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HUMAN ANATOMY AND PHYSIOLOGY
The Skeletal System Notes
2 divisions:
1. ____________________________bones that form longitudinal axis
2. _______________________________bones of the limbs and girdles
 The system includes joints ,cartilage and ligaments.
I.
Bones:An Overview
A. Functions-besides giving body shape and Form:
1. Support-supports body and cradles soft organs
2. Protection-protect soft organs-eg. Protects brain/vertebraespine and ribs for organs of the thoracic cavity
3. Movement-Skeletal muscles attach to bones by
_______________and bones work as levers.
4. Storage ______in internal cavities of bones
 Storehouse for minerals-esp.Ca and P….A small
amount of Ca must be in blood at all times to reach
the nerve tissue for transmission,so muscles
contract and help clot blood.Ca in bones as salts go
provide Ca 2+ ions for blood
 Hormones control the movement of Ca to and from
blood according to body need…..too much Ca can
be a problem
5. Blood Cell Formation or ________________________ in
the marrow cavities of certain bones
B. Classification of Bones
» There are 2 main types of osseous tissue
1. ____________________________dense and looks smooth
and homogeneous
2. ___________________________ made of needlelike
pieces of bone and lots of open space
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» Many sizes and shapes:-eg. Tiny pisiform bone of __________________-size of a
pea and at the other extreme-the ________________-thigh bone is ~ 2’ long and
has large,ball shaped head
» Shape grouping:
1. _____________________-longer than they are wide;shaft
with heads at both ends;mostly compact bone; bones of
limbs
2. _________________________-generally cube shaped and
mostly spongy bone ;bones of wrist and
ankle;____________________bones-within tendonsspecial type of short bone-patella
3. ____________________-thin,flattened and usually curved2 thin layers of compact bone sandwiching spongy boneskull,ribs,sternum
4. __________________________don’t fit other categoriesvertebrae and hip
Classification of Bones on the Basis of
Shape
Figure 5.1
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
C. Structure of a long bone
GROSS ANATOMY
__________________-shaft-makes most of bone length and is
__________________bone
Diaphysis is covered by fibrous connective tissue membrane_________________________-Hundreds of connective tissue
fibers,called perforating or Sharpey’s fibers secure periosteum to
underlying bone
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•
_______________________at the ends of each long
bone…consists of thin compact layer of bone filled with spongy
bone…._____________cartilage covers the external
surface(glassy hyaline cartilage gives smooth to decrease friction
at joint surfaces
Adult bones have a thin line of bony tissue at epiphysis-called
____________________________________-a remnant of
epiphyseal plate of hyaline cartilage in young ,growing bones
epiphyseal plates cause lengthwise growth of long bones
At end of puberty,hormones inhibit long bone growth and the
epiphyseal plate is completetly replaced w/bone
Cavity of shaft stores adipose tissue-_____________________________,or medullary cavity …In
infants this area forms RBC’s-red marrow is there as well
For adults ___________________________is in cavities of spongy bone of flat
—Note:Areas of
red marrow are more limited in
adults—to places such as sternum
bones and epiphyses of some long bones
Surfaces have bumps holes and
ridges=__________________________-show where
muscles,tendons,and ligaments were attached and where blood
vessels and nerves pass
1. projections or processes
-grow out from bone surface---goes w/terms beginning w/T
2.depressions or ________________________-indentations in bone---goes
w/terms starting w/F(except facet)
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Long Bones-MICROSCOPIC ANATOMY
______________________-mature bones cells found in matrix
in lacunae cavities
Lacunae arranged in concentric circles
called____________________around central(Haversian) canals
_______________________is a complex of central canal and
matrix rings
Central canals run lengthwise through bony matrix to carry blood
vessels and nerves to all of bone
______________________________-tiny canals that radiate
outward from central canals to all lacunae-form a transportation
system that connects all bone cells to nutrients in matrix -therefore well nourished
_____________________________________run into compact
bone at right angles to shaft and communicate from outside to
interior
Bone light in weight,but strong
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D. Bone Formation,Growth and Remodeling
2 most strong and supportive tissue-bone and cartilage
Except for flat bones,most bones develop using hyaline
cartilage as model
____________________-bone formation in 2 phases:
1. Hyaline cartilage model is completely covered by bone matrix(a
“collar”) by bone forming _________________________.For a
while,fetus has cartilage enclosed by bony bones.Enclosed hyaline
cartilage model is digested away,forming a medullary cavity
2. By birth most hyaline converted to bone.except articular cartilage on
