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Director, Southwest Region Global Clinical Sciences Pharmacia Houston, Texas
| Edited by Steven R Cummings MD, Felicia Cosman MD, Sophie A
Jamal MD FRCP (C). Published by the American College of
Physicians–American Society of Internal Medicine, Philadelphia, 2002.
ISBN 0-943126-95-9. Paperbound, 290 pp. (23 x 15 cm), $43.
www.acponline.com
|
www.theannals.com, DOI
The book is the latest in the American College of Physicians Women's Health series. The 14 chapters are divided into 5 sections and are, for the most part, authored by internationally recognized experts in the discipline. The introduction contains a single chapter on bone biology and general principles. The second section, with 2 chapters, encompasses laboratory and clinical assessment as well as fracture risk. The bulk of the material is gathered in the third section, titled Prevention and Treatment. Specific chapters address nutrition, physical activity, estrogens, selective estrogen-receptor modulators, phytoestrogens and dihydroepiandrosterone (DHEA), bisphosphonates, calcitonin, anabolic agents, and glucocorticoid-induced osteoporosis. The Clinical Cases and Selection of Medications and Guidelines for Fracture Prevention sections have 1 chapter apiece.
The chapter authors are successful in their aim to offer evidence to support rational choices for primary care physicians in caring for patients. For example, the chapter on phytoestrogens and DHEA begins with a brief discussion of the increased interest in "natural" options by patients, followed by a section on dietary and synthetic phytoestrogens, their effect on bone metabolism, and tissue-specific effects of phytoestrogens. Included is a page-long table that elegantly summarizes the randomized clinical trials on skeletal effects of ipriflavone. A brief (two sentence) section on natural progesterone is followed by a discussion of the data on DHEA. Straightforward and practical recommendations for the clinician complete the chapter. This is typical of the book.
The chapters are succinctly written. Each is extensively referenced (several pages in length), even though several chapters are in the 10-page range. Many contain a key points section at the beginning of the chapter as a quick reference. The tables are well done and easy to read. For a busy primary care practitioner, they serve as a useful resource of the published literature. A limitation of this text is that the inclusion of references has been determined by the date of publication.
The clinical cases complement the previous sections. Seven cases are presented in a teaching format. They span the gamut from a postmenopausal woman with a vertebral fracture and a history of breast cancer to a man with Crohn's disease having a flare. A question-and-answer style is employed by each author to discuss relevant points of their cases.
The format is intended to serve the busy practicing physician with a quick overview of the material, perhaps as a refresher, rather than a thorough discourse on the topic. The final chapter, a summary of the rest of the book, resembles a what-to-do-tomorrow-in-clinic addition to the material presented in the previous sections.
Priced reasonably, this text is useful as a teaching tool, both for physicians and other healthcare professionals in training. The primary care practitioner may find it helpful as a resource, but the specialist clinician will have more substantial resources available.
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