Skeletal System


The skeletal system is a living, dynamic, bony framework of the body, with networks of infiltrating blood vessels.


The human skeletal system. Humans are born with more than 300 bones, but some fuse during growth, reducing the overall number.

Because the bones making up the human skeleton are inside the body, the skeleton is called an endoskeleton. Some animals, such as the crab, have an external skeleton called an exoskeleton.

Types of bone

Bones may be classified according to their various traits, such as shape, origin, and texture. Four types are recognized based on shape. These are long bones, short bones, flat bones, and irregular bones. Long bones have a long central shaft, called the diaphysis, and two knobby ends, called the epiphysis. In growing long bones, the diaphysis and epiphysis are separated by a thin sheet of cartilage. Examples of long bones include bones of the arms and legs, the metacarpals of the hand, metatarsals of the foot, and the clavicle. Short bones are about as long as wide. The patella, carpels of the wrist, and tarsals of the ankle are short bones. Flat bones take several shapes, but are characterized by being relatively thin and flat. Examples include the sternum, ribs, hip bones, scapula, and cranial bones. Irregular bones are the odd-shaped bones of the skull, such as the sphenoid, the sacrum, and the vertebrae. The common characteristic of irregular bones is not that they are similar to each other in appearance, but that they cannot be placed in any of the other bone categories.

Bones may also be classified based on their origin. All bones (as well as muscles and connective tissue) originate from an embryonic connective tissue called mesenchyme, which makes mesoderm, also an embryonic tissue. Some mesoderm forms the cartilaginous skeleton of the fetus, the precursor for the bony skeleton. However, some bones, such as the clavicle and some of the facial and cranial bones of the skull, develop directly from mesenchyme, thereby bypassing the cartilaginous stage. These types of bone are called membrane bone (or dermal bone). Bone that originates from cartilage is called endochondral bone.

Finally, bones are classified based on texture. Smooth, hard bone called compact bone forms the outer layer of bones. Inside the outer compact bone is cancellous bone, sometimes called the bone marrow. Cancellous bone appears open and spongy, but is actually very strong, like compact bone. Together, the two types of bone produce a light, but strong, skeleton.


The human skeletal system is divided into two main groups: the axial skeleton and the appendicular skeleton. The axial skeleton includes bones associated with the body's main axis, including:

The appendicular skeleton consists of the bones that anchor the body's appendages to the axial skeleton, including:

AXIAL SKELETON. There are 28 bones in the skull. Of these, eight bones comprise the cranium and provide protection for the brain. In adults, these bones are flat and interlocking at their joints, making the cranium immobile. Fibrous joints, or sutures, occur where the bony plates of the cranium meet and interlock. Cartilage-filled spaces between the cranial bones of infants, known as soft spots or fontanelles, allow their skull bones to move slightly during birth. This makes birth easier and helps prevent skull fractures, but may leave the infant with an odd-shaped head temporarily while the skull regains its shape. Eventually, the fontanelles in an infant's head are replaced by bone, and fibrous joints develop. In addition to protecting the brain, skull bones also support and protect the sensory organs responsible for sight, hearing, smell, and taste.

The eight bones of the cranium are:

Fourteen bones shape the cheeks, eyes, nose, and mouth. These include:

The upper, bony bridge of the nose is formed by the nasal bones and provides an attachment site for the cartilage making up the softer part of the nose. The zygomatic bones form the cheeks and part of the eye sockets. Two bones fuse to form the maxillae, the upper jaw of the mouth. These bones also form the hard palate of the mouth. The mandible forms the lower jaw of the mouth and is moveable, enabling chewing of food and speech. The mandible is the bone that connects to the temporal bones.

Located behind these facial bones are other bones that shape the interior portions of the eyes, nose, and mouth. These include:

In addition to these 28 skull bones is the hyoid bone, located at the base of the tongue. Technically, the hyoid bone is not part of the skull but it is often included with the skull bones. It provides an attachment site for the tongue and some neck muscles.

