Image segmentation operation has a great importance in most medical imaging applications, by extracting anatomical structures from medical images. There are many image segmentation techniques available in the literature, each of them having advantages and disadvantages. The extraction of bone contours from X-ray images has received a considerable amount of attention in the literature recently, because they represent a vital step in the computer analysis of this kind of images. The aim of X-ray segmentation is to subdivide the image in various portions, so that it can help doctors during the study of the bone structure, for the detection of fractures in bones, or for planning the treatment before surgery. The goal of this paper is to review the most important image segmentation methods starting from a data base composed by real X-ray images. We will discuss the principle and the mathematical model for each method, highlighting the strengths and weaknesses.