Factors Affecting Bone Development, Growth, and Repair

Increase in bone density. Bone hypertrophy occurs in response to physical activity.
The bones in the throwing arm of

a baseball pitcher and the racket arm of a tennis player are denser and thicker than the other arm. In addition,
physical activity increases bone density throughout the skeletal system, not only in the bones being stressed. Bone
hypertrophy is stimulated more by the magnitude of the skeletal loading than by the frequency of loading.
Consequently, it appears to be greater in weight-lifters than runners. Although it occurs in response to weight-
bearing exercises, it also occurs to a lesser extent in response to some non-weight bearing exercises such as cycling.
Swimmers who spend much time in the water, however, may have a lower bone mineral density than that of
sedentary individuals. Bone hypertrophy reduces the risk of osteoporosis. Compare bone atrophy.
Factors affecting bone development, growth, and

repair.
A number of factors influence bone development, growth, and repair.
These include nutrition, exposure to sunlight, hormonal secretions, and
physical exercise. For example, vitamin D is necessary for proper
absorption of calcium in the small intestine. In the absence of this
vitamin, calcium is poorly absorbed, and the inorganic salt portion of
bone matrix lacks calcium, softening and thereby deforming bones. In
children, this condition is called rickets, and in adults, it is called
osteomalacia.
Vitamin D is relatively uncommon in natural foods, except for eggs. But it

is readily available in milk and other dairy products fortified with vitamin
D. Vitamin D also forms from a substance (dehydrocholesterol) produced
by cells in the digestive tract or obtained in the diet. Dehydrocholesterol
is carried by the blood to the skin, and when exposed to ultraviolet light
from the sun, it is converted to a compound that becomes vitamin D.
Vitamins A and C are also required for normal bone development and
growth. Vitamin A is necessary for osteoblast and osteoclast activity
during normal development. Thus, deficiency of vitamin A may retard
bone development. Vitamin C is required for collagen synthesis, so its
lack also may inhibit bone development. In this case, osteoblasts produce
less collagen n the intercellular material of the bone tissue, and the
resulting bones are abnormally slender and fragile.
Hormones secreted by the pituitary gland, thyroid gland, parathyroid

glands, and ovaries or testes affect bone growth and development. The
pituitary gland, for instance, secretes growth hormone, which stimulates
division of cartilage cells in the epiphyseal disks. In the absence of this
hormone, the long bones of the limbs fail to develop normally, and the
child has pituitary dwarfism. Such a person is very short, but has normal
body proportions. If excess growth hormone is released before the
epiphyseal disks ossify, height may exceed 8 feet-a conduction called
pituitary gigantism. In an adult, secretion of excess growth hormone
causes a condition called acromegaly, in which the hands, feet, and jaw
enlarge.
Thyroid hormone stimulates replacement of cartilage in the epiphyseal

disks of long bones with bone tissue. Thyroid hormone can halt bone
growth by causing premature ossification of the disks. Deficiency of
thyroid hormone also may stunt growth, because without its stimulation,
the pituitary gland does not secrete enough growth hormone. In
contrast to the bone-forming activity of thyroid hormone, parathyroid
hormone stimulates an increase in the number and activity of osteoclasts.
Both male and female sex hormones (called androgens and estrogens,
respectively) from the testes, ovaries, and adrenal glands promote
formation of bone tissue. Beginning at puberty, these hormones are
abundant, causing the long bones to grow considerably. However, sex
hormones also stimulate ossification of the epiphyseal disks, and
consequently they stop bone lengthening at a relatively early age. The
effect of estrogens on the disks is somewhat stronger than that of
androgens. For this reason, females typically reach their maximum
heights earlier than males.
Physical stress also stimulates bone growth. For example, when skeletal
muscles contract, they pull at their attachments on bones, and the
resulting stress stimulates the bone tissue to thicken and strengthen
(hypertrophy). Conversely, with lack of exercise, the same bone tissue
wastes, becoming thinner and weaker (atrophy). This is why the bones of
athletes are usually stronger and heavier than those of nonathletes. It is
also why fractured bones immobilized in casts may shorten.
2 WAYS BONE MODELING
OCCURS THROUGHOUT
LIFE: HYPERTROPHY AND
ATROPHY
By Steve Glass, Brian Hatzel, Rick Albrecht
Bone modeling occurs throughout life in two

ways: hypertrophy (growth) or atrophy (shrinking). Understanding the
difference between the two enables you to acknowledge the effects
that being physically active has on your support system and general
health as you age.
BONE DEVELOPMENT IN THE EARLY