____________________and epiphyseal plates
New cartilage is continually on the face of articular
cartilages(covering bone ends) and epiphyseal plate surface
that faces bone ends.At the same time,old cartlage abutting
internal face of articular cartlage and the medullary cavity is
BROKEN down and replaced by bony matrix
Growing bones must widen as they lengthen---osteoblasts in
______________________add bone tissue to external face of
diaphysis as osteoclasts in endosteum remove bone from inner
face of diaphysis wall---both occur at same rate circumference
of long bone expands and bone
widens….>______________________________growth.This is
controlled by hormones –esp. growth hormones and ,during
puberty , sex hormones
Overall growth ends at puberty ,when
_______________________________are converted to bone
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Long Bone Formation and Growth
Figure 5.4a
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Bones dynamic and active tissue and continuously remodeled
in response to :
1. Ca levels in blood-When blood Ca levels drop below
homeostatic levels,the
____________________________in throat stimulated
to release parathyroid hormones-______-into
blood.PTH activates _____________________-giant
bone destroying cells in bones to break down bone
matrix and release Ca into blood.
If blood Ca levels are too high,Ca is deposited
into bone matrix as Ca salts
2.In response to gravity and muscle mass-long bones
retain normal proportions and strength and bones become thicker and form large
projections to increase their strength where muscle is bulky….here
_______________________lay down new matrix and become trapped w/in
it….now,trapped,they become osteocytes-mature bone cells
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Long Bone Formation and Growth
Figure 5.4b
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
Those that are bedridden and /or weakened lose mass
Rickets-look up
p.142________________________________________________
____________________________________________________
____________________________________________________
______________________________________
E.Bone Fractures


Bones amazingly strong
_____________________= breaks---in young due to
activity level and in older people due to thin and
weakened bones_
1. Closed fracture-clean break that does not penetrate skin
2. _____________________________is when the broken bone breaks the
skin
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Common Types of Fractures
Table 5.2
Copyright © 2006 Pearson Education, Inc., publishing as Benjamin Cummings
A fracture is treated by ________________-where the
realignment of break happens.In closed breaks,the ends are
coaxed back into their position by M.D..For OPEN
breaks,surgery is performed and pins or wires are used.After
reduction it is _________________________by cast or traction
Simple fracture takes 6-8 weeks to heal….bot longer for large
bones and bones of older people(due to their poor circulation)
4 Events for bone repair:
1. _________________________forms and blood cells deprived of nutrition
die
2. The break is splinted by a
___________________________________________________________growth of new capillaries(granulation tissue) into hematoma at site of
damage.as this happens,connective tissue of various types form a mass
called fibrocartilage callus containing some cartilage matrix,some bony
matrix,collagen and acts to splint the bone
3. bony callus forms-more osteoblasts and osteoclasts come to area-the
fibrocartilage callus is relaced by one made of spongy bone
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4. Bone remodeling occurs-weeks to months-forms strong,permanenet bone
patch at site
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HUMAN ANATOMY_SKELETON CONTINUED
II.
Axial Skeleton
Forms longitudinal axis of body
A. Skull
Formed by cranium –protects brain and ____________________-hold
eyes in anterior position and allow facial muscles to show expression
All but one bone of skull is joined by ____________-interlocking ,
immovable joints(mandible has a freely movable joint)
1.
Cranium-8 large ,flat bones
___________________________forms forehead,bony
projections under eyebrows,and superior portion of
orbit
____________________________paired,forms
superior and lateral walls of cranium;include
_________________________and
____________suture
Temporal Bones(pair) lie inferior to parietal and join at
___________________________________
Temporal bone markings:
a-External acoustic meatus- sound enters ear
-leads to eardrum- and middle earb-Styloid process-sharp/attachment for many neck muscles
c-__________________-process bridge of bone that joins with
cheek bone(zygomatic bone) anteriorly
d-Mastoid process-full of air cavities(mastoid sinuses)-rough
projection posterior and inferior to external acoustic meatussome neck muscles attach here---The proximity to middle ear
makes these sinuses a hot spot for infections__________________________---also could spread to the brain
d-______________foramen allows passage of jugular vein(largest
vein of head-drains the brain)-anterior to this is the
e-_____________________________________-transmits cranial
nerves VII and VIII-facial and vestibulocochlear nerves….
