The growth plate: a physiologic overview

Overview

This 2020 review in EFORT Open Reviews by Ağırdil describes the physiology of the growth plate (physis), the cartilaginous region at the ends of long bones where longitudinal growth takes place. It aims to help clinicians better understand bone health and the mechanisms behind disorders of bone growth.

Who it is for

Paediatric orthopaedic surgeons, paediatric endocrinologists, paediatricians, clinical geneticists and trainees who need a structured grounding in how bones grow.

Key areas covered

The review explains the structure of the growth plate, in which chondrocytes suspended in a collagen matrix pass through resting, proliferative, prehypertrophic, hypertrophic and terminal phases before being replaced by bone. It describes endochondral ossification and the wide network of regulators that coordinate it, including growth hormone, parathyroid hormone, oestrogen, growth factors, cytokines and signalling pathways, as well as key transcription factors. It also explains how oestrogen gradually depletes the resting chondrocyte pool, leading to growth plate closure.

Notable emphasis

The author stresses that these regulatory signals are genetically determined, so disruption of any of the genes involved can cause abnormal bone growth. The large number of described chondrodysplasias is presented as evidence of how complex this control system is, and of how much remains to be understood.

How to use this guideline

The article is a physiology reference rather than a clinical guideline. Readers should consult the full text for the detailed signalling pathways and their links to specific growth disorders.