Bone Biopsy: Indications and Methods

In the context of metabolic bone disorders, obtaining biopsies of iliac bone can be useful for establishing a diagnosis in an individual patient or for investigating pathomechanisms when a series of samples is examined. Although bone specimens are usually decalcified for routine pathology to facilitate sample processing, when investigating metabolic bone disorders it is usually much more informative to analyse undecalcified samples. Biopsy samples can be assessed qualitatively and quantitatively. Quantitative analysis by computerised histomorphometry of undecalcified bone biopsy samples is a key tool for studying bone metabolism and, to a lesser extent, bone mass and structure. Standard histomorphometric analyses focuses on trabecular bone and therefore mainly provides information on trabecular remodelling. Remodelling activity changes markedly with age during development. This has to be taken into account when histomorphometry is used in the paediatric setting. Children and adolescents with severe bone fragility should have a bone biopsy for diagnostic purposes unless the diagnosis is obvious from non-invasive examinations. Quantitative histomorphometric analysis of transiliac bone biopsy samples is especially valuable in clinical studies, as this method provides safety and efficacy data that can not be obtained in any other way.