Bone is formed by one of two processes:
endochondral ossification or
intramembranous ossification. Endochondral ossification is the process of forming bone from cartilage and this is the usual method. This form of
bone development is the more complex form: it follows the formation of a first skeleton of
cartilage made by
chondrocytes, which is then removed and replaced by bone, made by osteoblasts. Intramembranous ossification is the direct ossification of
mesenchyme as happens during the formation of the
membrane bones of the skull and others. During osteoblast
differentiation,
the developing progenitor cells express the regulatory
transcription factor Cbfa1/Runx2. A second required transcription factor is
Sp7 transcription factor.
Osteochondroprogenitor cells differentiate under the influence of
growth factors, although isolated mesenchymal stem cells in tissue culture may also form osteoblasts under permissive conditions that include
vitamin C and substrates for
alkaline phosphatase, a key
enzyme that provides high concentrations of phosphate at the mineral deposition site.
Bone morphogenetic proteins Key growth factors in endochondral skeletal differentiation include
bone morphogenetic proteins (BMPs) that determine to a major extent where chondrocyte differentiation occurs and where spaces are left between bones. The system of cartilage replacement by bone has a complex regulatory system.
BMP2 also regulates early skeletal patterning.
Transforming growth factor beta (TGF-β), is part of a superfamily of proteins that include BMPs, which possess common signaling elements in the
TGF beta signaling pathway. TGF-β is particularly important in
cartilage differentiation, which generally precedes bone formation for endochondral ossification. An additional family of essential regulatory factors is the
fibroblast growth factors (FGFs) that determine where skeletal elements occur in relation to the skin
Steroid and protein hormones Many other regulatory systems are involved in the transition of cartilage to bone and in bone maintenance. A particularly important bone-targeted hormonal regulator is
parathyroid hormone (PTH). Parathyroid hormone is a protein made by the
parathyroid gland under the control of serum calcium activity. Intermittent PTH stimulation increases osteoblast activity, although PTH is bifunctional and mediates bone matrix degradation at higher concentrations. The skeleton is also modified for reproduction and in response to nutritional and other
hormone stresses; it responds to
steroids, including
estrogen and
glucocorticoids, which are important in reproduction and energy metabolism regulation. Bone turnover involves major expenditures of energy for synthesis and degradation, involving many additional signals including
pituitary hormones. Two of these are
adrenocorticotropic hormone (ACTH) and
follicle stimulating hormone. The physiological role for responses to these, and several other
glycoprotein hormones, is not fully understood, although it is likely that ACTH is bifunctional, like PTH, supporting bone formation with periodic spikes of ACTH, but causing bone destruction in large concentrations. In mice, mutations that reduce the efficiency of ACTH-induced glucocorticoid production in the adrenals cause the skeleton to become dense (
osteosclerotic bone). ==Organization and ultrastructure==