartilage remnants and enlarging the marrow cavity. d. The region of transition at each end of the primary marrow cavity is called a metaphysic. e. At the epiphyses, secondary ossification centers form as chondrocytes enlarge and die.

4. The secondary ossification center becomes hollowed out, generating a secondary marrow cavity. a. In bones with two epiphyseal, secondary ossification centers, one center lags in development. b. The joints of the limbs are still cartilaginous at birth. (Fig. 7.11) 5. During infancy and childhood, the epiphyses fill with spongy bone, and cartilage becomes limited to the articular cartilage of each joint surface and to an epiphyseal plate that separates the primary and secondary marrow cavities. 6. Growth occurs from the epiphyseal plate. a. By the late teens to early twenties, all remaining cartilage has been consumed and the gap between epiphysis and diaphysis closes. b. Once the gap is closed, the bone can no longer grow in length. D. Ossification occurs throughout life with the growth and remodeling of bones. (pp. 224227) 1. The epiphyseal plate is the region in which bone elongation takes place. a. The epiphyseal plate consists of hyaline cartilage in the middle with a transitional zone on each side. b. The transitional zone, facing the marrow cavity, is called the metaphysis. c. Cartilage converts to bone in the metaphysis in a five-stage process. (Fig. 7.13) i. In the zone of reserve cartilage (1), hyaline cartilage has not yet begun to transform into bone. ii. In the zone of cell proliferation (2), chondrocytes multiply and arrange themselves into longitudinal columns of flattened lacunae. iii. In the zone of cell hypertrophy (3), the chondrocytes cease dividing and enlarge. iv. In the zone of calcification (4), minerals are deposited in the matrix and calcify the cartilage. v. In the zone of bone deposition (5), walls between lacunae break down and chondrocytes die; osteoblasts line up along the walls of the

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channels and begin depositing concentric lamellae; osteoclasts dissolve the temporarily calcified cartilage. d. A region of spongy bone is created at the end of the marrow cavity facing the metaphysis and remains for life; continuing ossification converts the spongy bone to compact bone. e. Chondrocyte multiplication in zone 2 and hypertrophy in zone 3 push the zone of reserve cartilage (1) toward the ends of the bone, resulting in elongation. f. The growth of cartilage from within the metaphyses is called interstitial growth; dwarfism can result from a failure of cartilage to grow in the long bones.

Insight 7.2 Achondroplastic Dwarfism (Fig. 7.14) g. Growth stops when all the cartilage is depleted; the site of the original epiphyseal plate is marked with a line of spongy bone called the epiphyseal line. h. The epiphyses are said to be closed at this point; the state of closure can be used in forensic science to estimate the age of a subadult skeleton. 2. Bones continually grow throughout life in diameter and thickness through a process called appositional growth that deposits new tissue at the surface. a. Appositional growth is similar to intramembranous ossification; osteoblasts in the inner periosteum deposit osteoid tissue, calcify it, and become trapped in it as osteocytes. b. They lay down matrix in layers parallel to the surface, not in cylindrical osteons; this process produces circumferential lamellae. c. As a bone increases in diameter, its marrow cavity widens due to the activity of osteoclasts of the endosteum. 3. Bones are continually remodeled throughout life by the absorption of old bone and deposition of new, replacing about 10% of skeletal tissue per year. a. Wolffs law of bone states that the architecture of a bone is determined by the mechanical stresses placed upon it; the bone adapts to withstand those stresses. i. This phenomenon is an example of the complementarity of form and function. ii. An example can be found in the bones of a tennis players racket arm, which are more robust compared to the other arm. b. Bone remodeling results from the action of osteoblasts and osteoclasts. i. In bones that are little used, osteoclasts remove matrix and get rid of unnecessary mass. ii. In bones that are heavily used or stressed, osteoblasts deposit new tissue and thicken the bone.

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c. On average, bones of athletes and people engaged in manual labor have denser and more massive bones, compared to sedentary people. d. Osteitis deformans (Paget disease), osteogenesis imperfecta (brittle bone disease), and osteoporosis are diseases linked to imbalance between osteoblast and osteoclast activity.

