LA WRENCE G. RAISZ, MD Division of Endocrinology and Metabolism, University of Connecticut Health Center. Farmington. CT The rapid transfer of new knowledge concerning the pathogenesis, diagnosis, preven­ tion, and treatment of disease into clinical practice has always been a major challenge in medicine. This challenge is particularly difficult to meet in osteoporosis, not only because has been so much new knowledge generated in recent years, but also because this there disorder has not caught the attention of many practicing physicians. The goal of this volume is to help primary care physicians develop a better understanding of osteoporosis and a more effective approach to diagnosis, prevention, and treatment. As primary care physicians become more and more responsible for the maintenance of health and the prevention of disease, osteoporosis must become one of their important concerns. The magnitude of the problem of osteoporosis has been widely publicized. Within the next 30 years, the cost of hip fractures alone is expected to exceed $40 billion a year in the United States and will be a major cause ofincreased mortality. In addition, vertebral crush fractures will cripple more and more of our elderly population, both men and women. This enormous toll is not inevitable. Current methods of identifying individuals at risk and applying preventive programs could reduce the incidence offractures by 50% or more. This should be the minimum goal of clinicians.

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Part I. Skeletal Physiology and Its Relevance to Osteoporosis. The Cellular and Biochemical Aspects of Bone Remodeling, Julie Glowacki. The Role of Calcium, Phosphorus, and Macro-Nutrients in the Maintenance of Skeletal Health, John J. B. Anderson. Vitamin D in Health and Prevention of Metabolic Bone Disease, Michael Holick. Part II. The Pathophysiology of Osteoporosis. The Pathophysiology of Osteoporosis, Cathy R. Kessenich and Clifford J. Rosen. The Epidemiology of Osteoporosis, Michael Kleerekoper. Psychosocial Aspects of Osteoporosis, Betsy Love McClung and Judy H. Overdorf. Part III. The Diagnosis of Osteoporosis. What Is an Osteoporotic Fracture? Richard Wasnich. Bone Densitometry Techniques in Modern Medicine, Sydney Lou Bonnick. Clinical Interpretation and Utility of Bone Densitometry, Paul D. Miller. Quantitative Ultrasound, Daniel T. Baran. Biochemical Markers of Bone Turnover, Clifford J. Rosen. Part IV. The Treatment of Osteoporosis. An Introduction to Clinical Decision Making in Osteoporosis, Gordon H. Guyatt. Calcium as a Primary Treatment and Prevention Modality for Osteoporosis, Robert Marcus. Use of Estrogen for Prevention and Treatment of Osteoporosis, Robert Marcus. Drug Therapy, John L. Stock. Nonpharmacologic Therapy for Osteoporosis, Michael R. McClung and Kristi Spencer. Clinical Scenarios. Part V. Case Presentations. Prevention of Osteoporosis: Case Presentation, Robert M. Levin. The Diagnosis and Treatment of Postmenopausal Osteoporosis, Clifford J. Rosen. The Approach to Osteoporosis in the Elderly Patient, Douglas P. Kiel. Preventing and Treating Glucocorticoid Osteoporosis, Robert A. Adler. Therapy for Osteoporosis in Men, Eric S. Orwoll and Robert F. Klein. Bone Mass in Renal Disease, Paul D. Miller. Prevention of Osteoporosis: Making Sense of the Published Evidence, Peter S. Millard. Glossary. Costs of Tests and Treatment. Index.