Bone Histomorphometry Laboratory


As the proportion of older people increases in our society, the complications of osteoporosis, a disease of the elderly, have a growing impact on our health care system. The various osteoporotic syndromes often lead to structural failure of the skeleton, and the management of affected patients costs billions of dollars annually.

Imaging modalities such as the DEXA scan or computerized tomography (CT) scan are accurate in diagnosing the presence of osteoporosis. Although these modalities recognize early bone loss, they can not diagnose the cause. However, the transiliac crest bone biopsy can. It is a way to diagnose the cause of osteoporosis by providing a direct look at the bone tissue. In a relatively simple and painless procedure, bone is removed from an osteoporotic patient, processed without removing the calcium, and studied with a computer. The cellular activity and the amount of bone can be accurately quantified. This analysis, called histomorphometry, provides information that even biochemical studies do not. The information obtained from the bone biopsy can guide the patient's doctor to the proper therapy.

In addition to older patients with osteoporosis, the bone biopsy is an important tool in the diagnosis and management of patients with other metabolic bone diseases such as renal osteodystrophy, osteomalacia, and bone disease due to endocrine gland dysfunction.

The bone biopsy is a useful diagnostic tool in the following clinical settings:

  • young patients with unexplained osteopenia or multiple fractures
  • middle-aged patients with osteopenia and fractures
  • older patients with multiple fractures
  • renal dialysis patients in whom aluminum toxicity is suspected
  • renal disease patients to rule out secondary hyperparathyroidism
  • to distinguish high turnover osteoporosis from low turnover osteoporosis

The Johns Hopkins Bone Histomorphometry Laboratory is a full service lab that specializes in the processing and evaluation of undecalcified bone biopsies for proven or suspected metabolic bone disease. It is directed by Edward McCarthy, M.D., Associate Professor of Pathology and Orthopaedic Surgery at The Johns Hopkins School of Medicine.