JA Kanis. 254 pages. Cambridge, MA: Blackwell Science; 1994. $70.00. ISBN 0-632-0382-X. Order phone 617-876-7000.
Four in 10 women will sustain one or more osteoporotic fractures in their lifetimes, and one hip fracture is estimated to occur every 20 seconds. Thus, the effect of osteoporosis is enormous. This book carries the reader through the state-of-the-art information on the disease.
The journey begins with a clear description of low bone mass and its consequences and then steps through an explanation of bone remodeling. Several commonly held beliefs are dispelled: Bone resorption and formation are not uncoupled but imbalanced; the categorizations of type I and type II osteoporosis and of high and low bone turnover are unsupported. An excellent discussion of peak bone mass and risk factors is summarized for future reference. The author proceeds logically to a detailed discussion of the biochemistry and endocrinology of osteoporosis (including a review of menopause), but the relevance of this to osteoporosis is not covered. Causes of osteoporosis and assessment of bone mineral density are discussed; potential consequences are distinguished from causes.
The remaining chapters are devoted to the prevention and treatment of osteoporosis; there is an excellent discussion of the appropriateness of targeting high-risk groups rather than practicing population-based prevention. The author is optimistic about the effect of hormone replacement therapy but does not advocate exercise as a promising preventive tool. The treatment options are detailed and highlight the fact that most agents act to decrease bone loss rather than to restore bone mass.
This book is clearly written and can be used as an excellent reference for those interested in osteoporosis, from clinicians to researchers. Easy, practical guidelines for the diagnosis, prevention, and treatment of osteoporosis are rendered. This book should also serve as a benchmark to help guide future investigations into issues about which little evidence is currently available.
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