The Aging Skeleton. C.J. Rosen, J. Glowacki, and J.P. Bilezikian (eds.), Academic Press, San Diego CA, U.S.A., 1999 (2000)

The aim of this well thought-out and timely book is to present a global examination of the aging skeleton, from molecular/cellular aspects through the organismal and even epidemiological level. A daunting task to undertake. Nevertheless, the editors have assembled together authors that approached these broad concerns with enthusiasm and at the same time in a concise fashion. The volume is organized into 5 parts with 49 chapters. The first sections present “General Aspects and Models of Aging,” with discussions on cellular, animal, and human models of the aging skeleton. The book appropriately begins with discussions of the anthropological perspective on aging and the relationship between aging and osteoporosis in an evolutionary context. Fundamental concepts, such as changes in calcium balance throughout aging are then described. This section ends with solid reviews of cellular and animal models of aging. Balance is a watchword in these discussions, with both strengths and limitations of various models presented in both the in vivo and the in vitro approaches. The second part on “Determinants of Peak Bone Mass; Maintenance of Peak Bone Mass” is well organized. Here, the important concept of achieving peak bone mass by 30 years of age is presented, with in-depth discussions of genetic, nutritional, hormonal, racial, and mechanical contributions to the attainment of peak bone mass in an individual. The next section, “Mechanisms of Age-Related Bone Loss,” is particularly interesting. It begins with a thought-provoking review of cellular mechanisms involved in bone turnover and aging. Additional topics that are reviewed include the complex influences of the sex steroids, parathyroid hormone, vitamin D, and nutrition, and finishes with new perspectives on cytokines, prostaglandins, the growth hormone/insulin-like growth factor axis, and pharmacologic interventions. These discussions are all appropriately presented with the focus on, and in relation to, the aging skeleton. The fourth part on “Quantifiable Manifestations of Age-Related Bone Loss” gives extremely useful discussions/reviews on methodologies, which have been developed to measure bone mass in a quantitative fashion. These range from histomorphometric, to densitometric and ultrasonic, to biochemical marker, and finally to biomechanical analyses. The last sections focus on the ultimate consequences of low bone mass, that is, fractures. The book ends with “Therapeutics,” beginning with joint replacement followed by a compendium of agents that have been or may be used to treat, potentially reverse, or even prevent the development of osteoporosis. Nutritional approaches and physical activity interventions have not been ignored. The flow from chapter to chapter and section to section is just so sensible that it entices one to continue reading. One omission in this comprehensive analysis is that there is little to no description of cellular apoptosis. With evidence accumulating that control of apoptosis may be a central theme in maintenance of bone mass (e.g., estrogen withdrawal and glucocorticoid hormone action) and perhaps the mechanism of action for effective therapeutics, this oversight is probably a result of timing. In summary, this wide-ranging and thoughtful text is a valuable reference for both academics and clinicians involved in osteoporosis diagnosis and treatment. It is also a good review for basic scientists and advanced graduate students interested in developing a better understanding of the issues surrounding their research into the aging process in bone. This is truly a useful book. Ultimately, the editor's hope that this substantial effort stimulates the “quest for solutions to the enigmas that surround the aging process in bone” may indeed be realized.