Bone and mineral metabolism from the molecule to the patient*

The seventh edition of the “Primer on the metabolic bone diseases and disorders of mineral metabolism” has just been published by the American Society for Bone and Mineral Research. With a new Editor, Clifford Rosen, MD, this edition maintains the high standards of the earlier editions and continues the tradition of obtaining the most current information from authors with the right expertise. With 109 chapters contributed by 188 authors it is complete with everything you might want to know and understand about the basic biology and relevant clinical disorders. It is not a text to read cover to cover, nor one you would need on your bookshelf, but an online personal and library edition is available (www.asbmr.org).

The first three sections detail the basic biology. The 10th section provides details of oral and maxillofacial biology and health, a topic that we did not consider too often in day-to-day practice until the specter of a potential side effect of bisphosphonate therapy arose and now every visit to a dentist frightens our patients more than necessary. They will be comforted to know that you have immediate access to the best scientific information to allay most of their fears.

The other clinical segments begin with a complete accounting and detailing of the investigations you are likely to need in patients with metabolic bone diseases and this is followed by 27 chapters devoted to osteoporosis. Each chapter is only a few pages long and written in clear, understandable language making it very straightforward to navigate to the precise information you are seeking. Disorders of calcium, inorganic phosphate, magnesium and vitamin D are described in the next section. There is a section on cancer and bone that covers the topics you might expect — metastases, hematologic malignancies, effects of cancer therapies — but the one that most caught my eye was the chapter on childhood cancer and bone. The five-year survival rate for children with cancer is ~80% overall and for acute lymphocytic leukemia it is approaching 90% — great news! The surprising number was the estimate that by 2010, one in 250 persons aged 15 to 45 years will be childhood cancer survivors. The onus is now on us to learn what is necessary to optimize skeletal growth during the treatment phases of childhood cancers and preserve the skeleton lifelong. Not an easy task, but clearly one that is now so common that it is imperative that we “bone” up on this.

Sclerosing and dysplastic bone diseases are not something you are likely to see very often but when you do you will quickly find the information you need in the primer. The remaining section is on kidney stones (look for it under the section labeled “Nephrolithiasis” — why do we still want to use big words our patients don’t know or understand?), and it too details the most appropriate investigations you will need for each patient.

Not a must-buy book, but a book to which you really should have ready access. My practice is clearly heavily biased toward patients with bone and mineral disorders, but I am privileged to have patents referred from many colleagues. Based on that experience I suspect that not a week will go by, perhaps not even a day, when you do not have one or more patients whose major clinical problem is not addressed in this primer.

* Disclosure statement: Dr. Kleerekoper is a member of the ASBMR, was an associate editor of the previous editions of the primer, and contributed a brief chapter to this edition.