BONE FRACTURE, REPAIR AND

REMODELLING
 HEALTHY BONE REMODELING
Bone remodeling is the ongoing replacement of old
bone tissue by new bone tissue.
• It involves:
 bone resorption, the removal of minerals and
collagen fibers from bone by osteoclasts resulting
into destruction of bone extracellular matrix
 bone deposition, the addition of minerals and
collagen fibers to bone by osteoblasts resulting into
the formation of bone extracellular matrix
• The remodeling process occurs throughout life and
becomes dominant by the time that bone reaches its
peak mass (typically by the early 20s).
• Remodeling continues throughout life so that most
of the adult skeleton is replaced about every 10 years
• The total process takes about 4 to 8 months, and
occurs continually throughout our lives.
• Remodeling may be triggered by factors such as
 Exercise
bone fractures
Mechanical stress
• Orthodontics is the branch of dentistry concerned with the
prevention and correction of poorly aligned teeth.
• Orthodontics is based on the predictable remodeling
of bone surrounding and supporting the teeth in response
to stimuli generated or brought about
by orthodontic appliances
• The movement of teeth by braces places a stress on the
bone that forms the sockets that anchor the teeth. In
response to this ARTIFICIAL STRESS, osteoclasts and
osteoblasts remodel the sockets so that the teeth
align properly. •
 Resting Phase

 In Resting Phase, bone tissue presents bone lining

cells(old bone cells) on its surface.
 In response to bone damage/mechanical stress,
osteocytes(in the bone matrix) undergo apoptosis
 Bone lining cells detach from bone surface that is to
be resorbed.
 Activation

 Osteocyte apoptosis, leads to release of factors

that increase increased blood flow and recruitment
of osteoclast precursors
 Osteoclast precursor cells are recruited from the
circulation and activated
 RESPORPTION (duration 2weeks)

 Activated osteoclasts produce matrix proteases and

collagenases.
 Osteoclasts dig out a cavity, called a resorption pit,
in spongy bone or burrow a tunnel in compact
bone.
 Calcium can be released into the blood for use in
various body functions.
 Osteoclasts under go cell death.
 REVERSAL (duration 2-5wks)

 The phase where bone resorption switches to

formation
 Macrophages remove the remaining debris left
from the resorbed surface, while growth factors
released from the resorbed bone matrix stimulate
formation of “precursors of osteoblasts”.
 Pre-cursors to osteoblasts, appear along the burrow
or pit where they… proliferate (increase in numbers)
and differentiate (change) into mature osteoblasts.
 FORMATION (duration 4months)

 Active osteoblasts synthesize and secrete bone

matrix.
 Also osteoblasts play a part in regulating bone
mineralization. (calcium deposition)
 Termination
• Once mineralization is complete, osteoblasts may
 undergo apoptosis
 remain as lining cells after Mineralization
 migrate within the bone matrix and terminally
differentiate into osteocytes.
• The area of bone remodeling rests until the next
remodeling cycle begins.
3. Hormones.
PTH >>> stimulates osteoclasts>> bone resorption
Calcitonin >>> stimulates osteoblasts>> bone
deposition.
Thyroid hormone >>>>stimulating
osteoblasts.>>bone deposition
insulin from the pancreas promotes
bone growth by increasing the synthesis of bone
proteins.
• At puberty, the secretion of hormones known as sex
hormones causes a dramatic effect on bone growth.
• The sex hormones include estrogens (produced by
the ovaries) and androgens such as testosterone
(produced by the testes).
• These hormones are responsible for increased
osteoblast activity and synthesis of bone matrix
• Estrogens also promote changes in the skeleton that
are typical of females, such as widening of the
pelvis.
 Bone diseases
Conditions due to Growth hormone imbalance.
 GH increases the length of the bones, until
epiphysis fuses with shaft, which occurs at the time
of puberty.
BONE FRACTURE AND REPAIR
•FRACTURE REPAIR
There are four stages in the repair of a broken bone:
• 1) the formation of hematoma at the break,
• 2) the formation of a fibrocartilaginous/soft callus,
• 3) the formation of a bony callus
• 4) Remodeling and addition of compact bone
Hematoma formation:
Blood vessels in the broken bone tear and hemorrhage, resulting in the formation of clotted blood,
or a hematoma, at the site of the break.
The severed blood vessels at the broken ends of the bone are sealed by the clotting process. Bone
cells deprived of nutrients begin to die.
Bone generation: /soft callus formation
Within days of the fracture, capillaries grow into the hematoma, while phagocytic cells begin to clear
away the dead cells.
Though fragments of the blood clot may remain, fibroblasts and osteoblasts enter the area and begin
to reform bone.
Fibroblasts produce collagen fibers that connect the broken bone ends, while osteoblasts start to
form spongy bone.
The repair tissue between the broken bone ends, the fibrocartilaginous/soft callus, is composed of
both hyaline and fibrocartilage.
Bony callous formation: /Hard callus formation
The fibrocartilaginous callus is converted into a bony callus of spongy bone.
It takes about two months for the broken bone ends to be firmly joined together after the fracture.
Bone remodeling:
The bony callus is then remodeled by osteoclasts and osteoblasts, with excess material on the
exterior of the bone and within the medullary cavity being removed.
Compact bone is added to create bone tissue that is similar to the original, unbroken bone. This
remodeling can take many months; the bone may remain uneven for years.
END