The aim of this multi-authored manual is to provide a quick and ready reference for immediate handling of both simple and complex clinical disorders of bone and mineral metabolism. Primarily the authors have targeted the manual for use by the primary care physician. However, the authors anticipate that the manual will also serve well the busy specialist for whom bone and mineral metabolism is not a primary area of specialty focus. The editors have gathered a number of experts to address the various topics covered in the text, and the book goes a long way towards succeeding in its aims.
The first 7 chapters provide a brief overview of the diagnostic procedures available for evaluation of bone and calcium metabolic diseases, subjects that have attracted significant dispute over the past several years. In this regard, the brevity of the chapters and the purposeful avoidance of background material result in the authors presenting their personal beliefs with the aura of indisputable fact. While this approach certainly will not harm the patient under treatment, it does provide a bias to the material offered the primary care physician. This is most evident in Chapter 4 when Dr. Kleerekoper professes unambiguously the situations in which to order biochemical markers of bone remodeling and how to interpret the values obtained. Unfortunately, he neglects to address the relative merit of the various measurements and the possibility that the assays as currently performed are inadequate.
Part two of the manual addresses directly the diagnosis and management of clinical disorders encountered in patients of all ages from pre-term infants to centenarians. The common problems managed frequently by the primary care physicians are covered extremely well in this section. Indeed, Dr. Bilezikian provides adequate information to assure that the primary care physician will reliably diagnose primary hyperparathyroidism and appropriately choose the best management strategy. Similarly, Dr. Favus provides outstanding information regarding the diagnosis and treatment of nephrolithiasis. Perhaps the only shortfall in this section of the manual is that the brevity employed presupposes baseline knowledge about the disease under consideration. In many cases, however, the relative rarity or complexity of the disease, such as fibrous dysplasia or osteogenesis imperfecta, make the disorders quite foreign to the proposed reader. Alternative means of discussing these diseases, which do not emphasize treatment, but emphasize when to consider them in the differential diagnosis, would suffice. Indeed, the concept of referral to a sub-specialist is seemingly overlooked. Fortunately, the complexity of many of the syndromes considered will serve to “chase” the primary care physician from the page to the pager.
Finally, in part 3 of the manual the authors provide a valuable treatise regarding patient and family education and the resources available to help in such endeavors. Betsy McClung, RN does a very nice job in introducing this subject, which is often overlooked by the physician.
In summary, the manual provides important precis regarding a host of bone and mineral disorders commonly encountered. A quick review for the primary care physicians is offered and a pathway to diagnosis and management well outlined. In this regard, the authors have done well in meeting the objectives of the book. However, the unambiguous facts offered cannot always withstand critical analysis and the wide variety of diseases covered in the manual in many ways exceeds the needs of the primary care physician. Nevertheless, the manual can find a valued place in the practices of many busy physicians who must care for patients with bone and calcium metabolic problems.