Osteoporosis overview for academic and clinician

The Osteoporosis Primeredited by Janet E. Henderson and David Glotzman. Cambridge University Press, 2000. US$64.95 (xiv + 372 pages)ISBN 0521644461The first nine chapters of this textbook (Part I), which describe the molecular and cellular environment of bone, make it quite evident that the book is far more than a ‘primer’. Although the introductions to each chapter are quite well written and helpful, some of the chapters, such as ‘Local Regulators of Bone Turnover’, ‘Bone Matrix Proteins’ and those concerning sodium-dependent phosphate transport and the genetic approach to bone development, are very complex and much more than one needs or even desires in a primer. The discussion of vitamin D metabolism is good but is also highly technical. The chapter covering parathyroid hormone contains a good discussion and is a good overview. Researchers and academics, as opposed to clinicians, will find Part I an interesting and detailed introduction to this subject.Part II (‘Determinants of Peak Bone Mass’) is somewhat more appropriate for clinicians than is Part I, and the key point on genetic determinants of osteoporosis provided in the figures is well made. Additionally, provision of non-genetic determinants of peak bone mass should be quite helpful to clinicians. The analysis of bone-mineral acquisition during childhood and adolescence, and tables concerning osteoporosis in children are helpful. Although initial discussion of childhood osteoporosis is minimal, additional information is provided in subsequent chapters.Part III of the book (‘Pathophysiology of the Aging Skeleton’) begins by describing the consequences of alterations in bone remodeling, illustrating that the many factors involved in the process are poorly understood. This section contains a good discussion of aging and hyperparathyroidism in osteoporosis, and a very good basic analysis of the mechanisms involved in the development of senile osteoporosis.Part IV (‘Clinical Aspects of Osteoporosis’) begins with a description of biochemical markers of bone turnover, which serves as a good reference for different tests of bone formation, resorption and turnover. A subsequent chapter makes the salient point about radiological assessment of osteoporosis that considerable bone has already been lost by the time radiographical detection is possible, making it ineffective for detection of early or intermediate osteoporosis.In particular, Paul Miller and Carol Zapalowski have written a delightful chapter describing bone-mineral density measurements. Miller is both a good clinician and an excellent teacher, and is a founding and active member of the International Society for Clinical Densitometry. Hormone replacement therapy (HRT) is well covered, but publication of The Osteoporosis Primer preceded the warnings recently raised by the Women's Health Initiative study ‘safety statement’, which led to somewhat surprising and stunning recommendations from the American Heart Association. Similarly, selective estrogen receptor modulators (SERM) are well covered, but publication preceded the discovery that highly specific C-reactive protein is an independent predictor of myocardial infarction. The SERM raloxifene decreases C-reactive protein by ∼4%, whereas six months of HRT increases C-reactive protein by ∼84%. Therefore, comments about estrogen in this part of the book no longer tell the whole story.Certainly, in the field of osteoporosis and its etiology, methods of diagnosis, prevention and management are changing rapidly and therefore related books contain somewhat dated information by the time they are published. Nevertheless, such works are very important to the physician and allied health provider in establishing a working knowledge of osteoporosis.In summary, the title of this book, The Osteoporosis Primer, is misleading because it goes far beyond being a ‘primer’. However, with that said, it remains a good treatise on osteoporosis. It is also very well referenced for those who desire further information. Parts I and II will be helpful to researchers and other academics, while Parts III and IV will be helpful to clinicians, nurse practitioners, physician assistants, residents, students and others in the clinical sector. It should be well worth the purchase for this wide range of individuals.