f- anterior to
foramen is carotid canal that carotid artery brings most of the
blood to the brain
Occipital bone-most posterior of cranium-floor and
back wall of skull
a._________________________suture joins
this bone with parietals
b. ______________________magnum allows
spinal cord to connect to brain
c._____________________________________
rest on 1st vertebra
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Sphenoid bone-butterfly shaped-spans width of skull
and is some of floor of cranial cavity
a. ________________________”Turk’s saddle”-encloses
pituitary gland
b. Foramen ovale allows cranial nerve v(trigeminal)to pass to
chewing muscles of mandible.
c. Parts form part of eye orbit
d. 1-______________________allows optic nerve to pass and
2-_____________________through which cranial nerves
III,IV,VI pass to control eye movement
Many air cavities--_________________________________
Ethmoid Bone-anterior to sphenoid
a-__________________________”cocks comb”outermost
covering of brain attaches here
b-Small holes on each side of crista galli__________________________________-for olafactory nerves
c-Extensions form superior and
__________________________________________-lateral walls
of nasal cavity-and increase turbulence of air here
2. facial bones-14 bones-12 are paired
plus mandible and vomer
Maxillae(maxillary)-2 fuse to form upper jaw-main –
or keystone bones of the face-carry upper teeth in
a)alveolar margin
b)palatine processes-form anterior part of hard palate
of __________________c) ________________________sinuses drain into
nasal cavity,lighten skull bones and amplify sound we
make….mucosa continue into nose and throat and is a
source of __________________________-infection of
sinuses which is an infection of sinuses.
______________________paired-posterior part of hard
plate-failure to fuse medially is called
___________________________________
__________________________________cheekbonesalso border of eye sockets
Lacrimal bones-finger-sized bones-part of medial wall
of each orbit-each has a groove for tears
________________________-small rectangular making
bridge of nose—lower part is cartilage
Vomer bone-single bone in median of nasal cavitymost of nasal septum
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Inferior nasal conchae-thin,curved-lateral walls of
nasal cavity
_____________________-lower jaw-largest and
strongest bone of face….meets temporal bone and is
onlu freely movable joint of face
---lower teeth lie in ______________________
3.Hyoid Bone-not really skull,but closely related to mandible
and temporal bones-movable base for tongue and attachment
for neck muscles
*****Fetal Skull—face small compared to cranium,but skull
large compared to infant’s body(1/8 of body length in adult
and _____body length in infant
 _________________________fibrous membranes connecting
cranial bones-“soft spots’-allow
compression during birth and
allows for brain growth in late
pregnancy and early infancy--fontanels replaced by bone by 2224 mos. after birth
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FETAL SKULL
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B. Vertebral Column-Spine
o Axial support of body-goes from skull(support) to pelvis-where it
transmits weight
o 26 irregular bones connected and reinforced by ligaments-resulting
in flexible,curved structure
o Surrounds and protects spinal cord
o Before birth is 33 vertebrae-9 fuse to form __________________
and _________________________
o There are 7 in neck_____________________________;12__________________________;and 5 in lower back-lumbar
o Individual vertebrae separated by flexible pads of fibrocartilage_____________________________-allow flexibility and absorb
shocks
o Intervertebral discs 90 % water in youth and are spongy and
compressible---water amount decreases w/ age and less
compressible
o _______________________disks is a slipped disc-occurs w/age
and/or great twisting force
o The discs and the “S” shape to spine function to prevent shock to
head
o The curvature in thoracic and sacral regions are called
__________________________________because they are present
at birth---a”C” in a newborn
o The curvature in cervical and lumbar regions are called
_______________________________________ because they
develop when the baby is ready to walk
o ABNORMAL SPINAL CURVATURES:
_______________________,lordosis and
__________________-may be congenital or from
diseases….
