Hard labour: bacterial infection of the skeleton.

The skeleton is the largest mammalian organ system, containing a myriad of blood vessels, tissue surfaces and bone cells for bacterial colonization. Although rock-like, the skeleton is a dynamic structure that is undergoing constant remodelling. This is the result of the opposing actions of two key cells: the osteoblast, which produces bone, and the osteoclast, a multinucleate cell that 'eats' bone. It is not generally realized that the most prevalent chronic bacterial diseases of Homo sapiens afflict the skeleton. Several pathogens, and members of the normal microbiota, have evolved specific cellular and molecular mechanisms for invading bone, including its cellular constituents. The host cellular pathways that are activated and lead to destruction or loss of the bone matrix will be described.