The adaptation of the skeleton to changes in mechanical loading depends on the ability of bone cells first to detect then to convert diverse mechanical forces into chemical signals that regulate cell behavior, a process known as mechanotransduction. A network of interactions between the extracellular matrix, integrin receptors that span the cell membrane, and intracellular cytoskeletal and signaling elements participates in mechanotransduction along with other proteins, most notably ion channels. Integrins are a family of heterodimeric proteins with binding specificity for extracellular matrix proteins, and the ability to influence cell behavior via various key effector functions in addition to mechanotransduction, including adhesion, motility, differentiation, proliferation, survival, and gene expression. The vast majority of what we know now about the relevance of extracellular matrix-integrin interactions for mechanical loading is based on evidence gathered from cells in culture, although the increasing use of animal models confirm the relevance of this network both in health and disease. Dissecting the integrin-extracellular matrix pathway provides mechanistic insight into skeletal changes during loading, distraction osteogenesis, and musculoskeletal disuse, and yields new therapeutic strategies both to inhibit bone resorption and improve the integration and survival of bone and dental implants.