The pathology of metabolic bone disease

The skeletal manifestations of the diverse group of metabolic bone diseases are mediated through the altered function of osteoblasts and osteoclasts and abnormal rates of mineralization. Appropriate understanding of their pathologic conditions requires familiarity with the normal anatomy and physiology of the skeleton. The accurate identification of metabolic bone disease frequently demands histologic confirmation and sophisticated analysis of undecalcified bone specimens labeled with tetracycline by histomorphometric techniques. These procedures allow the assessment of many morphologic features that characterize specific disease states. The most common types of metabolic bone diseases are acquired disorders; nonetheless, rare forms frequently are genetically based and cause intrinsic alterations in the bone-cell populations.