Arthritis Sourcebook, Sixth Edition

James Chambers

• Publisher: Omnigraphics
• Year: 2022
• ISBN:
  9780780819870
• Topic: Medicine
• Subtopic: General Health

Consumer health information about symptoms, diagnosis, and treatment for major forms of arthritis, along with self-care tips and coping strategies. Includes index, glossary of related terms, and other resources.

Part 1 | Introduction to Arthritis

Chapter 1 | Understanding Bones, Muscles, and Joints

Chapter Contents

Section 1.1—Structure and Function of Bones and Joints

Section 1.2—Structure and Function of Muscles

Section 1.3—Importance of Healthy Bones and Joints

Section 1.1 | Structure and Function of Bones and Joints

This section includes text excerpted from “Anatomy & Physiology,” Surveillance, Epidemiology, and End Results (SEER) Program, National Cancer Institute (NCI), June 30, 2002. Reviewed January 2022.

Humans are vertebrates, animals having a vertebral column or backbone. They rely on a sturdy internal frame that is centered on a prominent spine. The human skeletal system consists of bones, cartilage, ligaments and tendons and accounts for about 20 percent of the body weight.

The living bones in our bodies use oxygen and give off waste products in metabolism. They contain active tissues that consume nutrients, require a blood supply and change shape or remodel in response to variations in mechanical stress.

Bones provide a rigid framework, known as the “skeleton,” that support and protect the soft organs of the body.

The skeleton supports the body against the pull of gravity. The large bones of the lower limbs support the trunk when standing.

The skeleton also protects the soft body parts. The fused bones of the cranium surround the brain to make it less vulnerable to injury. Vertebrae surround and protect the spinal cord and bones of the rib cage help protect the heart and lungs of the thorax.

Bones work together with muscles as simple mechanical lever systems to produce body movement.

Bones contain more calcium than any other organ. The intercellular matrix of bone contains large amounts of calcium salts, the most important being calcium phosphate.

When blood calcium levels decrease below normal, calcium is released from the bones so that there will be an adequate supply for metabolic needs. When blood calcium levels are increased, the excess calcium is stored in the bone matrix. The dynamic process of releasing and storing calcium goes on almost continuously.

Hematopoiesis, the formation of blood cells, mostly takes place in the red marrow of the bones.

In infants, red marrow is found in the bone cavities. With age, it is largely replaced by yellow marrow for fat storage. In adults, red marrow is limited to the spongy bone in the skull, ribs, sternum, clavicles, vertebrae and pelvis. Red marrow functions in the formation of red blood cells (RBCs), white blood cells (WBCs) and blood platelets.

Structure of Bone Tissue

There are two types of bone tissue: compact and spongy. The names imply that the two types differ in density, or how tightly the tissue is packed together. There are three types of cells that contribute to bone homeostasis. Osteoblasts are bone-forming cell, osteoclasts resorb or break down bone, and osteocytes are mature bone cells. An equilibrium between osteoblasts and osteoclasts maintains bone tissue.

Compact Bone

Compact bone consists of closely packed osteons or haversian systems. The osteon consists of a central canal called the “osteonic” (haversian) canal, which is surrounded by concentric rings (lamellae) of matrix. Between the rings of matrix, the bone cells (osteocytes) are located in spaces called “lacunae.” Small channels (canaliculi) radiate from the lacunae to the osteonic (haversian) canal to provide passageways through the hard matrix. In compact bone, the haversian systems are packed tightly together to form what appears to be a solid mass. The osteonic canals contain blood vessels that are parallel to the long axis of the bone. These blood vessels interconnect, by way of perforating canals, with vessels on the surface of the bone.

Spongy (Cancellous) Bone

Spongy (cancellous) bone is lighter and less dense than compact bone. Spongy bone consists of plates (trabeculae) and bars of bone adjacent to small, irregular cavities that contain red bone marrow. The canaliculi connect to the adjacent cavities, instead of a central haversian canal, to receive their blood supply. It may appear that the trabeculae are arranged in a haphazard manner, but they are organized to provide maximum strength similar to braces that are used to support a building. The trabeculae of spongy bone follow the lines of stress and can realign if the direction of stress changes.

Figure 1.1. Bone Tissue

Bone Development and Growth

The terms osteogenesis and ossification are often used synonymously to indicate the process of bone formation. Parts of the skeleton form during the first few weeks after conception. By the end of the eighth week after conception, the skeletal pattern is formed in cartilage and connective tissue membranes and ossification begins.

Bone development continues throughout adulthood. Even after adult stature is attained, bone development continues for repair of fractures and for remodeling to meet changing lifestyles. Osteoblasts, osteocytes and osteoclasts are the three cell types involved in the development, growth and remodeling of bones. Osteoblasts are bone-forming cells, osteocytes are mature bone cells and osteoclasts break down and reabsorb bone.

There are two types of ossification: intramembranous and endochondral.

Intramembranous

Intramembranous ossification involves the replacement of sheet-like connective tissue membranes with bony tissue. Bones formed in this manner are called “intramembranous bones.” They include certain flat bones of the skull and some of the irregular bones. The future bones are first formed as connective tissue membranes. Osteoblasts migrate to the membranes and deposit bony matrix around themselves. When the osteoblasts are surrounded by matrix they are called “osteocytes.”

Endochondral Ossification

Endochondral ossification involves the replacement of hyaline cartilage with bony tissue. Most of the bones of the skeleton are formed in this manner. These bones are called “endochondral bones.” In this process, the future bones are first formed as hyaline cartilage models. During the third month after conception, the perichondrium that surrounds the hyaline cartilage “models” becomes infiltrated with blood vessels and osteoblasts and changes into a periosteum. The osteoblasts form a collar of compact bone around the diaphysis. At the same time, the cartilage in the center of the diaphysis begins to disintegrate. Osteoblasts penetrate the disintegrating cartilage and replace it with spongy bone. This forms a primary ossification center. Ossification continues from this center toward the ends of the bones. After spongy bone is formed in the diaphysis, osteoclasts break down the newly formed bone to open up the medullary cavity.

The cartilage in the epiphyses continues to grow so the developing bone increases in length. Later, usually after birth, secondary ossification centers form in the epiphyses. Ossification in the epiphyses is similar to that in the diaphysis except that the spongy bone is retained instead of being broken down to form a medullary cavity. When secondary ossification is complete, the hyaline cartilage is totally replaced by bone except in two areas. A region of hyaline cartilage remains over the surface of the epiphysis as the articular cartilage and another area of cartilage remains between the epiphysis and diaphysis. This is the epiphyseal plate or growth region.

Bone Growth

Bones grow in length at the epiphyseal plate by a process that is similar to endochondral ossification. The cartilage in the region of the epiphyseal plate next to the epiphysis continues to grow by mitosis. The chondrocytes, in the region next to the diaphysis, age and degenerate. Osteoblasts move in and ossify the matrix to form

Figure 1.2. Bone Growth

bone. This process continues throughout childhood and the adolescent years until the cartilage growth slows and finally stops. When cartilage growth...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Table of Contents
• Preface
• Part 1. Introduction to Arthritis
• Part 2. Types of Arthritis and Other Related Medical Conditions
• Part 3. Current Treatment Strategies for Arthritis
• Part 4. Arthritis Self-Management: Strategies to Reduce Pain and Inflammation
• Part 5. Living with Arthritis
• Part 6. Additional Help and Information
• Index