Book Reviews Osteoporosis: Etiology, Diagnosis, and Management, edited by B. Lawrence Riggs and L. Joseph Melton III, 501 pp, with illus, $88, New York, Raven Press, 1988 The editors begin the preface to this book with the statement that "osteoporosis is a disease whose time has come," and they end the preface with the hope that the book "will be valuable for practitioners of many disciplines, residents in training, and for research scientists working in this field." This text is a book "whose time has come," and the editors can be assured that this excellent volume will be of value to the wide spectrum of readers they hoped to attract. The first quarter of the book is devoted to a basic-science discussion of "Cells of Bone/' "Bone Remodelling," "Biochemistry of Bone," and "Biomechanical Aspects of Fractures." This superbly written collection of four chapters should be required reading for all basic and clinical investigators in this field. The writing is extremely clear and succinct, and the illustrations, although few, are easy to understand and form an excellent adjunct to the text. Each of these chapters is extensively referenced to provide investigators with ready access to everything they need to know about the topics discussed. Residents in training and practitioners, however, will find little use for this section. The second section of the book covers all the clinical aspects of osteoporosis, aside from management. The seven chapters in this section are not uniformly of the high quality apparent in the first section. The outstanding original contributions of the editors to the fields of the epidemiology of fractures and the clinical spectrum of osteoporosis that no doubt inspired them to edit the text are clearly evident in their respective chapters in this section. Osteoporosis is a disease "whose time has come" because it has finally been recognized as a major community health problem, and its effect on society is expected to increase as greater proportions of the population live longer. The chapter by Melton on the epidemiology of fractures is a complete thesis on this topic. As more has been learned about osteoporosis and more practicing clinicians have seen patients with this disorder, it has become apparMayo Clin Proc 63:841-848,1988
ent that it is not a single disease but a spectrum of diseases, which are clearly delineated in the chapter on the clinical spectrum by Melton and Riggs. Just as the section on basic sciences should be required reading for clinical and basic investigators, these two chapters should be required reading for all physicians who examine and treat patients with osteoporosis. All the questions that they and their patients have asked are answered in these two chapters, to the best of currently available knowledge. The chapter on the radiologic features of osteoporosis is hampered somewhat by being too comprehensive. In the first 16 pages of the chapter, radiologic aspects of osteoporosis are discussed in considerable detail. The remaining 22 pages are devoted to a similar detailed discussion of numerous rare and unusual disorders with interesting radiologic features, most of which, however, would never be mistaken for osteoporosis. Although this section of the chapter is well written and the illustrative roentgenograms are exceptional, such material does not belong in a textbook on osteoporosis. The two chapters on measurements of bone mass are extremely complete. All the applications and limitations of the various methods available for such measurements are discussed in depth. Although this much detail is essential for those who must make a decision concerning which measurement techniques should be available for their practice, the detail is somewhat excessive for the physician attempting to interpret the results of a study ordered for a particular patient. It must be pointed out, however, that this excess is the fault of neither the book nor the authors— as yet, no simple answers are available for the many questions that practitioners may encounter in this area. Practitioners with access to a particular technique for measurement of bone mass should use these chapters to familiarize themselves with the limitations, advantages, and disadvantages of the technique available to them. Without first doing their homework—such as reading the relevant sections in these c h a p t e r s practitioners will not be able to make optimal use of the currently available techniques. Thus, selected portions of these chapters are a must for busy practitioners.
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For decades, clinicians have studied "stan- and then proceed to the other five chapters that dard" biochemical markers of bone metabolism discuss specific aspects of the management of and found them frustratingly unhelpful in the osteoporosis before returning to read this conassessment and management of patients with cluding chapter again. This text clearly accomplishes the goals of the osteoporosis. During the past decade, advances in bone mass measurement and quantitative editors. It is an extremely complete text on all bone histology have allowed parallel advances in aspects of osteoporosis. The editors have done a the understanding of the biochemistry of bone remarkable job of maintaining a high standard remodeling. All the methods such as measure- of quality throughout the multiauthored text. Alment of hydroxyproline and alkaline phospha- though some chapters and sections are clearly tase are now easier to put into perspective clini- better than others, none is anything less than cally, and new methods involving osteocalcin good. There is something in this text for basic and tartrate-resistant acid phosphatase are be- scientists, clinical investigators, practitioners, coming readily available and easier to put into and residents, and some sections or chapters perspective. The chapter on biochemical markers should be regarded as required reading. As osteoof bone turnover and osteoporosis covers this field porosis becomes a more widely recognized major exceptionally well. The chapter on quantitative community health problem, all general medical bone histomorphometry provides an equally good libraries should benefit from having at least one account of the current state-of-the-art in this field. copy of this book. Additional copies should be Read in conjunction with the earlier basic-science available in the libraries of the departments of chapters on bone cells and bone remodeling and medicine, endocrinology, and orthopedic surgery. the chapters on the clinical spectrum and biochemistry, this chapter takes bone histology out Michael Kleerekoper, M.D. of the realm of an esoteric procedure and into the Head, Bone and Mineral Division role of an important clinical tool in selected Henry Ford Hospital patients. Detroit, Michigan The third section of the text includes three chapters on the pathophysiologic features of osteoporosis. Residents and practicing clinicians often Diagnosis and Management of Diabetes Melfind themselves too busy to devote the time neceslitus, 2nd ed, by O. Charles Olson, 333 pp, with sary for understanding pathophysiologic changes. illus, $27.50, New York, Raven Press, 1988 Skipping over these three chapters would be a mistake. Major advances have been made in this This text, written primarily for medical students, area during the past several years, all of which residents, and primary-care physicians, is inare included in these easy-to-read chapters. Al- tended as a quick and easy "desk reference" on though clinicians might be overwhelmed by the the general management of patients with diadetail in the earlier chapters on basic science, betes mellitus. This revised edition contains inthese three chapters are a must. Likewise, al- formation on some of the latest developments in though basic scientists may not be interested in the care of such patients, including home blood the clinical aspects of the management of osteo- glucose monitoring, insulin infusion pumps, transporosis, for them, too, these three chapters on plantation of the pancreas, second-generation sulfonylureas, and the use of immunosuppression pathophysiologic findings are worthwhile. The final section of the book consists of six early in the course of insulin-dependent diabetes chapters devoted to the management of osteo- mellitus. The text is simple and straightforward. Most porosis. Here, too, the major original contributions of the editors shine through. Although it of the chapters are not referenced, however—a is the last chapter in the book, Dr. Riggs' chapter format that suggests that some of the informaon practical management of the patient with tion reflects regional preference rather than scienosteoporosis should be read before any other. tifically documented data. Although the author These seven well-written pages represent the clearly states that he has "... purposely omitted state-of-the-art in the management of osteoporo- numbered references which the practicing physisis. The reader is advised to read this chapter first cian may not look into anyway," a list of sug-