During the last fifteen years, an increasing number of studies have examined the origin, the ontogeny, and the distribution of nerve fibers in bone. They have also investigated the nature of neuromediators conveyed by these skeletal nerve fibers. Experimental models of sensory and sympathetic denervation and clinical studies have shown that these two neuronal systems are involved in bone development, growth and remodeling. More recently, some new concepts regarding the role of nerve fibers in bone physiology have emerged with the demonstration of a leptin-dependent central control of bone formation via the sympathetic system. This new neural regulating pathway of bone cell functions could have enormous implications for human skeletal biology and treatment of bone pathologies.