COMMON FEATURES OF VERTEBRAE
1. Body or ___________________-disclike,weightbearingfacing anteriorly
2. ____________________________arch formed
from joining of all posterior extensions_________________________________
3. ______________________________-canal through
which spinal cord passes
4. Transverse processes-2 lateral projections from thr
arch
5. ______________________________-single
projection from post. Aspect of arch(= fused
laminae
6. __________________________________________
__________________-paired projections Lateral to
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vertebral foramen-allows a vertebra to form joints
w/ adjacent vertebrae
Vertebral Regions:
i. CERVICAL7
1st 2 atlas and___________.Atlas has no
body;Transverse processes contain lg
depressionsto receive occipital condyles of
skull—allows nodding (“yes”)/Axis is a
pivot for rotatopn of atlas and skull
______pivot point on axis
Joint between____________allow you to
rotate head from side to side(“no)
C3 through C 7 lightest and smallest
vertebrae;usually spinosous process short
and in 2 branches______________________contain
foramina(for vertebral arteries)
ii. THORACIC12(T1-T12)-all typical
Only vertebrae to articulate with ribs
Body somewhat heart –shaped and
has 2 costal facets(articulating
surfaces0 on ea. Side receiving heads
of robs
Transverse processes articulate
w/knoblike tubercles of ribs
Spinous process long
iii. Lumbar(L1-L5)
o Massive
blocklike
bodies;short
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spinous
processes
(“moose head”)
o Sturdiest
vertebrae
because
receives most
stress
SACRUM
 From fusion of 5 vertebrae
 Superiorly articulates w/L5 and inferiorly connects w/coccyx
 Winglike _________articulate laterally w/hip booone,making
sacroiliac joints
 Posterior wall of pelvis
 _________________________________fused spinous process
of sacral vertebrae
 Laterally-_________________________________
 Sacral canal terminates in
______________________________opening
COCCYX:
 Fusion of 3-5 tiny vertebrae
 Tailbone
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C.THORACIC CAGE
 Sternum,ribs and thoracic
vertebrae=______________________________,also called
thoracic cage
Sternum(breastbone)
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 Flat and is the fusion of 3
bones:______________________________________________
 Attaches to the 1st 7 prs. of ribs
 Bony landmarks:
1. ______________________________concave upper border of manubriumlevel of T3
2. _____________________________from manubrium body meeting at
slight angle to each other,making transverse ridge-level of 2nd rib
3. _______________________________-pt. where sternal body and xiphoid
process fuse-level of 9th vertebrae
 _____________________________taking marrow sample at
sternum for diagnoses of blood diseases
Ribs-12 pairs
 All articulate with vertebral column and then curve downward
 ________________________-1st 7 pairs attach directly to
sternum by __________________________________
 __________________________-next 5 pairs either not attached
to sternum or indirectly.Last 2 pair are called
______________________________sometimes
 Intercostals spaces attach to intercostals muscles
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III.
Appendicular Skeleton
126 bones of limbs and pectoral or pelvic girdle(which
attach limbs to axial skeleton)
A. Bones of Shoulder Girdle
2 bones:______________________and _____________________
1. CLAVICLE
Also called
______________________
Slender ,doubly curved and
attaches to manubrium and
to scapula(shoulder joint
Brace against arm touching
top of thorax and helps
prevent________________
w/o it shoulder caves in
2. SCAPULAE
-shoulder blades-triangular and commonly
called ____________________because they
flare when we move our arms posteriorly
Each has a flattened body with
__________________process-enlarged spine
of scapula-connects clavicle at
acromialclavicular joint and beaklike
_____________________________________
That points over top of shoulder and anchors some arm
muscles
____________________________-serves as
nerve passageway
Scapula loosely held by trunk muscles
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Scapula has 3 borders_______________________________________
_ and 3 angles:superior,inferior and lateral
________________________________-shallow
socket receives head of arm bone-in lateral
angle
Shoulder girdle is light and allows upper limb
free movement due to 3 factors:
1. each shoulder girdle attaches at one point to axial skeleton________________________________
2. loose attachment of scapula allows it to slide back and forth
v. thorax
3. ___________________________is shallow and shoulder
joint is poorly reinforced by ligaments
*****drawback to so much flexibility is
___________________________________________________
B.Bones of the Upper Limbs-30 bones-arms,forearms and hands
1. ARM
Humerus-head fits into glenoid
cavity,_________________________;2 bony projections
separated by intertubercular sulcus and
_______________________________________-sites of muscle
attachment;also ____________________________-most
