13 - Osteoporosis and the Bone Biopsy

Abstract

This chapter focuses on the role of bone biopsy in osteoporosis. The nondecalcified bone biopsy has been an invaluable tool in diagnosing and following treatment of numerous metabolic disorders of bone, the most significant example of which may be renal osteodystrophy. This family of skeletal disorders that accompanies renal failure is now remarkably well understood and largely treatable and preventable, the latter as a result of the availability of the nondecalcified bone biopsy. The histologic examination is the most effective means of documenting aluminum-induced osteodystrophy. The bone biopsy can often prove to be diagnostic in osteoporotic syndromes especially in patients with nonsecreting forms of multiple myeloma, and others with systemic mastocytosis. Patients with osteomalacia often remain misdiagnosed, because blood levels of 25-(OH)D3 may prove misleading in this regard. The potential of the bone biopsy in treating the osteoporotic patient can be utilized in order to characterize the cellular aspects of the osteoporotic process.