Bone histomorphometry in the evaluation of osteomalacia

Abstract

With the widespread use of measurement of bone mineral density to detect, diagnose, and monitor therapy in the management of osteoporosis, bone histomorphometry has largely been relegated to research settings and academic pursuits. However, bone density measurement cannot distinguish between osteoporosis and other metabolic bone disorders such as different types of osteomalacia, osteitis fibrosa, renal osteodystrophy, hypophosphatasia, and Paget’s disease of bone. Furthermore, bone density test cannot tell us anything about microarchitecture of bone, tissue level dynamics, bone cellular activity, bone mineralization and bone remodeling, understanding of which is essential to make a specific diagnosis of a suspected metabolic bone disease, to evaluate beneficial (or adverse) effects of various therapies, treatment (medical or surgical) decisions in hyperparathyroid states. As a research tool, bone histomorphometry contributed immensely to our understanding of bone biology, revolutionized the study of the mechanism of actions of various therapies, and provided crucial understanding of the adverse effects of drugs.

Osteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosis

“…Гистоморфометрическое исследование является наиболее точным методом для установления диагноза остеомаляции, позволяющим оценить скорость костеобразования и кальцификации. Уровень аппозиции минералов, скорость остеогенеза, а также объем остеоида/костной ткани можно определить по результатам одной биопсии, но только после последовательной маркировки тетрациклином, необходимой для измерения расстояния между двумя фронтами минерализации [58,59]. Интервалы маркировки несколько варьируют, однако, как правило, составляют 3 сут в начале (1-3-и сутки) и далее 3-21 сут с применением 250 мг тетрациклина 3-4 раза в сутки.…”

Treatment of Human Immunodeficiency Virus Infection With Tenofovir Disoproxil Fumarate–Containing Antiretrovirals Maintains Low Bone Formation Rate, But Increases Osteoid Volume on Bone Histomorphometry

“…Despite stabilizing or increasing after the first year, BMD typically does not return to pre‐ART levels . Low BMD observed by dual‐energy X‐ray absorptiometry (DXA) may result either from decreased bone volume with microarchitectural deterioration, which is characteristic of age‐related osteoporosis, or from impaired bone mineralization, which is characteristic of osteomalacia . Because osteomalacia is a histologic diagnosis and may occur in the absence of laboratory and radiologic abnormalities, a definitive diagnosis may require a bone biopsy.…”

“…(6)(7)(8)(9)(10)(11) Low BMD observed by dual-energy X-ray absorptiometry (DXA) may result either from decreased bone volume with microarchitectural deterioration, which is characteristic of age-related osteoporosis, or from impaired bone mineralization, which is characteristic of osteomalacia. (12) Because osteomalacia is a histologic diagnosis and may occur in the absence of laboratory and radiologic abnormalities, (13) a definitive diagnosis may require a bone biopsy. Tenofovir disoproxil fumarate (TDF)-based ART has been associated with greater reductions in BMD compared to non-TDF containing regimens.…”

Advances in Sensing Technologies for Monitoring of Bone Health

“…Bones become softer in osteomalacia. The outer surface of bone (cortex) is made up of minerals mainly including phosphate, vitamin D, and calcium, while a softer inner matrix consists of collagen fibers [36,37]. Improper mineralization and the toxic effects of drugs make the bone softer in osteomalacia [38,39].…”