Consequences of glucocorticoid therapy: Glucocorticoid-Induced Osteoporosis edited by Andrea Giustina, Alberto Angeli, and Ernesto Canalis. Karger, 2002. CHF 196.00/€140.00/US$170.05 (vii+204 pages) ISBN 3 8055 7296 4

View Large Image | Download PowerPoint SlideThis book is a compilation of presentations at the First International Congress on Glucocorticoid-Induced Osteoporosis in Gardone Riviera, Italy in April 1999. This volume in a distinguished series is divided into three sections: pathogenesis and diagnosis, clinical aspects and epidemiology, and treatment. The first section begins with a detailed review of the pathogenesis of glucocorticoid-induced osteoporosis (GIOP). Subsequent chapters review non-invasive and invasive techniques for measuring GIOP. Currently, dual energy X-ray absorptiometry of spine and hip remains the diagnostic test of choice, but insight into the pathogenesis of GIOP and the response to treatment can be obtained from bone histomorphometry and markers of bone turnover. In the section on clinical aspects, the reader learns of the special aspects of certain rheumatological diseases and the difficulty of separating the effects of the disease on bone from the effects of glucocorticoid therapy. Additional information is provided on lung diseases and GIOP, on bone loss in endogenous glucocorticoid excess (Cushing's syndrome), and on the overall epidemiology of GIOP. Finally, many potentially useful treatments are reviewed in the therapy section. For a reader seeking a comprehensive source on an important clinical disorder, Glucocorticoid-Induced Osteoporosis serves well. Most of the chapter authors are from Italy and elsewhere in Europe, and it is a tribute to them and to the editors that the book is well written and lucid.A few chapters stand out. One by Angeli et al. relates the possibility that adrenal incidentalomas, perhaps with subclinical glucocorticoid excess, might be associated with bone loss. Although this turns out not to be the case, the possibility that the commonly found incidental adrenal mass might have such clinical consequences is very interesting and deserving of attention. The chapter by Giannini et al. on osteoporosis associated with organ transplantation and anti-rejection drugs such as glucocorticoids is an excellent review of an important subject. It is clear that glucocorticoids are only part of the reason why patients undergoing organ transplantation are at high risk for fracture. The chapter by Doga et al. on bisphosphonate therapy provides strong evidence for why drugs in this category are the first choice for treatment.In any book of this sort, the biggest concern is timing. The Congress took place in 1999, but publication was in 2002. The authors and editors have managed to have most chapters include references as recent as 2000. This is admirable, but the reader must look elsewhere for the most up-to-date information. In addition, several chapters contain too much repetitious introductory material on the pathogenesis of GIOP. The chapter on calcitonin treatment was striking because it went right to key data, reviewing the reported effects of calcitonin in this disorder. Unfortunately, the short length of the calcitonin chapter reflects the lack of strong efficacy data.For the practitioner who uses chronic glucocorticoid therapy, this relatively concise book will serve as an excellent reminder that attention must be paid to an important side effect: bone loss. In addition, specific choices of therapy can be made from reading the section on treatment. The book might also serve to induce interested physicians and scientists to attend the Third International Congress on Glucocorticoid-Induced Osteoporosis, which will take place in Turin, Italy in March 2003.