Several of the facial and cranial bones contain sinuses, or cavities, that connect to the nasal cavity and drain into it. These are the frontal, ethmoid, sphenoid, and maxillae bones, all located near the nose. Painful sinus headaches result from the buildup of pressure in these cavities. Membranes that line these cavities may secrete mucus or become infected, causing additional aggravation for humans.

The skull rests atop of the spine, which encases and protects the spinal cord. The spine, also called the vertebral column or backbone, consists of 33 stacked vertebrae, the lower ones fused. Vertebra are flat with two main features. The main oval-shaped, bony mass of the vertebra is called the centrum. From the centrum arises a bony ring called the neural arch that forms the neural canal (also called a vertebral foramen), a hole for the spinal cord to pass through. Short, bony projections (neural spines) arise from the neural arch and provide attachment points for muscles. Some of these projections (called transverse processes) also provide attachment points for the ribs. There are also small openings in the neural arch for the spinal nerves that extend from the spinal cord throughout the body. Injury to the column of vertebrae may cause serious damage to the spinal cord and the spinal nerves, and could result in paralysis if the spinal cord or nerves are severed.

There are seven cervical, or neck, vertebrae. The first one, the atlas, supports the skull and allows the head to nod up and down. The atlas forms a condylar joint (a type of synovial joint) with the occipital bone of the skull. The second vertebra, the axis, allows the head to rotate from side to side. This rotating synovial joint is called a pivot joint. Together, these two vertebrae make possible a wide range of head motions.

Below the cervical vertebrae are the 12 thoracic, or upper back, vertebrae. The ribs are attached to these vertebrae. Thoracic vertebrae are followed by five lumbar, or lower back, vertebrae. Last is the sacrum, composed of five fused vertebrae, and the coccyx, or tail bone, composed of four fused bones.

The vertebral column helps to support the weight of the body and protects the spinal cord. Cartilaginous joints rather than synovial joints occur in the spine. Disks of cartilage lie between the bony vertebrae of the back and provide cushioning, like shock absorbers. The vertebrae of the spine are capable of only limited movement, such as bending and some twisting.

A pair of ribs extends forward from each of the 12 thoracic vertebrae, for a total of 24 ribs. Occasionally, a person is born with an extra set of ribs. The joint between the ribs and vertebrae is a gliding (or plane) joint, a type of synovial joint, as ribs do move, expanding and contracting with breathing. Most of the ribs (the first seven pair) attach in the front of the body via cartilage to the long, flat breastbone, or sternum. These ribs are called true ribs. The next three pair of ribs are false ribs. False ribs attach to another rib in front instead of the sternum and are connected by cartilage. The lower two pair of ribs that do not attach anteriorly are called floating ribs. Ribs give shape to the chest and support and protect the body's major organs, such as the heart and lungs. The rib cage also provides attachment points for connective tissue, to help hold organs in place. In adult humans, the sternum also produces red blood cells as well as provides an attachment site for ribs.

APPENDICULAR SKELETON. The appendicular skeleton joins with the axial skeleton at the shoulders and hips. Forming a loose attachment with the sternum is the pectoral girdle, or shoulder. Two bones, the clavicle (collar bone) and scapula (shoulder blade), form one shoulder. The scapula rests on top of the ribs in the back of the body. It connects to the clavicle, the bone that attaches the entire shoulder structure to the skeleton at the sternum. The clavicle is a slender bone that is easily broken. Because the scapula is so loosely attached, it is easily dislocated from the clavicle, hence the dislocated shoulder injuries commonly suffered by persons playing sports. The major advantage to the loose attachment of the pectoral girdle is that it allows for a wide range of shoulder motions and greater overall freedom of movement.

Unlike the pectoral girdle, the pelvic girdle, or hips, is strong and dense. Each hip, left and right, consists of three fused bones, the ilium, ischium, and pubic. Collectively, these three bones are known as the innominate bone.

