Bone biopsy

Hence, the reason why this method is considered the gold-standard technique for measuring bone remodelling.

[1] Patients undergo double tetracycline labelling, and then samples of bone are collected using trephine under local anesthetic from the iliac crest as it is the only readily accessible site for bone biopsy.

[2] This technique is subject to large measurement errors; it is complex and costly to perform and is invasive, meaning that it is painful to the patients.

[2][3][4][5][6][7] Moreover, multiple biopsies using double tetracycline labelling are necessary for the same patient to assess treatment response or disease progression.

Another drawback is that the iliac crest may not provide a true measurement of changes in bone metabolism at the lumbar spine or hip as considerable differences in regional bone metabolism estimates are observed at different skeletal sites.