The Role of the Periosteum in Bone Formation From Adolescence to Old Age

Bone formation is a complex process involving the coordinated activity of many different cell types, including osteoblasts and osteocytes. The periosteum is a dense membrane of connective tissue that covers the outer surface of bones and is essential for the growth, repair, and maintenance of osseous tissue. The present study aims to summarize the contribution of the periosteum in bone formation from adolescence to adulthood and old age. This is a narrative literature review using the PubMed electronic internet database. The search was based on the keyword "periosteal bone formation". Inclusion criteria were preclinical or clinical studies evaluating the role of the periosteum in bone formation. Non-English studies were excluded. The original search provided 126 published papers. After inclusion and exclusion criteria, we finally accepted 20 articles for our current review. After checking the references list of the included studies, 14 more studies were added, leaving 34 studies for the present review. Across the lifespan, periosteal bone formation undergoes dynamic changes. During adolescence, the periosteum is highly osteogenic and actively contributes to rapid bone growth. In adulthood, it plays a role in maintaining bone strength and adapting to mechanical loading. In adulthood, the periosteum continues to provide a source of osteoprogenitor cells, which contribute to the ongoing process of bone remodeling and repair. At more advanced ages, the response of the periosteum to hormones and cytokines in terms of bone formation decreases; however, the power of osteogenetic differentiation of periosteal cells may be preserved.