The innominates fuse with the sacrum to form the pelvic girdle. Specifically, the iliums shape the hips and the two ischial bones support the body when a person sits. The two pubic bones meet anteriorly at a cartilaginous joint. The pelvic girdle is bowl-shaped, with an opening at the bottom. In a pregnant woman, this bony opening is a passageway through which her baby must pass during birth. To facilitate the baby's passage, the body secretes a hormone called relaxin that loosens the joint between the pubic bones. In addition, the pelvic girdle of women is generally wider than that of men. This also helps to facilitate birth, but is a slight impediment for walking and running. Hence, men, with their narrower hips, are better adapted for such activities. The pelvic girdle protects the lower abdominal organs, such as the intestines, and helps supports the weight of the body above it.

The arms and legs, the upper and lower appendages of the body, are very similar in form. Each attaches to the girdle, pectoral or pelvic, via a balland-socket joint, a special type of synovial joint. In the shoulder, the socket, called the glenoid cavity, is shallow. The shallowness of the glenoid cavity allows for great freedom of movement. The hip socket, or acetabulum, is larger and deeper. This deep socket, combined with the rigid and massive structure of the hips, give the legs much less mobility and flexibility than the arms.

The humerus, or upper arm bone, is the long bone between the elbow and the shoulder. It connects the arm to the pectoral girdle. In the leg the femur, or thigh bone, is the long bone between the knee and hip that connects the leg to the pelvic girdle. The humerus and femur are sturdy bones, especially the femur, which is a weight-bearing bone. Since the arms and legs are jointed, the humerus and femur are connected to other bones at the end opposite the ball-andsocket joint. In the elbow, this second joint is a type of synovial joint called a hinge joint. Two types of synovial joints occur in the knee region, a condylar joint (like the condylar joint in the first vertebra) that connects the leg bones, and a plane, or gliding joint, between the patella (knee cap) and femur.

At the elbow the humerus attaches to a set of parallel bones, the ulna and radius, of the forearm. The radius is the bone below the thumb that rotates when the hand is turned over and back. The ulna and radius then attach to the carpel bones of the wrist. Eight small carpel bones make up the wrist and connect to the hand. The hand is made up of five long, slender metacarpal bones (the palms) and 14 phalanges of the hand (fingers and thumb). Some phalanges form joints with each other, giving the human hand great dexterity.

Similarly, in the leg, the femur forms a joint with the patella and with the fibula and tibia bones of the lower leg. The tibia, or shin bone, is larger than the fibula and forms the joint behind the patella with the femur. Like the femur, the tibia is also a weight-bearing bone. At the ankle joint, the fibula and tibia connect to the tarsals of the upper foot. There are seven tarsals of the upper foot, forming the ankle and the heel. The tarsals in turn connect to five long, slender metatarsals of the lower foot. The metatarsals form the foot's arch and sole and connect to the phalanges of the feet (toes). The 14 foot phalanges are shorter and less agile than the hand phalanges. Several types of synovial joints occur in the hands and feet, including plane, ellipsoid, and saddle. Plane joints occur between toe bones, allowing limited movement. Ellipsoid joints between the finger and palm bones give the fingers circular mobility, unlike the toes. The saddle joint at the base of the thumb helps make the hands the most important part of the body in terms of dexterity and manipulation. A saddle joint also occurs at the ankles.

Bone development and growth

Since most bone begins as cartilage, it must be converted to bone through a process called ossification. The key players in bone development are cartilage cells (chondrocytes), bone precursor cells (osteoprogenitor cells), bone deposition cells (osteoblasts), bone resorption cells (osteoclasts), and mature bone cells (osteocytes).

