Toward understanding bone quality: Transilial bone biopsy and bone histomorphometry

Transilial bone biopsy specimens have been used for more than three decades-in our laboratory and in several others-for microscopic examination of undecalcified bone. Microscopic examination of undecalci- fied bone biopsies includes qualitative evaluation of cellular and noncellular components as well as quantitative measurements (histomorphometry) of its static (i.e., structural) features. Flurochrome labeling prior to obtaining the biopsy specimen further allows dynamic measurements of ongoing bone cell activity. Scores of measurements and calculated variables have been devised. We identify here two subsets that relate to the current discussion, with brief descriptions of each measure adapted from an earlier publication. As we will show, the same specimens can also be examined by use of newer imaging and materials-testing technologies. Presentations of information about bone histomorphometry frequently conclude with a list of limitations: risks of the procedure and attendant difficulty of enlisting research subjects, the special skill and equipment required for specimen collection, the fact that few laboratories are equipped to process and analyze specimens, and the concern that a local sample may not reflect the skeleton as a whole. Although we remain aware of these limitations, our own experience indicates that they are not prohibitive. The purpose of this article is to consider the contributions of bone histomorphometry to the understanding of bone quality, with bone quality understood broadly as resistance to failure. © Copyright 2006 by Humana Press Inc. All rights of any nature whatsoever reserved.