Table Of ContentThe Bone Biopsy
TOPICS IN BONE AND MINERAL DISORDERS
Series Editor: Louis V. Avioli, M.D.
Washington University School of Medicine
St. Louis, Missouri
PAGET'S DISEASE OF BONE
Frederick R. Singer, M.D.
THE BONE BIOPSY
Jenifer Jowsey, D. Phil.
A Continuation Order Plan is available for this series. A continuation order will bring
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The
Bone Biopsy
Jenifer Jowsey, D. Phil.
Mayo Clinic and Mayo Foundation
Rochester, Minnesota
PLENUM MEDICAL BOOK COMPANY
New York and London
Library of Congress Cataloging in Publication Data
Jowsey, Jenifer.
The bone biopsy.
(Topics in bone and mineral disorders)
Bibliography: p.
Includes index.
1. Bones - Biopsy. I. Title. II. Series. [DNLM: 1. Bone diseases - Diagnosis.
2. Biopsy - Methods. 3. Bone and bones - Anatomy and histology. WE141 J87b]
RC930.5.J68 616.7'1'0758 77-8647
ISBN 978-1-4684-2381-5
ISBN 978-1-4684-2381-5 ISBN 978-1-4684-2379-2 (eBook)
DOI 10.1007/978-1-4684-2379-2
© 1977 Plenum Publishing Corporation
Softcover reprint of the hardcover 1s t edition 1977
227 West 17th Street, New York, N. Y. 10011
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To
Fenwick C. Riley, M.D., my husband
Foreword
During the last ten years, the diagnostic approach to disorders of
bone and mineral metabolism has benefited considerably from
the development of radioimmunoassay and competitive protein
binding techniques for measurements of circulating parathyroid
hormone, calcitonin, and biologically active vitamin D me
tabolites. Accumulated experiences with radiogrametrical and
densinometric methods of quantitating appendicular bone mass
now facilitate the detection of changes in bone mineral content
heretofore unrecognized by routine roentgenographic vertebral
analysis.
During this same decade, the diagnosis of metabolic bone
disease and the skeletal response to remedial therapeutic ma
neuvers have also been facilitated by the routine application of
the bone biopsy. Improvements in tinctorial techniques, stan
dardization in methodology essential for adequate preparation of
thin undecalcified specimens, and the incorporation of tetracy
cline bone formation or mineralization "markers" should now
herald the "routine" use of this diagnostic procedure.
Moreover, the compilation and ready availability of reference
morphometric data, spanning the prepubescent years charac
terized by skeletal growth and remodeling and the later senes
cent period during which bone loss normally proceeds in an un-
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8 FOREWORD
relenting fashion, allow adequate differentiation between normal
age-sex-related changes in skeletal turnover attendant on
skeletal maturation and aging and acquired or inherited de
rangements in bone metabolism.
In this volume, Dr. Jowsey, a renowned international ex
pert in bone metabolism, has presented the case for the bone
biopsy. Her vast experience in the analysis of bone morphology
and performance of innumerable studies in both experimental
animals and human patients continue to enlighten pathologists,
orthopedic surgeons, pediatricians, and radiologists, as well as
those internists with fundamental interests in the diagnosis and
management of metabolic bone disease. This book should prove
invaluable to all who appreciate the need for definitive diagnosis
of specific disease processes prior to therapeutic intervention.
Louis V. A violi
St. Louis, Missouri
Preface
Bone is a complex and unusual tissue; complex because it con
sists of a variety of very differently shaped units linked by joints
and ligaments and unusual because of its hardness and the rela
tive paucity of cells. The rigidity of bone depends on the pres
ence of calcium and phosphorus which is embedded in the dense
collagen that makes up the bone matrix. The field of bone
physiology, therefore, includes many disciplines of science,
such as crystallography, endocrinology, and biomechanics. Be
cause the primary function of the skeleton is to store calcium
that is made available when inadequate calcium is ingested in
the presence of obligatory calcium losses, the relationship be
tween bone metabolism and kidney function, hormone action on
bone, kidney, liver, gut, and other target organs and systems
must also be part of any discussion of bone as a tissue. No one
person can be an expert in all these various disciplines. And
perhaps one of the most poorly understood aspects of bone is its
morphology.
Bone morphology is a specialized field partly because the
hardness of the tissue precludes the use of conventional methods
of tissue preparation and staining and also because most of the
worthwhile information has come from quantitative evaluation
of parameters such as bone mass, volume of unmineralized os-
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10 PREFACE
teoid, and so forth, rather than qualitative comments. This has
necessitated the development of special tools to take the biopsy,
special methods for preparing the sections and for evaluating the
material. The purpose of this volume is to describe both the
special techniques now in use, the information that can be de
rived from a bone section, and what use this is in the diagnosis
of metabolic bone disorders and in understanding the structure
and physiology of bone tissue.
Jenifer Jowsey
Rochester, Minnesota
Acknowledgments
I would like to acknowledge, with pleasure, the efforts of
my assistants in producing this volume. Mrs. Randi Carlson and
Mrs. Joan Toensing have been exceptionally helpful in the prep
aration of the manuscript; Mrs. C. Yerke, Mr. J. Bronk, Mr. A.
Schroeder, Mr. E. Greenwald, and Miss P. Feist have been
most industrious and careful in their laboratory work, and Mrs.
P. Baker has been of inestimable value in her efforts in record
ing data and scheduling patient studies. The Medical Illustra
tions and Photographic Departments, in particular, Mr. Louis
Nichols and Miss Jane Hanson, have consistently produced
magnificent illustrations which are especially valuable in any
morphological treatise. I would also like to thank Dr. M. Cov
entry and Dr. E. Henderson for their continued encouragement
and friendship and also thank my co-workers, Dr. 1:3. L. Riggs
and Dr. P. J. Kelly. Research required for a large Jart of the
original data included in this book was supported in part by
National Institutes of Health Grant AMO 8658.
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