During ossification, blood vessels invade the cartilage and transport osteoprogenitor cells to a region called the center of ossification. At this site, the cartilage cells die, leaving behind small cavities. Osteoblast cells form from the progenitor cells and begin depositing bone tissue, spreading out from the center. Through this process, both the spongy textured cancellous bone and the smooth outer compact bone forms. Two types of bone marrow, red and yellow, occupy the spaces in cancellous bone. Red marrow produces red blood cells, while yellow marrow stores fat in addition to producing blood cells. Eventually, in compact bone, osteoblast cells become trapped in their bony cavities, called lacunae, and become osteocytes. Neighboring osteocytes form connections with each other and thus are able to transfer materials between cells. The osteocytes are part of a larger system called the Haversian system. These systems are like long tubes, squeezed tightly together in compact bone. Blood vessel, lymph vessels, and nerves run through the center of the tube, called the Haversian canal, and are surrounded by layers of bone, called lamellae, that house the osteocytes. Blood vessels are connected to each other by lateral canals called Volkmann's canals. Blood vessels are also found in spongy bone, without the Haversian system. A protective membrane called the periosteum surrounds all bones.

Bone development is a complex process, but it is only half the story. Bones must grow, and they do so via a process called remodeling. Remodeling involves resorption of existing bone inside the bone (enlarging the marrow cavities) and deposition of new bone on the exterior. The resorptive cells are the osteoclasts and osteoblast cells lay down the new bone material. As remodeling progresses in long bones, a new center of ossification develops, this one at the swollen ends of the bone, called the epiphysis. A thin layer of cartilage called the epiphyseal plate separates the epiphysis from the shaft and is the site of bone deposition. When growth is complete, this cartilage plate disappears, so that the only cartilage remaining is that which lines the joints, called hyaline cartilage. Remodeling does not end when growth ends. Osteocytes, responding to the body's need for calcium, resorb bone in adults to maintain a calcium balance.


The skeletal system has several important functions:

Common diseases and conditions

Even though bones are very strong, they may be broken. Most fractures do heal. The healing process may be stymied if bones are not reset properly or if the injured person is the victim of malnutrition. Osteoprogenitor cells migrate to the site of the fracture and begin the process of making new bone (osteoblasts) and reabsorbing the injured bone (osteoclasts). With proper care, the fracture will fully heal, and in children, often without a trace.

The joint between the mandible and the temporal bones, called the temporomandibular joint (TMJ), is the source of the painful condition known as temporomandibular joint dysfunction. Sufferers of TMJ dysfunction experience a variety of symptoms including headaches, a sore jaw, and a snapping sensation when moving the jaw. There are several causes of the dysfunction. The cartilage disk between the bones may shift, or the connective tissue between the bones may be situated in a manner that causes misalignment of the jaw. Sometimes braces on the teeth can aggravate TMJ dysfunction. The condition may be corrected with exercise or, in severe cases, surgery. Another condition, cleft palate, is due to the failure of the maxillary bones in the jaw to completely fuse in the fetus.

Bones are affected by poor diet and are also subject to a number of diseases and disorders. Some examples include scurvy, rickets, osteoporosis, arthritis, and bone tumors. Scurvy results from the lack of vitamin C. In infants, scurvy causes poor bone development. It also causes membranes surrounding the bone to bleed, forming clots that are eventually ossified and thin bones that break easy. In addition, adults are affected by bleeding gums and loss of teeth. Before modern times, sailors were often the victims of scurvy, due to extended periods of time at sea with limited food. They consequently tried to keep a good supply of citrus fruits, such as oranges and limes, on board because these fruits supply vitamin C. By the twentyfirst century, scurvy had become extremely rare in Western societies.

