Book Review

Dynamics of Bone and Cartilage Metabolism

N Engl J Med 2000; 342:1225-1226April 20, 2000

Article

Dynamics of Bone and Cartilage Metabolism
Edited by Markus J. Seibel, Simon P. Robins, and John P. Bilezikian. 672 pp., illustrated. San Diego, Calif., Academic Press, 1999. $149.95. ISBN: 0-12-634840-5

The close developmental and spatial relation between bone and cartilage is self-evident, yet these two issues are often considered as separate entities. The approach taken in this book — to consider the structural, functional, metabolic, and pathologic aspects of bone and cartilage in parallel — is a welcome departure and provides the reader with an unusual and interesting range of topics. In part I, the composition of the organic extracellular matrix of bone and cartilage is described; part II covers the cellular and molecular characteristics of these tissues; and part III is devoted to the technical and clinical aspects of biochemical markers of bone and cartilage metabolism. In all, there are 46 chapters, each approximately 10 to 15 pages long and most with comprehensive references. The book is generally well illustrated, although almost exclusively in black and white. There is broad coverage of the basic scientific and clinical aspects of this field, thus supporting the effort, stated in the preface, to appeal both to laboratory researchers and to the wide range of clinical specialists who may encounter disorders of bone and cartilage.

The first 10 chapters, which constitute part I, are an excellent background to the rest of the book. They include clear and comprehensive descriptions of collagen biochemistry, noncollagenous proteins in cartilage and bone, and other aspects of bone and cartilage biochemistry. Research on cartilage has lagged significantly behind bone research, and this is evident in several of these initial chapters. For example, a large number of adhesion molecules are expressed in cartilage, but little is known about their role. The following 14 chapters, which constitute part II of the book, cover a variety of topics related to bone and cartilage physiology, including bone remodeling, parathyroid hormone and parathyroid hormone–related peptide, 1,25-dihydroxyvitamin D, sex steroids, and calcium and phosphate homeostasis. The last five chapters in this section are devoted to cartilage and include interesting accounts of the fluid dynamics of the joint space, animal models of cartilage breakdown, and in vitro models of cartilage metabolism.

The third section of the book, “Markers of Bone and Cartilage Metabolism,” discusses metabolic bone diseases, primarily osteoporosis but also Paget's disease, osteomalacia and rickets, renal osteodystrophy, primary hyperparathyroidism, and metastatic bone disease. Diseases of cartilage receive less coverage, with one chapter on rheumatoid arthritis and other inflammatory joint diseases and one chapter on osteoarthritis. All these chapters emphasize the use of biochemical markers of bone and cartilage metabolism in the diagnosis and monitoring of disease and, in some cases, as a research tool to understand better the underlying pathophysiologic mechanisms. Genetic markers are also considered in relation to bone and cartilage disorders, and the calculation of biochemical indexes of bone and cartilage homeostasis is described in some technical detail. Markers in bone include not only biochemical markers of bone turnover but also vitamin D metabolites, calcium and phosphate, and parathyroid hormone. In addition, there is a chapter on markers of cartilage metabolism in joint fluid, serum or plasma, and urine. Although the study of cartilage metabolism is in its infancy, there have been promising developments, such as the identification of potential prognostic markers in osteoarthritis, including serum hyaluronan (hyaluronic acid), cartilage oligomeric matrix protein, and C-reactive protein.

Scientists and physicians who wish to cross the divide between bone and cartilage will find this book of considerable interest and value. There is excellent coverage of the structural and physiologic characteristics of these tissues and detailed descriptions of the methods involved in assessing tissue markers of metabolism in body fluids. Inevitably, there are some omissions. The chapters on clinical aspects provide an up-to-date account of the use of markers in diagnosis and disease monitoring, but physicians seeking comprehensive coverage of diseases of bone and cartilage will be disappointed. Many of the clinical chapters, particularly those on secondary forms of osteoporosis, emphasize that data on biochemical markers are currently not sufficient to allow assessment of their value in clinical practice. Nevertheless, there are grounds for optimism that a better understanding of bone and cartilage metabolism will make possible considerable advances in the clinical management of diseases affecting these tissues. This is an important challenge for both scientists and clinicians.

Juliet E. Compston, M.D.
University of Cambridge, Cambridge CB2 2QQ, United Kingdom