Portable XRF offers quick, non-invasive in vivo quantification of bone lead. Compared to traditional KXRF systems, pXRF is limited to cortical bone but allows for quicker and similar results. Current methodologies of lead exposure need re-evaluation as lead-related disease burden and trends are dependent on both cumulative and acute impacts. We examined the evolution of XRF techniques for measuring bone lead, comparing current methods with previous ones. We assessed their accuracy, identified limitations, and discussed potential advances in future techniques. Legacy lead exposures call for a revitalization of lead surveillance methods, and pXRF measurement of bone lead offers such a solution.