Bone histomorphometry: a concise review for endocrinologists and clinicians

Abstract

SummaryBone histomorphometry is a quantitative histological examination of an undecalcified bone biopsy performed to obtain quantitative information on bone remodeling and structure. Labeling agents taken before the procedure deposit at sites of bone formation allowing a dynamic analysis. Biopsy is indicated to make the diagnosis of subclinical osteomalacia, to characterize the different forms of renal osteodystrophy and to elucidate cases of unexplained skeletal fragility. Bone histomorphometric parameters are divided into structural and remodeling subgroups, with the latter being subdivided into static and dynamic categories. Metabolic bone disorders such as osteomalacia, hyperparathyroidism, hypothyroidism, osteoporosis and renal osteodystrophy display different histomorphometric profiles. Antiresorptive and anabolic drugs used for the treatment of osteoporosis also induce characteristic changes in the bone biopsy. Bone histomorphometry is an important research tool in the field of bone metabolism and provides information that is not available by any other investigative approach. Arq Bras Endocrinol Metab. 2010;54(2):87-98 Keywords Bone histomorphometry; metabolic bone diseases; bone biopsy; bone structure; osteoporosis drugs Sumário Histomorfometria óssea é uma avaliação histológica quantitativa de uma biópsia óssea calcificada realizada para obter informação sobre a remodelação e a estrutura óssea. Uma análise dinâmica é possível quando substâncias que fazem a marcação do osso são tomadas antes do procedimento e se depositam no local de formação óssea. A biópsia é indicada para diagnós-tico de osteomalácia, diferentes formas de osteodistrofia renal e nos casos não explicados de fragilidade esquelética. O preparo e a análise das amostras necessitam de um laboratório especializado. A histomorfometria avalia parâmetros estruturais e de remodelação óssea, sendo o último subdividido em estático e dinâmico. Doenças osteometabólicas como osteomalácia, hiperparatireoidismo, hipoparatireoidismo, osteoporose e osteodistrofia renal apresentam parâmetros histomorfométricos distintos. Medicações antirreabsortivas e anabólicas usadas no tratamento da osteoporose também induzem alterações características na biópsia óssea. A histomorfometria óssea é uma ferramenta importante no metabolismo ósseo e oferece informação que não é possível por nenhum outro método diagnóstico. Arq Bras Endocrinol Metab. 2010;54(2):87-98

Iliac crest histomorphometry and skeletal heterogeneity in men

“…With diminishing growth, the modelling drift ceases after the mid-teens (Rauch et al, 2006, Schnitzler and Mesquita, 2013). As a result, in studies included growing individuals, properties of iliac cortices were usually recorded separately (Kulak and Dempster, 2010), while average values (esp. cortical width) of both inner and outer cortices were frequently utilized by studies on adults (Arlot et al, 2008, Ostertag et al, 2009).…”

Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score

“…These features and characteristics of the skeleton that influence a bone's ability to resist fracture are known as bone quality (6). Important aspects of bone quality, namely, bone microarchitecture and bone remodeling, can be assessed in bone biopsies by histomorphometry and microecomputed tomography (7). However, iliac crest bone biopsy is an invasive, not widely available procedure, now used primarily as a research tool.…”

Trabecular bone score: perspectives of an imaging technology coming of age

“…The major determinants of bone strength are both bone mineral density (BMD) and skeletal microarchitecture. While BMD can be readily measured by dual-energy X-ray absorptiometry (DXA), the technologies used to determine skeletal microarchitecture, such as histomorphometric analysis and micro-computed tomography (µCT) of the transiliac crest bone biopsy (2,3), high resolution peripheral quantitative computed tomography (HRpQCT) (4), and magnetic resonance imaging (MRI) (5) are not routinely available. To this end, and based upon previous studies using 2D X-ray images to estimate bone microstructure (6)(7)(8), the trabecular bone score (TBS), a new approach for assessing skeletal microarchitecture from 2D DXA images (9)(10)(11), has been developed.…”