frequently fractured part of
bone;___________________________roughened area in midshaft-deltoid muscle attaches
;___________________________runs down posterior aspect of
shaft,marking the place for the radial nerve;distal is the
________________-spool-like;ballike capitulum;coronoid and
olecranon fossae-depressions that articulate w and medial and
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______________________allow ulna to move freely when
elbow is bent and extended
2.-forearm –
_______________________-lateral bone on thumb side
Both bones of forearm articulate at radioulnar joints
2 bones connected by
________________________________________
Both have _______________________at distal end
______________________________-below head-tendon of
biceps muscle attaches
________________________medial bone on little finger side
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Proximal end has ___________________ and olecranon
process,separated by trochlear notch-grip trochlea of humerous
in pliers-like joint
2. .hand-carpals,metacarpals and phalanges
8 _____________bones-2 irregular rows of 4 bones
ea.-form carpus(wrist)-bound by ligaments to restrict
movement between them(see 8 names p.1620)
Palm consists of _____________________________#’ed 1-5(thumb side outward);heads are knuckles
Ea. hand has 14 phalanges(3 ea. Finger-thumb has 2)
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C.bones of the Pelvic Girdleformed by 2 coxal(_____________________)-hip
bones;form bony pelvis w/sacrum and coccyx
bony pelvis=2 coxal bones,sacrum and coccyx; whereas
pelvic girdle=2coxal bones
large and heavy and attached securely to
___________________________
sockets deep and securely attached by ligaments
most important function is
____________________________ and protect organs
each hip bone formed by fusion of 3
bones:________________________________________
illium +connects posteriorly w/
____________________joint-forms most of hip bone;alae
are winglike portions of ilia-upper portion=
_____________________ and ends at anterior superior iliac
spine and posteriorly w/posterior iliac spine
ischium-_______________________-interior of coxal
bone;________________________________roughened area
receiving weight when sitting;ischial spine-superior to
tuberosity-THIS NARROWS THE OUTLET OF PELVIS
FOR PASSAGE OF BABY IN CHILDBIRTH !
----____________________________allows blood vessels and
lg sciatic nerve to pass from pelvis posteriorly into thigh--injections must stay clear of this area
_______________________most anterior of
coxal;__________________________________-opening that
allows blood vessels and nerves to pass to ant. Thigh;each
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pubis joins to form cartilaginous joint__________________________________
Ilium,ischium and pubis fuse at deep
socket:__________________________________-“vinegar
cup”-receives head of thigh bone
Bony pelvis divided into false and true pelvis-which must
large enough to allow passage of infants head in women for
childbirth-_______________________measured by obgyn
Individual pelvic measurements vary,but stark difference in
male and female
 Female inlet larger and more
circular
 Fem. pelvis as a whole more
shallow and bones lighter and
thinner
 Fem ilia flare more laterally
 Her sacrum shorter and less curved
 Her ischial spines shorter and
farther apart-thus outlet larger

Her pubic arch rounder because
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angle of pubic arch greater
D.Bones of Lower limbs-carry total body weight when erect-thus very thick and
stronger
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 Thigh=________________heaviest and strongest bone
of body
Proximal has ball-like head,neck and
_____________________________________________-separated anteriorly by
intertrochanteric line and posteriorly by intertrochanteric crest-----along w/ gluteal
tuberosity form sites for muscle attachment;head articulates w/ acetabulum-but also a
big fracture site-esp. in elderly;slants medially to bring in line w/center of gravity;lateral
and medial condyles distally-articulate w/tibia below……these condyles separated by
deep intercondylar fossa/anterior is smooth ______________________-forms joint
w/patella-knee
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 Leg
 -tibia and fibula connected
by
______________________
___________-tibia is chin
bone-condyles proximally
and articulate w/distal
femur to make
________joint-patellar
ligament attaches to
_____________________distally________________
_____forms inner bulge of
ankle-ant. tibia is sharpanterior border for muscles
 ________________-lies
alongside tibia and joints
proximally and distally-NO
PART Of KNEE JOINTlateral malleolus outer part
of ankle
 FOOT
 Tarsals,metatarsals and
phalanges
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 2 most important
functions_______________
______________________
 Tarsus-post. 1/2 of foot-7
tarsal bones
 ________________heelbone
 ______________lies
between tibia and
calcaneus
 5 metatarsals and 14
phalanges-each toe has 3