Rickets is a children's disease resulting from a deficiency of vitamin D. This vitamin enables the body to absorb calcium and phosphorus; without it, bones become soft and weak and actually bend, or bow out, under the body's weight. Vitamin D is found in milk, eggs, and liver and may also be produced by exposing the skin to sunlight. Pregnant women can also suffer from a vitamin D deficiency, osteomalacia, resulting in soft bones. The elderly, especially women who had several children in succession, sometimes suffer from osteoporosis, a condition in which a significant amount of calcium from bones is dissolved into the blood to maintain the body's calcium balance. Weak, brittle bones dotted with pits and pores are the result. Osteoporosis occurs most often in older people and in women after menopause. It affects nearly half of all those, men and women, over the age of 75. Women, however, are five times more likely than men to develop the disease. They have smaller, thinner bones than men to begin with, and they lose bone mass more rapidly after menopause (usually around age 50), when they stop producing a bone-protecting hormone called estrogen. In the five to seven years following menopause, women can lose about 20% of their bone mass. By age 65 or 70, though, men and women lose bone mass at the same rate. As an increasing number of men reach an older age, they are becoming more aware that osteoporosis is an important health issue for them as well.

Arthritis is another condition commonly afflicting the elderly. This is an often painful inflammation of the joints. Arthritis is not restricted to the elderly, and even young people can suffer from this condition. There are several types of arthritis, such as rheumatoid, rheumatic, and degenerative. Arthritis basically involves the inflammation and deterioration of cartilage and bone at the joint surface. In some cases, bony protuberances around the rim of the joint may develop. Most people will probably develop arthritis if they live to a significant older age. Degenerative arthritis is the type that commonly occurs with age. The knee, hip, shoulder, and elbow are the major targets of degenerative arthritis. A number of different types of tumors, some harmless and others more serious, may also affect bones.

Effect of fitness and nutrition

Most individuals take for granted good mobility and alignment. Getting out of bed in the morning, getting into the shower, and moving through everyday routines are managed in part by a strong and healthy skeletal system.

Building and maintaining bone is important for everyone. The skeletal system needs to be “well maintained” in order to keep it strong and mobile. Strength exercises help bone density to remain intact, while stretching exercises help develop flexibility for continued good range of motion throughout the body. Doing yoga, Pilates, or working with resistance bands are also good forms of exercise for the skeletal system.

A fitness program should include strength training to improve balance and energy, prevent or minimize bone loss, and minimize weight gain (which in turn minimizes strain on bones). An exercise routine should include not only aerobic and strength training, but a warm-up period as well. Doing so will give muscle groups added flexibility for use during more intense activity and will help prevent injury. Stretching after a workout is also needed to move muscles and bones through an increased range of motion and allow for tissues to cool down gradually.

The use of weights is especially important in strengthening the skeletal system. It is important to use weights in a progressive manner, increasing the amount of weight as well as the number of repetitions, gradually and with safety in mind. Overdoing or overzealous weightlifting can lead to muscle injury, stress fractures, and early fatigue. It is best to have a goal in mind and work slowly and methodically toward that goal. A professional trainer may be of help when putting together an exercise schedule and routine.

Due to the reduction in estrogen levels, older women and menopausal women are especially at risk for osteoporosis so they should include strength training exercises in their fitness routine. Light weights will help add lean muscle (not bulk) and keep bones strong, reducing the chance for osteoporosis.

Some exercises and physical activities that enhance the skeletal system include:

These exercises also promote cardiovascular fitness, including improved heart function and increased heart, lung, and muscle endurance.

In addition to good bone health, a balanced, systematic, and routine workout offers individuals numerous fitness benefits, as exercise helps to:

