Janet E. Henderson and David Goltzman, editors. Cambridge,
United Kingdom: Cambridge University Press; 2000. 388 pages. $64.95.
Although this book is called a primer and has been published
as a paperback, it is a very thorough text with outstanding references
for each chapter. The chapters are written by scientists and clinicians
who are well known in their fields.
The book is divided into four parts. The first three parts are
devoted to the molecular and cellular environment of bone, the determinants
of peak bone mass, and the pathophysiology of the aging skeleton.
These sections explore the basic science of bone physiology very
well and will be useful to any orthopaedic surgeon who is interested
in this area. There is excellent material on osteoblast and osteoclast
function, parathyroid-hormone and vitamin-D metabolism, and the
genetics of osteoporosis. This is a comprehensive basic-science
review, but it may be of only modest value to the clinician seeking guidelines
for diagnosis and treatment.
The fourth part of the text (comprising about one-third of the
total volume) deals with the clinical aspects of osteoporosis. Rather
than giving recommendations or algorithms for evaluation and treatment,
the authors present data from studies and let the reader make his
or her own judgments. The studies that are cited are very up-to-date,
and the references, which include many review articles, are excellent.
An especially good chapter on bone-density measurement will give
the reader a thorough understanding of the diagnosis of osteoporosis. Only
ten pages are devoted to the use of hormone-replacement
therapy in osteoporosis. The recently published Heart and Estrogen/Progestin
(HERS) study, which cast some doubt on whether hormone-replacement
therapy can truly reduce the prevalence of both cardiovascular events
and fractures, is mentioned only briefly. The authors report the
lack of cardiovascular benefits of hormone-replacement therapy but
make no mention of the fact that there also was no decrease in the
prevalence of fractures in women taking hormone-replacement therapy during
the study, certainly an important point for orthopaedic surgeons.
The chapter on the use of bisphosphonates is surprisingly
short considering that these compounds have become the cornerstone of
osteoporosis therapy. Alendronate and risedronate, the only two
bisphosphonate treatment medications that have been approved by
the Food and Drug Administration, are covered in only about a page
and a half. In fact, as much space is given to the action
of fluoride on bone, an unproven and controversial therapy, as to
the entire chapter on bisphosphonates.
This book will make a good addition to any orthopaedic surgeon’s
library, but it probably should not be the only text on osteoporosis
on one’s bookshelf. The text is not recommended for the
reader who is new to the study of osteoporosis and is interested
in current concepts for diagnosis and clinical treatment. It is,
however, a thorough basic-science review, not only of osteoporosis
but of metabolic bone disease in general. It is extremely up-to-date, with
numerous references, and it will help to enhance the reader’s
knowledge in the very fast-moving field of osteoporosis.