Micrograph showing low-turnover osteomalacia

Bone biopsy showing low-turnover osteomalacia associated with aluminum accumulation in end-stage kidney disease.
(Left panel) Goldner Masson trichrome stain shows thin mineralized bone in blue surrounded by wide unmineralized osteoid with no cellular activity in orange-brown. There are no osteoblasts or erosive surfaces present.
(Right panel) Villanueva stain following tetracycline labeling and viewed under fluorescent light reveals a marked increase in width of the osteoid seams (orange) with no evidence of mineralization of new bone (which would result in tetracycline deposition, as manifested by a yellow line appearing beneath the osteoid seams).

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.