Bone biopsy

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Bone biopsy
PMC4421499 sfn169fig2.jpg
Bone biopsy - Masson–Goldner stain (magnification ×100)

A bone biopsy is a procedure in which a small bone sample is removed from the outer layers of bone for examination, unlike a bone marrow biopsy, which involves the innermost part of the bone. The bone biopsy sample retains the architecture of bone when seen using histopathological examination slide.


The technique of bone biopsy allows the histomorphometric analysis of the bone samples obtained from the iliac crest. Therefore, it can provide a direct assessment of regional bone metabolism. Hence, the reason why this method is considered the gold-standard technique for measuring bone remodelling.[1] Patients undergo double tetracycline labelling, and then samples of bone are collected using trephine under local anesthetic from the iliac crest as it is the only readily accessible site for bone biopsy.[2] This technique is subject to large measurement errors; it is complex and costly to perform and is invasive, meaning that it is painful to the patients.[2][3][4][5][6][7] For these reasons, a bone biopsy is not readily acceptable to patients.[2][3][4][5][6][7] Moreover, multiple biopsies using double tetracycline labelling are necessary for the same patient to assess treatment response or disease progression. Another drawback is that the iliac crest may not provide a true measurement of changes in bone metabolism at the lumbar spine or hip as considerable differences in regional bone metabolism estimates are observed at different skeletal sites. Revell et al.[8] describes the measurement of various parameters such as trabecular bone volume, osteoid volume, osteoid surface, active osteoblastic surface, resorption surface, osteoclastic resorption surface, mineralization front, osteoid index, appositional rate, and osteoclastic index via histomorphometric analysis of bone samples.[citation needed]

If a biopsy is to be obtained along with medical imaging examinations, as a rule, biopsy should be done after all necessary imaging has been performed. A bone biopsy can also be used to find out if cancer,[9] or infection,[10] or other abnormal cells are present in the bone tissue.


  1. Steiniche, Torben (1995). "Bone histomorphometry in the pathophysiological evaluation of primary and secondary osteoporosis and various treatment modalities". APMIS. 103 (S51): 5–44. doi:10.1111/j.1600-0463.1995.tb05544.x. ISSN 0903-4641. S2CID 24954648.
  2. 2.0 2.1 2.2 Compston, J.E.; Croucher, P.I. (1991). "Histomorphometric assessment of trabecular bone remodelling in osteoporosis". Bone and Mineral. 14 (2): 91–102. doi:10.1016/0169-6009(91)90086-f. ISSN 0169-6009. PMID 1912765.
  3. 3.0 3.1 Arlot, Monique; Meunier, Pierre J; Boivin, Georges; Haddock, Lillian; Tamayo, Juan; Correa-Rotter, Ricardo; Jasqui, Salomón; Donley, David W; Dalsky, Gail P; Martin, Javier San; Eriksen, Erik Fink (2005). "Differential Effects of Teriparatide and Alendronate on Bone Remodeling in Postmenopausal Women Assessed by Histomorphometric Parameters". Journal of Bone and Mineral Research. 20 (7): 1244–1253. doi:10.1359/jbmr.050309. ISSN 0884-0431. PMID 15940379.
  4. 4.0 4.1 Jiang, Yebin; Zhao, Jenny J; Mitlak, Bruce H; Wang, Ouhong; Genant, Harry K; Eriksen, Erik F (2003). "Recombinant Human Parathyroid Hormone (1-34) [Teriparatide] Improves Both Cortical and Cancellous Bone Structure". Journal of Bone and Mineral Research. 18 (11): 1932–1941. doi:10.1359/jbmr.2003.18.11.1932. ISSN 0884-0431. PMID 14606504.
  5. 5.0 5.1 Flygare, Lennart; Hosoki, Hidehiko; Rohlin, Madeleine; Petersson, Arne (1997). "Bone Histomorphometry using interactive image analysis. A methodological study with application on the human temporomandibular joint". European Journal of Oral Sciences. 105 (1): 67–73. doi:10.1111/j.1600-0722.1997.tb00182.x. ISSN 0909-8836. PMID 9085031.
  6. 6.0 6.1 Lindsay, Robert; Zhou, Hua; Cosman, Felicia; Nieves, Jeri; Dempster, David W; Hodsman, Anthony B (2007). "Effects Of a One-Month Treatment With PTH(1-34) on Bone Formation on Cancellous, Endocortical, and Periosteal Surfaces of the Human Ilium". Journal of Bone and Mineral Research. 22 (4): 495–502. doi:10.1359/jbmr.070104. ISSN 0884-0431. PMID 17227219. S2CID 911699.
  7. 7.0 7.1 Dempster, David W.; Cosman, Felicia; Kurland, Etah S.; Zhou, Hua; Nieves, Jeri; Woelfert, Lillian; Shane, Elizabeth; Plavetić, Katarina; Müller, Ralph; Bilezikian, John; Lindsay, Robert (2001). "Effects of Daily Treatment with Parathyroid Hormone on Bone Microarchitecture and Turnover in Patients with Osteoporosis: A Paired Biopsy Study*". Journal of Bone and Mineral Research. 16 (10): 1846–1853. doi:10.1359/jbmr.2001.16.10.1846. ISSN 0884-0431. PMID 11585349.
  8. Revell, P A (1983). "Histomorphometry of bone". Journal of Clinical Pathology. 36 (12): 1323–1331. doi:10.1136/jcp.36.12.1323. ISSN 0021-9746. PMC 498562. PMID 6361070.
  9. Leeuw, Jan A; Koudstaal, Jan; Wiersema-Buist, Janneke; Kamps, Willem A; Timens, Wim (2003). "Bone Histomorphometry in Children with Newly Diagnosed Acute Lymphoblastic Leukemia". Pediatric Research. 54 (6): 814–818. doi:10.1203/ ISSN 0031-3998. PMID 12930910.
  10. Serrano, S.; Mariñoso, M.L.; Soriano, J.C.; Rubiés-Prat, J.; Aubia, J.; Coll, J.; Bosch, J.; Del Rio, L.; Vila, J.; Goday, A.; Nacher, M. (1995). "Bone remodelling in human immunodeficiency virus-1-infected patients. A histomorphometric study". Bone. 16 (2): 185–191. doi:10.1016/8756-3282(94)00028-x. ISSN 8756-3282. PMID 7756046.