Book Review

Principles of Bone Biology

N Engl J Med 1998; 338:552-553February 19, 1998

Article

Principles of Bone Biology
Edited by John P. Bilezikian, Lawrence G. Raisz, and Gideon A. Rodan. 1398 pp., illustrated. San Diego, Calif., Academic Press, 1996. $149.95. ISBN: 0-12-098650-7

Over the past two decades the field of bone biology has expanded rapidly and exponentially. This remarkable growth is due to a large extent to the development of tools that allow an understanding of the fundamental molecular and cellular mechanisms controlling bone metabolism in physiologic and pathophysiologic conditions. A spinoff of this research endeavor was the development of new diagnostic and therapeutic tools and their application to clinical investigations of various bone diseases. Moreover, skeletal disorders received progressively more attention with the appreciation of their prevalence in the population. One of these disorders, osteoporosis, was little known 20 years ago, but today is considered a major public health problem requiring preventive programs and the support of fundamental and clinical research.

The book consists of nearly 100 chapters in four sections. The first and most extensive part deals with basic principles of bone biology. It encompasses a series of chapters on the generation and function of bone-forming and bone-resorbing cells, their interaction with the bone marrow environment, and the endocrine and local factors controlling bone activity. The structure, synthesis, and regulation of the bone-matrix components, the various adhesion molecules in bone cells, and the components that determine the mechanical behavior of bone are also reviewed. Several of the chapters describe functional studies that use powerful genetic means to assess in vivo the role of supposedly important controlling or structural molecules of bony tissue.

The next section logically follows, since it presents 17 chapters describing how the basic knowledge discussed in the first part can be used to explain the pathogenesis of metabolic bone and calcium phosphate disorders. These chapters discuss the molecular features that underlie diseases such as osteoporosis, hyperparathyroidism, hypercalcemia in malignant conditions and skeletal metastasis, and Paget's disease, as well as rarer conditions.

The third section consists of a series of overviews of the mechanisms by which therapeutic agents exert beneficial effects on bone metabolism. Some of these agents, such as bisphosphonates, calcitonin, estrogens, and fluoride, are in current clinical use. Others are still under development.

The fourth section presents the state of the art of various methods and tools used in both basic and clinical bone research. This section rounds off advantageously the previous ones. It will allow readers with various backgrounds to gain rapid insight into the way one can clone or knock out genes, obtain basic information on the usefulness and limitations of different cell-culture or tissue-culture systems, or use methods available for the diagnosis and therapeutic monitoring of bone diseases.

Most chapters are necessarily brief, but on the whole they adequately present the essentials while stimulating the reader to learn more about a specific area. Many diagrams illustrate important concepts. Several chapters contain black-and-white or colored micrographs of very good quality. The sources of the information in the tables are often cited. The references at the end of each of the 97 chapters are usually abundant, although a selected list of a few key references would have been useful. A comprehensive index of 44 pages facilitates the search for a particular subject.

As structured, this multiauthored book ran the risk of substantial overlap, particularly within related chapters appearing in the first three sections. However, the overlap is rather modest. Indeed, the related chapters complement one another, as for instance, the three chapters on the recently discovered calcium-sensing receptors. Nevertheless, more frequent inclusion of cross-references to other chapters of the book would have helped a reader looking for more information. Some chapters have no conclusions. Others conclude with a summary of the main knowledge. A few end the way the readers will probably appreciate most — by adding to the summary a vision of the future.

This book will be useful to newcomers in the field or bone specialists who want basic information on unfamiliar subjects. Students, teachers, and practitioners will benefit from reading it, and investigators will use it as a reference work; it will certainly be consulted frequently.

Jean-Philippe Bonjour, M.D.
University Hospital of Geneva, Geneva 1121, Switzerland