Micrograph showing osteitis fibrosa due to severe secondary hyperparathyroidism

Bone biopsy from the iliac crest showing osteitis fibrosa due to severe secondary hyperparathyroidism.
(Left panel) Goldner Masson trichrome stain shows an increased number of multinucleate osteoclasts at the resorptive surfaces (arrow) and extensive bone marrow fibrosis (as shown by the light blue staining of the marrow) replacing normal marrow elements. The increased resorptive activity results in a thin and scalloped appearance to mineralized trabecular bone (blue).
(Right panel) Tetracycline labeling reveals a marked increase both in osteoid (orange-red staining) and in new bone formation (two distinct yellow-green bands below the majority of orange-red stained osteoid surfaces).

Histologic appearance of normal bone.
(Left panel) Goldner Masson trichrome stain shows mineralized lamellar bone in blue and adjacent nonmineralized osteoid in red-brown. Osteoid usually comprises less than 25% of bone surfaces. The cellular area between the osseous structures is the marrow space.
(Right panel) Villanueva-stained section viewed under polarized light following time-spaced tetracycline labeling. Osteoid appears orange, mineralized bone is green, and tetracycline markers appear as luminescent yellow-green bands within bone and beneath osteoid (arrow). The distinct dual bands represent active mineralized bone formation.