YEARS
During the early years, as children walk, run, and otherwise function in
their daily activities, bones are continually ossifying (hardening and
becoming more dense) and meeting the demands of the structural
system. Bone hypertrophy occurs in response to this activity during
these years.
Despite the ossification that is occurring, adolescents still possess

points of vulnerability within these structures.
Problems with the growth plate: The epiphyseal (or growth)

plates are especially vulnerable to overuse. Significant
compression and shearing of the epiphyseal plate can slow bone
growth and have a long-lasting impact on the overall
development of the bone. Shearing typically occurs when
muscles exert force on the bone during activity,
whereas compression is usually a result of walking, running, and
jumping.
In moderation, these activities are normal and healthy; in fact,

theyre necessary for normal bone development. But when they
progress too quickly or are engaged in to the extreme, negative
effects can occur.
Osgood-Schlatter disease and other difficulties with the

apophysis: In adolescents, bone injury often revolves around
the disproportionate, or imbalanced, abilities of the muscular
system compared to the skeletal system. Through adolescence,
significant growth and development occur within the muscular
system, and additional hormonal influences further spur
muscular development such that the muscles begin to make
demands that the bones arent quite ready to accommodate.
As muscles pull harder and harder on the bones, the modeling

occurs so quickly that apophysitis (the inflammation of the
apophysis, the raised section where tendons and/or muscles
insert onto the bone) occurs, which can be quite painful.
The most common site of apophysitis is where the patellar
tendon inserts on the tibial tuberosity. The increased tension that
both bone and muscle growth place on this site can cause
tenderness where the tendon attaches. This condition is
commonly referred to as Osgood-Schlatter disease. In other
cases, the increased tension created by muscles causes the
growth plates to shift, resulting in growth retardation.
Many issues like apophysitis are complicated by over activity in

adolescents. The solution, however, isnt to avoid activity; in fact,
encouraging regular physical activity is paramount. The key is to
recognize signs of overuse and make certain that children progress
into activity in a way that allows for their bodies to accommodate the
stresses theyll incur.
Inevitably, many adolescents will experience complications due to

growth and activity. In nearly all cases, the discomfort goes away over
time as the body is able to better accommodate the forces, and the
bones adapt appropriately.
CHANGES IN BONES THROUGHOUT THE

ADULT YEARS
By adulthood, the bones have become fully ossified, or hardened, and
the risk of injury to the growth plates due to overuse is no longer an
issue. However, even though longitudinal growth does not occur in the
adult years, circumferential growth continues for quite some time and
is usually dictated by function.
Thats why its so important to exercise regularly and to be active. The

more active you are, the more dense your bones become. Because
bones are constantly accommodating their environment, they change
either growing stronger or weaker to meet the demands that the
forces put on them.

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Increase in bone density. Bone hypertrophy occurs in response to physical activity.

The bones in the throwing arm of

Factors affecting bone development, growth, and

Vitamin D is relatively uncommon in natural foods, except for eggs. But it

Hormones secreted by the pituitary gland, thyroid gland, parathyroid

Thyroid hormone stimulates replacement of cartilage in the epiphyseal

By Steve Glass, Brian Hatzel, Rick Albrecht

Bone modeling occurs throughout life in two

BONE DEVELOPMENT IN THE EARLY

Despite the ossification that is occurring, adolescents still possess

Problems with the growth plate: The epiphyseal (or growth)

In moderation, these activities are normal and healthy; in fact,

Osgood-Schlatter disease and other difficulties with the

As muscles pull harder and harder on the bones, the modeling

Many issues like apophysitis are complicated by over activity in

Inevitably, many adolescents will experience complications due to

CHANGES IN BONES THROUGHOUT THE

Thats why its so important to exercise regularly and to be active. The

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