Physiology of Bone Remodeling

Bone is remodeled constantly throughout the life.

Remodeling of the bone is under the control of two kinds of cells
osteoblasts and osteoclasts.
The process of remodeling begins by migration of osteoclasts, followed by
resorption of bone by these cells.
This is followed by a reversal phase characterized by the apoptosis of the
osteoclasts
and a final phase of bone formation by newly formed osteoblasts.
The critical initial step in this process-the development of osteoclasts-is
under the control of preosteoblastic/stromal cells; this ensures that the bone
resorption and formation processes will be tightly coupled, allowing a wave
of bone formation to follow each cycle of bone resorption thus maintaining
skeletal integrity. In adults, as much as 18% of the total bone calcium is
removed and deposited every year. The extracellular component of the
bone consists of an organic matrix and an inorganic reservoir of largely
calcium and phosphorous. The organic matrix of the bone is produced by
osteoblasts and mainly consists of type 1 collagen, which is involved in the
formation of new bone. The osteoblasts also produce several
noncollagenous proteins such as osteocalcin and alkaline phosphatase,
which are increased in high-turnover bone conditions. The factors
implicated in the growth and differentiation of osteoblasts include
interleukin 1, interleukin 6, tumor necrosis factor-, transforming growth
factor, fibroblast growth factor, bone morphogenic proteins (BMP), insulinlike growth factor (IGF) and IGF-binding protein. These factors function in
an autocrine manner and may also serve as the mediators of stimulation
by parathyroid hormone. Other systemic processes that affect the skeleton
include accumulation of 2 microglobulin and steroid-induced or post
menopausal osteoporosis.
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