IV. Physiology of Osseous Tissue (pp. 227232) A. Mineral deposition is a crystallization process in which calcium, phosphate, and other ions are taken from the blood plasma and deposited in bone tissue, mainly as crystals of hydroxyapaptite. (p. 228) 1. Osteoblasts lay down collagen fibers along the length of the osteon. 2. These fibers become encrusted with minerals that harden the matrix; hydroxyapatite crystals form when the product of calcium and phosphate concentrations reaches the solubility product value. a. Most tissues have inhibitors that prevent this from happening. 3. The first crystals to form act as seed crystals that attract more mineral ions, until the matrix is thoroughly calcified. 4. Osseous tissue sometimes forms in other organs, resulting in abnormal calcification called ectopic ossification. a. Arteriosclerosis is one example of ectopic ossification and consists of calcification of the arterial walls. b. A calcified mass in an otherwise soft organ is called a calculus. B. Mineral resorption is the process of dissolving bone, releasing minerals into the blood. (p. 228) 1. Osteoclasts carry out resorption by secreting hydrogen ions into the extracellular fluid outside the ruffled border. a. The space between the osteoclast and the bone becomes filled with hydrochloric acid with a pH of about 4. 2. Osteoclasts also secrete acid phosphatase that digests the collagen of the bone matrix. C. Calcium must be kept in a state of homeostasis between the bones and the blood. (pp. 228231) 1. Both calcium and phosphate have many roles in human physiology, and the skeleton acts as a reservoir for these minerals. 2. The adult body contains about 1,100 g of calcium with 99% in the bones in two reserves. a. One reserve is the stable pool of calcium that is incorporated into hydroxyapatite and is not readily exchangeable. b. The other reserve is exchangeable calcium that is easily released into the tissue fluid.

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3. The calcium concentration in the blood plasma is normally 9.2 to 10.4 mg/dL and must be kept close to this narrow range. a. 45% is in ionized form (Ca2+) and the rest is bound to plasma proteins as a reserve. b. A calcium deficiency is called hypocalcemia; it can cause excessive excitability of the nervous system and muscle tremors, spasms, or tetany. i. Tetany begins to occur as the plasma calcium level drops to 6 mg/dL; one sign is tetany of the hands and feet called carpopedal spasm. (Fig. 7.15) ii. At 4 mg/dL, muscles of the larynx contract (laryngospasm) and can cause suffocation. iii. Lower levels of calcium ion lower the charge difference across the cell membrane of excitable cells, allowing sodium ions to enter too freely and trigger excitation. c. A calcium excess is called hypercalcemia; it can cause nerve and muscle cells to become less excitable than normal. i. At a blood calcium concentration of 12 mg/dL and higher, symptoms may include emotional disturbances, muscle weakness, sluggish reflexes, and sometimes cardia arrest. d. Hypercalcemia is rare, but hypocalcemia can result from many causes, including vitamin D deficiency, diarrhea, thyroid tumors, or underactive parathyroid glands. i. Pregnant and lactating women are also at risk due to the calcium demands of the fetus or of milk production. ii. The leading cause of hypocalcemic tetany is accidental removal of the parathyroid glands during thyroid surgery. e. Calcium homeostasis depends on a balance between intake, excretion and elimination, and exchanges with the osseous tissue. f. Calcium homeostasis is regulated by three hormones: Calcitriol, calcitonin, and parathyroid hormone. 4. Calcitriol is a form of vitamin D. a. Calcitriol is produced by sequential action of the skin, liver, and kidneys. (Fig. 7.16) i. Epidermal keratinocytes use UV radiation to convert a steroid, 7dehyrocholesterol, to previtamin D3; the warmth of sunlight over the next 3 days converts this to vitamin D3, which enters the blood. ii. The liver adds a hydroxyl group, converting D3 to calcidiol.

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iii. The kidney adds another hydroxyl group, converting calcidiol to calcitriol (the most active form of vitamin D). b. Calcitriol behaves as a hormone; it is called a vitamin only because it can be added to the diet as in fortified milk. c. The principle function of calcitriol is to raise the blood calcium concentration, which it does in three ways. (Fig. 7.17) i. Calcitriol increases calcium absorption by the small intestine ii. It increases calcium resorption from the skeleton by binding to osteoblasts, causing release of a chemical messenger that binds with stem cells that produce osteoclasts; these increase and release calcium and phosphate from bones. iii. It promotes the reabsorption of calcium ions by the kidneys, so less is lost in urine. d. Calcitrol is also necessary for bone deposition; without it, bones become soft, as in rickets in children and osteomalacia in adults.

5. Calcitonin is secreted by C cells (clear cells) of the thyroid gland. a. Calcitonin is secreted when the blood calcium concentration rises too high; it lowers the concentration by two mechanisms. (Fig. 7.17, 7.18) i. Calcitonin reduces osteoclast activity by as much as 70% within 15 minutes of secretion. ii. It increases the number and activity of osteoblasts within an hour of secretion. b. Calcitonin plays an important role in children, in which osteoclasts are highly active, but has only a weak effect in adults. 5. Parathyroid hormone (PTH) is secreted by the parathyroid glands, which adhere to the posterior surface of the thyroid gland. a. A drop of 1% in the blood calcium level doubles the secretion of PTH, which raises blood calcium by four mechanisms. (Fig. 7.17, 7.18) i. PTH binds to osteoblasts, causing them to secrete a signal that increases the osteoclast population, promoting bone resorption. ii. PTH promotes reabsorption of calcium by the kidneys. iii. PTH promotes the final step of calcitriol synthesis in the kidneys. iv. PTH inhibits collagen synthesis by osteoblasts. b. Regardless of these normal effects of PTH, intermittent secretion or injection of PTH at low levels can stimulate bone deposition. c. Therefore PTH can increase or decrease bone mass, depending on other factors.

