Atlas of Clinical Endocrinology: Volume III Osteoporosis. Robert Marcus, Volume Editor, Current Medicine, Philadelphia, PA, USA., 1999


You are invited to give yet another lecture on osteoporosis but this time the audience is a little different and you find yourself missing one or two extra slides that would be just right for this target audience. Do not despair! Just pick up your digital camera (the one purchased with the honorarium from your last lecture) and open up your new osteoporosis atlas. If you cannot find the illustrative material you need in this book, you probably should not have accepted the invitation to lecture.

This volume of the Atlas of Clinical Endocrinology is a multiauthored, highly illustrated textbook dealing with the disease osteoporosis. The preface describes the intended audience of endocrinologist, rheumatologists, pediatricians, epidemiologists, mechanical engineers, and cell biologists, quite a diverse group and difficult to maintain the interest of each group throughout. However, as editor, Robert Marcus has done an outstanding job of hitting each of these target audiences with information of importance and interest.

It is not a book to be read from cover to cover but seems best suited for supplementing an existing knowledge base. Not that the disease is not covered comprehensively. However, it dose not always flow in a logical manner. For example, Chapter 1 deals substantially with bone quality and to only a limited extent with bone mass. Bone gain is discussed in Chapter 2 and maintenance of bone is discussed in Chapter 3. Bone density is not really covered until Chapter 6 and one must wait until Chapter 12 for a discussion of bone biomechanics. There is a chapter on the radiology of osteoporosis with excellent illustrative radiographs, and the clinical chapters (skeletal assessment, osteoporosis associated with systemic illness and medications, glucocorticoid-induced osteoporosis, and immobilization osteoporosis) also contain radiographs of high quality, some even better than those in the radiology chapter. The atlas is rounded out by a chapter on the epidemiology of osteoporosis and fractures, clinical chapters on estrogen-dependent bone loss and bone loss in men, and three chapters on treatment of osteoporosis (nonpharmacologic, antiresorptive therapy, and bone anabolic agents). It is a very comprehensive work.

With minimal exception, the text is provided as figure legends. The text is crisp and clear and complete with supporting references where appropriate. Each chapter is sprinkled liberally with black and white photographs, blue and white cartoons, and numerous black and white charts and graphs reproduced from the published literature. It is disappointing that there is not more color to spruce up the well-chosen artwork. It is not until the very end of the atlas, even after the index, that one is given 31 outstanding color plates. True, the legends of the black and white versions of these illustrations do refer the reader to “see color plate” but this is an unsatisfactory process, particularly because the color plates do not themselves have the figure legends. Although the color plates are indeed outstanding, a further disappointment is that 30 of the 31 are photomicrographs and only one color illustration actually depicts clinical medicine. Not quite good enough for an atlas of clinical endocrinology. The presumed cost savings from grouping the color plates in this manner are no doubt substantial but the production costs of this folio-sized text on high-quality glossy paper probably were not trivial.

The authors are to be congratulated for the quality of the cartoons, most of which appear to have been produced specifically for this work. Each of these depicts the author's visual perception of an important concept and is coupled to a detailed descriptive legend. An excellent example is the geometric depiction of the different perturbations in bone remodeling in different pathological states that result in bone loss. This compares and contrasts normal remodeling from the increased activation frequency of hyperthyroidism, the inefficiency of the osteoblastic response as a result of glucocorticosteroid excess, and the exaggerated osteoclastic activity of estrogen deficiency. The cartoon is marred somewhat by the typographical error in the legend, which really are too frequent for a high-quality publication.

For many of us in clinical medicine the concepts of biomechanics are difficult to get across verbally. The cartoons and photographs on this aspect of osteoporosis and fractures are very good and will be particularly helpful. The biomechanics experts probably will find these less helpful but will be more impressed with the cartoons describing a unitary concept for bone loss in postmenopausal women and a matching one for bone loss in aging men.

This atlas of osteoporosis probably should not be the only osteoporosis text on your bookshelf but it should be on your shelf. No matter what the focus of your particular interests, in osteoporosis you will find this book particularly helpful to round out knowledge in other aspects of the disease. Use your digital camera diligently and then use your image program to spruce up the color. That is the major downside from an otherwise very worthwhile atlas of osteoporosis.