Most patients with a metabolic bone disorder can be managed without evaluation of a bone biopsy. However, some patients may benefit from a careful examination of bone histopathology.
Examination: histomorphometry (in order to maximize information)
Usual biopsy site: iliac crest
Indications for doing a quantitative a bone biopsy:
(1) renal osteodystrophy, especially if aluminum intoxication is present
(2) to confirm the presence of a defect in bone mineralization
(3) vitamin D resistant osteomalacia or other rare metabolic disease
(4) excessive bone fragility of uncertain etiology
(5) evaluating the effectiveness and safety of a new bone-active medication
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