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D. Phosphate levels must also be kept in homeostasis. (pp. 231232)

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1. The average adult has 500 to 800 g of phosphorus, of which 85% to 90% is in the bones. 2. Phosphate concentration in the plasma ranges between 3.5 and 4.0 mg/dL and occurs in two forms, HPO42 and H2PO4. 3. The blood level of phosphate is not as tightly regulated as is the level of calcium, and changes are not associated with immediate functional disorders. 4. Calcitriol raises the phosphate level by promoting its absorption from the small intestine; parathyroid lowers the phosphate level by promoting its excretion. E. At least 20 other factors, including hormones, growth factors, and vitamins, affect bone. (p. 232) (Table 7.1) 1. Bone growth is rapid in puberty and adolescence due to surges of growth hormones and the sex hormones; these hormones stimulate cell division and activity. 2. Adolescent girls grow faster than boys because estrogen has a stronger effect than testosterone; but males grow for a longer time. 3. Deficiency or excess of hormones can cause abnormalities ranging from stunted growth to extremely tall stature. 4. Use of anabolic steroids by adolescent athletes can cause closure of the epiphyseal plates and result in short adult stature. V. Bone Disorders (pp. 233236) A. Bone fractures are classified in many ways. (p. 233235) 1. A stress fracture is a break caused by abnormal trauma to a bone, such as impact from falls, athletics, or combat. 2. A pathologic fracture is a break in a weakened bone due to a disease, such as bone cancer or osteoporosis. 3. Fractures are also classified according to the direction of the fracture line, whether the skin is broken, and whether the bone is cracked or is broken into pieces. (Table 7.2) (Figure 7.19) 4. An uncomplicated fracture heals in 8 to 12 weeks, but complex fractures and fractures in the elderly take longer; the healing process has four stages. (Fig. 7.20) a. Formation of a hematoma and granulation tissue. i. Blood vessels are severed by a fracture; the blood forms a clot called a fracture hematoma. ii. Fibroblasts, macrophages, osteoclasts, and osteogenic cells invade the tissue, along with blood capillaries, coverting the clot to a mass called granulation tissue.

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b. Formation of a soft callus; fibroblasts deposit collagen while some osteogenic cells become chondroblasts and produce patches of cartilage called the soft callus. c. Conversion to hard callus. i. Other osteogenic cells become osteoblasts, which produce a bony collar called the hard callus around the fracture. ii. The hard callus acts as a temporary splint; it takes 4 to 6 weeks for a hard callus to form. iii. During this period, the broken bone should be immobilized to prevent reinjury. d. Remodeling. i. The hard callus pesists for 3 to 4 months, while osteoclasts dissolve small fragments of broken bone, and osteoblasts deposit spongy bone to bridge the gap. ii. The spongy bone gradually fills in to become compact bone, in a process similar to intramembranous ossification. iii. A fracture may leave a slight thickening of bone visible on X-ray, but in some cases no trace is visible.

2. Treatment of fractures involves reducing the displacement of broken bones and stabilizing the bone during healing. (Fig. 7.21) a. In closed reduction, the bone fragments are manipulated into their normal positions without surgery. b. In open reduction, the bone is exposed surgically, and plates, screws, or pins may be used to realign fragments. c. Fractures are set in casts to stabilize the bone. d. Traction is used to treat fractures of the femur in children by overriding the force of thigh muscles; traction is rarely used in elderly people. e. Hip fractures are usually pinned, and early ambulation (walking) is encouraged to promote blood circulation and healing. f. Orthopedics deals with prevention and correction of injuries and disorders to the bones, joints, and muscles. B. Several other bone disorders exist, the most common of which is osteoporosis. (p. 235) (Table 7.3) Insight 7.4 Osteoporosis (Fig. 7.22) Connective Issues: Skeletal system interactions

Cross References

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Additional information on topics mentioned in Chapter 7 can be found in the chapters listed below. Chapter 9: Ligaments Chapter 10: Tendons Chapters 11 and 12: Excitation of nerve and muscle cells Chapter 17: Effects of hormones Chapter 21: Red bone marrow Chapter 29: Aging and the skeletal system