phalanges and big toe has 2
 Form 3 strong archesbound by ligaments and
tendons(for muscles)-fallen
arches or flat feet occur
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IV.Joints= articulations
*****Except for hyoid,all bones form joints with at least 1 other bone
 2 functions:___________________________ and give rigid
skeleton mobility
 2 classifications;1)functionally-focuses on movement.There are
****__________________immovable and
________________________________slightly movable(1st 2 in
axial skeleton) and _______________________freely
movable(limbs)
2)structurally-based on whether fibrous
tissue,cartilage or joint cavity separate bony regionsfibrous,cartlagenous and synovial
A. Fibrous Joints-united by fibrous tissue-ex. Sutures of skullbound by connective tissue fibers w/no movement
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
_______________________-connective fibers
longer than sutures-so has more “give”
B.Catilagenous Joints-connected by cartilage-slightly movableex;pubic symphysis of pelvis and __________________________________-pads of
fibrocartilage—also epiphyseal plates and synarthrotic-immovable-joints of 1st ribs and
sternum
C. Synovial Joints-joint cavity contains synovial fluid
 4 features:
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1. _______________________________-hylaline-covers end
of joint bones
2. _______________________________________-joint
surfaces enclosed by sleeve of fibrous connective tissue and
capsule lined w./synovial membrane
3. Joint cavity-articular capsule encloses a cavity-containing
lubricating fluid
4. ______________________________-fibrous capsule
reinforced w/ligaments
 _______________flattened fibrous sacs w/ thin film of synnovial fluidcommon where ligaments,muscles,skin,tendons or bones agitate
 __________________________elongated bursa that wraps completely
around a tendon
 _________________________-bone forced out of normal position
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C. Types of synovial joints based on Shape:
o _____________________________-articular surface flat-short
slipping and gliding-nonaxial—intercarpal wrist joints
o _____________________________-cylindrical end of one bone
fits into trough-shaped surface of another-angular movement in 1
plane----elbow,ankle and fingers-uniaxial-1axis
o __________________________-rounded end of one bone fits into
sleeve or ring of another of bone and maybe ligaments-uniaxial—
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examples:proximal radioulnar joint and joint between atlas and
_______________of axis
o ____________________________”knuckle-like”—egg-shaped
surface into oval cavity-side to side or back and forth-can’t rotate
around long axis-biaxial-knuckle joints
o Saddle joints-convex and concave area on both surfaces-thumbtwiddling thumbs
o ____________________________head of one bone in round
socket of another-multiaxial-shoulder and hips
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 __________________________-inflammation of bursae or synovial membrane
 ________________________-ligaments or tendons damaged by stretching-or tornheal slowly due to poor blood supply
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 ________________________> 100 different inflammatory or degenerative joint
diseases---possibly bacterial invasion
 __________________________(OA)-most common arthritis-chronic and
degenerative ,typically afftects aged-affects articular cartilage-bone thickens and
bone spurs grow on margin of joint-make crunching-___________________-noise---affects fingers,C and L spine and knees and hips;slow and irreversible,but rarely
crippling;can be treated symptomatically for pain and inflammation….possible
treatments(?)-capsaicin or glucosamine sulfate
 ____________________________(RA)-a chronic inflammatory disorder-usually
begins 40-50,but there is a juvenile form;3x as many women as men-many joints
affected and usually symmetrically;course varies.It is _________________________destroy own tissue-trigger unknown;begins w/ inflammation of synovial membranes
and fluid accumulates and destroy tissue;PANNUS-abnormal tissue clings to joint
and erodes articular cartilage;scar tissue forms and ossifies and bone ends become
formly fused________________________________-not all cases reach this
stage.Treatment includes immunosuppressant drugs and symptomatic treatment
 ________________________-uric acid(normal waste of nucleic acid metabolism)
accumulates in blood and may deposit as crystals in joints-extreme pain….more
common in men,usually after 30-untreated bones fuse and joint is
immobilized….several drugs prevent acute gout-colchicine,ibuprofen and dietary
recommendations
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V.Developmental aspects
 Young fetus is _________________________ and fibrous
membranes
 Bone growth along epiphyseal plates as one matures
 Changes from”C” spine to “S” spine
 __________________________-bone thinning disease-
 READ THIS SECTION AND TAKE ADDITIONAL
NOTES
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