Several high-frequency ultrasound techniques have been developed during the last decade with the intention of assessing elastic properties of bone at the tissue level. The basic measurement principles can be divided into: 1) measurement of the compressional wave velocity in thin tissue sections; 2) measurement of surface acoustic wave velocities in thick sections; and 3) derivation of the acoustic impedance from the confocal reflection amplitude in thick sections. In this paper, the 3 principles are described with example measurements given in the frequency range from 50 MHz to 1.2 GHz. The measurements were made with 2 microscopes operating in the pulse-echo mode, either with frequencies up to 200 MHz and time-resolved detection or between 100 MHz and 2 GHz and amplitude detection. The methods are compared and their application potentials and limitations are discussed with respect to the hierarchical structure of cortical bone. Mapping of the confocal reflection amplitude has superior capabilities for deriving quantitative elastic and structural parameters in the heterogeneous bone material. Even at low frequencies (50 MHz), the mineralized tissue matrix can be separated from the larger pores (Haversian canals), and the elastic coefficient in the probing direction can be measured in 2 dimensions. Depending on the type of sample surface preparation (flat or cylindrically shaped), local distribution of a single elastic coefficient or the average transverse isotropic stiffness tensor can be derived. With frequencies in the GHz range, the lamellar bone structure can be analyzed. However, at one GHz, the acoustic wavelength is still one order of magnitude larger than the individual mineralized collagen fibrils. Although the thickness of a lamellar unit can easily be assessed from the acoustic image, the derivation of the anisotropic elastic properties of the mineralized collagen fibrils as well as the detailed structure of a lamella can only be accomplished with further model assumptions.