Composed primarily of a nonliving matrix of calcium salts and a living matrix of collagen fibers, bone is the major component that makes up the human skeleton. Bone produces blood cells and functions as a storage site for elements such as calcium and phosphorus.
A naturally occurring element that primarily combines with phosphate to form the nonliving matrix of bones.
A type of connective tissue that takes three forms: elastic cartilage, fibrocartilage, and hyaline cartilage. Hyaline cartilage forms the embryonic skeleton and lines the joints of bones.
Haversian system—
Tubular systems in compact bone with a central Haversian canal that houses blood and lymph vessels surrounded by circular layers of calcium salts and collagen, called lamellae, in which reside osteocytes.
A type of connective tissue that fills the spaces of most cancellous bone. It produces blood cells and stores fat.
The process of replacing connective tissue such as cartilage and mesenchyme with bone.
The bone cell that deposits calcium salts and collagen during bone growth, bone remodeling, and bone repair.
The bone cell responsible for reabsorbing bone tissue in bone remodeling and repair.
Mature bone cell whose main function is to regulate the levels of calcium and phosphate in the body.
Consists of bones and cartilage that are linked together by ligaments. The skeleton protects vital organs of the body and enables body movement.
Synovial joint—
One of three types of joints in the skeleton and by far the most common. Synovial joints are lined with a membrane that secretes a lubricating fluid. Includes ball-and-socket, pivot, plane, hinge, saddle, condylar, and ellipsoid joints.
Includes all animals with a vertebral column protecting the spinal cord such as humans, dogs, birds, lizards, and fish.
  • What are the indications that I may have a problem with my skeletal system?
  • What diagnostic tests are needed for a thorough assessment?
  • What kind of fitness program should I follow?
  • What tests or evaluation techniques can you perform to see if my fitness and nutritional choices promote a healthy skeletal system?
  • What treatment options do you recommend for me?
  • What physical or health limitations do you foresee?
  • What measures can be taken to prevent skeletal system problems?
  • How can my quality of life be improved?
  • What symptoms are important enough that I should seek immediate treatment?

With a decline in hormone production, the incidence of bone fracture is of concern as we grow older (especially for women, who have two to three times as many bone fractures as men), so for this reason, care must be taken to practice good nutritional habits to aid in skeletal structure and support as well.

The American Heart Association recommends 30 minutes of exercise five times a week in conjunction with a heart-healthy diet regimen. Remember to read food labels to examine not only calorie, fat, carbohydrate, and protein content, but also to determine serving size in relation to these numbers. Dieticians may be of assistance in understanding these food labels.

Making good nutritional choices and developing a healthy exercise regimen is beneficial to the skeletal system and the entire body as a whole. A strong and healthy skeletal system will support your wellness efforts. A well-balanced fitness and nutrition regimen can improve not only the way you look and feel, but also have a positive impact on the health and quality of your life.

See also Arthritis ; Cardiovascular system .



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Kohlstadt, Ingrid. Advancing Medicine with Food and Nutrients, 2nd ed. Boca Raton, FL: CRC Press, 2012.

Manocchia, Pat. Anatomy of Exercise: A Trainer's Inside Guide to Your Workout. Richmond Hill, ONT: Firefly Books, 2009.

Plant, Jane, and Gill Tidey. Eating for Better Health. New York: Virgin Books, 2010.

Reiner, Barti, and Bertha Frisch. The Skeleton in Medicine, 3rd ed. New York: Springer, 2012.

Rizzo, Donald C. Introduction to Anatomy and Physiology. Clifton Park, NY: Delmar, 2011.

Schneider, Diane L. The Complete Book of Bone Health. Amherst, NY: Prometheus Books, 2011.

Shils, Maurice E. Modern Nutrition in Health and Disease, 11th ed. New York: Lippincott Williams & Wilkins, 2012.


Boskey, Adele L. “Musculoskeletal Disorders and Orthopedic Conditions” Journal of the American Medical Association 285 (2001): 619–623.

Feder, G., et al. “Guidelines for the Prevention of Falls in People over 65.” British Medical Journal 321 (2000): 1007–1011.

McClung, Michael R., et al. “Effect of Risedronate on the Risk of Hip Fracture in Elderly Women.” New England Journal of Medicine 344, no. 5 (2001): 333–40.


International Skeletal Society, 2575 NW Pkwy., Elgin, IL, 60124, (847) 752-6245, info@internationalskeletal, .

Crystal Heather Kaczkowski, MSc
Revised by Laura Jean Cataldo, RN, EdD

  This information is not a tool for self-diagnosis or a substitute for professional care.