Book Review

Osteoporosis

N Engl J Med 2008; 359:104-105July 3, 2008

Article

Osteoporosis
Third edition. Edited by Robert Marcus, David Feldman, Dorothy A. Nelson, and Clifford J. Rosen. 1941 pp., in two volumes, illustrated. San Diego, CA, Elsevier Academic Press, 2008. $400. ISBN: 978-0-12-370544-0

The first edition of Osteoporosis appeared in 1996 and was followed by the second edition in 2001. The third edition of this multiauthored book keeps up remarkably well with the explosion of knowledge in the field. The two volumes of the latest edition consist of 80 chapters divided into 7 sections. Volume 1, which is focused largely on basic science, includes an introduction that is followed by discussions of the basic science of bone biology, bone structure, and biomechanics; the epidemiology of osteoporosis; and risk factors. The chapters in volume 2 are mostly clinical and address pathophysiology, evaluation and management, pharmacology, and therapeutics.

A series of strong chapters written by experts in the field covers bone biology. The distinction between type 1 osteoporosis and type 2 osteoporosis is not discussed in this edition of the book, and the topic of fluoride — which took up two chapters in the second edition — has also disappeared. Chapters new to the third edition review osteocytes, phosphatonins, Wnt signaling, bone quality, adult scoliosis, degenerative disease and bone mineral density, and many other topics. Chapter 38, “Local and Systemic Factors in the Pathogenesis of Osteoporosis,” is superb, as are the chapters on osteoporosis in childhood and adolescence, on users of glucocorticoids, on osteoporosis in men, on the clinical use of bone densitometry, and on new therapeutic approaches.

Several topics have been extensively reworked for this edition. The chapter that was previously titled “The Biochemistry of Bone” has been renamed “The Regulatory Role of Matrix Proteins in Mineralization of Bone,” and the topic is addressed accordingly. The chapter that was titled “Coupling of Bone Resorption and Formation during Bone Remodeling” in the second edition has become “Intercellular Communication during Bone Remodeling.” The chapter on genetics has been substantially updated. The new chapter on leptin-dependent regulation of bone mass unfortunately is misplaced in the clinical section of volume 2.

Because of its weight and size, this is clearly not a book to simply pick up and read. Fortunately, there is a complete table of contents in each of the volumes, although the index appears only in volume 2. The few color illustrations are relegated to the back of each volume. Despite these shortcomings, because of its scope, this is a reference work that should be useful for basic scientists in the bone field as well as for rheumatologists, endocrinologists, and other clinicians who can benefit from the resources put together so ably by this group of editors and authors.

Nelson B. Watts, M.D.
University of Cincinnati College of Medicine, Cincinnati, OH 45267