Abstract
This second edition provides an update of the 2006 edition, with the addition of some new chapters. At that time, research and development in the field of osteoporosis was at its zenith with fierce competition between several pharmaceutical companies to provide data to demonstrate preference for one bisphosphonate over another in terms of bone density increase and fracture reduction. Alongside this was a substantial research publications race on which of the diagnostic and monitoring tests such as dual-energy X-ray absorptiometry (DXA) and bone biochemical markers were superior or most suitable for clinical trials. To add to the excitement at the time there were emerging trials and licensing of more potent bisphosphonates with different molecular mechanisms of action or routes of administration as well as new anabolic agents and dual acting drugs. When one looks at these chapters now in the light of current knowledge of how these drugs work in the routine clinical setting, cost-effectiveness (e.g. NICE and its recommendations) and the importance of fracture risk assessment rather than DXA alone, much of this is of historical interest. Nonetheless this could be of value to new entrants into the field seeking a compilation of relevant information in one place, rather than having to trawl for information through Internet search engines.
The new chapters in the second edition are of particular value since they have contemporary flavour both in style and references. Those relating to technology developments such as magnetic resonance imaging swiftly move on from simple explanations to complex mathematical formulae. This is appropriate for a specialist in radiological sciences but difficult to follow for the non-specialist. In other chapters such as male osteoporosis, there are tables giving long lists of causes. These are similar in format to those repeated in many textbooks but lose their value unless they are set in order of importance in relevance to clinical practice. The section on fracture risk assessments makes the point that DXA results need to be interpreted together with other key risk factors adopted in the fracture-risk assessment (FRAX) tool now commonly used (
A lot of material is provided for the clinical biochemist on the various aspects of bone health with particular reference to endocrinology. The basic bone biology of oestrogens and androgens is quite comprehensive, covering issues from molecular mechanisms to clinical effects. The two chapters on vitamin D, one on basics, the other on clinical aspects, are good reviews of the complex sets of data from different studies. Apart from bone health, the effects of vitamin D on cancer prevention and on many chronic disorders are accumulated from different studies without a critical account of whether they were observational findings or studies designed intentionally to study this issue. There is a specific chapter dedicated to bone biochemical markers. It reviews a collection of research papers which in the early days were controversial and ever changing but used as evidence of efficacy and also for designing dosing intervals in later clinical trials. There is a good section on the contributions of different preanalytical and analytical factors contributing to the variability of biochemical tests results. The discussion of least significant change is also of value, since this is pertains to several other analytes and is not always taken into account when interpreting results. But several years on, there is still no critical evaluation of bone marker use in the routine clinical setting and whether it is cost-effective and applicable to routine use. The answer may lie in the fact that biochemical tests are not included in FRAX fracture risk assessment but are used more for monitoring response to therapy.
Overall, this edition is useful to have in a library collection for those intending to start specialization in osteoporosis care who would like a compendium on different aspects of the subject in one place. This is an ever changing field, with new therapies such as denosumab, which acts on molecular signalling thorough the RANK-OPG pathways, making a rapid transition from the laboratory to the bedside. Having a historical perspective puts on a valuable dimension on the subject. A critical appraisal of the relevance of previous studies would be of immense value for contemporary use but unfortunately some of this is missing from this book.