Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM(UK), FTCD Trinity College D

Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM(UK), FTCD Trinity College D www.phwiki.com

Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM(UK), FTCD Trinity College D

Reed, Jessi, Morning Drive On-Air Personality has reference to this Academic Journal, PHwiki organized this Journal Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM(UK), FTCD Trinity College Dublin Classification of Bones in addition to Joints Bone

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Cortical Bone Dense, hard bone found in cortex Three quarters of skeletal tissue High mineral content Carter & Hayes, 1976 Stiffer than cancellous Withst in addition to s greater stress, less strain Fractures when strain exceeds 2% Carter & Hayes, 1976 Cortical Bone Low surface area Porosity 5-30% Slow metabolic rate Develops in line of stress Einhorn,1996 Cortical Bone

The shaft of the tibia is mainly compact bone A central medullary cavity containing mainly fat The ends are compact bone With an inner core of cancellous bone The periosteum is the vascular fibrous connective tissue investing bone Tibia Trabecular or Cancellous Bone Found inside cortical shell e.g. Vertebrae Consists of horizontal in addition to vertical plates Spaces are filled with bone marrow Large surface area Porosity is between 30-90% Greater capacity to store energy In vitro fractures at strains >75% Metabolically more active More sensitive to changes in endocrine hormones Carter & Hayes,1976; Einhorn, 1996 Trabecular or Cancellous Bone

Compressive strength is proportional to the square of the apparent density Small changes in density Large change in strength Dalen et al., 1976 Cancellous Bone Organic matrix Type I collagen as long as ms 90% of skeletal weight Mineral hydroxyapatite ratio Calcium 10 Phosphate 6 Carbonate 1 Bone Bone Remodelling Bone is a living tissue Osteoclastic activity i.e. bone resorption takes only few days Osteoblastic or bone as long as mation takes several months

Bone Remodelling D1202 Phases of Bone Remodelling A Healthy Skeleton depends on a Balanced RANK Lig in addition to : OPG Ratio Prevents Bone Loss 1 Hofbauer LC et al. JAMA 2004;292: 490–495; 2 Lacey DL et al. Cell 1998;93:165–176; 3 Boyle WJ et al. Nature 2003;423:337–342 RANK Lig in addition to OPG Increases Bone Loss

A Healthy Skeleton requires a Balance of Bone Resorption in addition to Formation Adapted from Baron, R. General Principles of Bone Biology. In: Primer on the Metabolic Bone Diseases in addition to Disorders of Mineral Metabolism. Favus MJ (Ed.) 5th Edition. American Society as long as Bone in addition to Mineral Research, Washington DC, 2003: 1–8 When bone turnover is increased, bone loss dominates Formation: 3 months Regulation of Osteoclastogenesis Osteoclast precursor osteoblast Osteoclast RANKL OPG RANK c-fms M-CSF differentiation Monoclonal antibody to RANKL AMG 162 Bones Require Normal hormones Adequate calories Particular protein Calcium Vitamin D Regular weight bearing Exercise Bone

The rate of turnover is determined by hormonal in addition to local factors Bone Four Mechanisms of Bone Mass Regulation Changes in bone function lead to changes in bone Bone is laid down where needed Bone is resorbed where it is not needed Wolff, 1892 Wolff’s Law

Osteogenesis is induced by dynamic not static strains The optimal type of osteogenic activity should provide relatively high levels of strain Rubin & Lanyon, 1984 Mechanical Strain Tensile as long as ces result in osteoclastic activity On the convex side of an angulated bone Compressive as long as ce results in osteoblastic activity on concave side Bone Bones require Normal hormones Adequate calories Particularly protein Calcium Vitamin D Regular weight bearing exercise Bone

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1. Compston JE. Clinical Endocrinology 1990;33:653-682 D1202 Age Related Changes in Bone Mass1 Peak Bone Mass Genetic Environmental factors Mechanical strain Hormones Weight bearing activity during adolescence in addition to early adulthood was a far more important predictor of peak bone mass than calcium intake Welten et al., 1994 Peak Bone Mass

Growing bone has a greater capacity to add new bone to skeleton than mature bone Forwood & Burr, 1993 Low Peak Bone Mass Osteogenesis Muscle action is main stimulus as long as bone as long as mation Mechanical as long as ce Weight bearing Birge et al., 1968 Classification of Bones By Shape Long Short Flat Irregular Sesamoid

Range of Joint Movement Shape of articulating surfaces Restraint due to ligaments in addition to muscles crossing joint Pain, weakness, spasm or contracture of muscles Bulk of adjacent soft tissue Impingement of bony surfaces Scarring of skin due to injury or burns “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”

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