Background: The expected ageing of the population and the increase in the number of patients with osteoporosis require a correct approach to identification of individuals with a high fracture risk, to their rational routing for the work-up and timely prescription of therapy. A preliminary analysis of characteristics of patients referred to specialized osteoporosis centers may help to optimize medical care for these patients. Aim: To analyze the profile of patients referred for densitometry and/or to an osteoporosis specialist at the Moscow Regional Osteoporosis Centre in order to optimize care for this patient population in the region. Materials and methods: The study was performed in the Moscow Regional Osteoporosis Centre located in Moscow Regional Research and Clinical Institute (MONIKI). We retrospectively analyzed medical files of all consecutive outpatients attending the center at their own or with a referral for densitometry and/or specialist consultation January 1 to December 31, 2019. Results: The study included 1940 patients aged 42 to 90 years, with 96.5% (n = 1873) being female, with the mean age of 65.4 8.5 years; males accounted for 3.5% (n = 67), their mean age was 65.6 9.0 years. Patients who had not previously been diagnosed with osteoporosis accounted for 63.8% (n = 1238), whereas 36.2% (n = 702) of the patients have been diagnosed earlier. 27.8% (n = 540) of all patients, were remarkable for the history of low-energy fractures. 88.1% of the patients were referred by endocrinologists or rheumatologists. The main purpose of the referral was to perform densitometry and get the prescription of treatment for osteoporosis (61%). The median FRAX-based risk of major fractures in the total group was 8.2 [6.9; 13.0] % (n = 1277), with the risk in women being significantly higher than in men (8.3 [7; 13] % vs. 4.6 [4.2; 7.7] %, respectively, p 0.001). When bone mineral density was assessed with the T-score (n = 1928), the result of +0.1 SD was found in 6.6% (n = 127), whereas 11.6% (n = 224), 44.4% (n = 856), 37.4% (n = 721) were judged as normal values, osteopenia, and osteoporosis, respectively. According to the specialist consultation in the Centre, a clinical diagnosis of osteoporosis was made in 53.2% of the cases (n = 1032), while 0.3% (n = 5) had another bone disease, 19.2% (n = 373) had no bone disease, and 27.3% (n = 530) had some other problems. The proportion the patients with indications for treatment for osteoporosis was 56% (n = 1089); 45% (n = 489) of them were recommended to initiate therapy, 36.7% (n = 400) continued with their previous medication and 18.3% (n = 200) needed a modification of their management. Conclusion: The study results have shown that patients are frequently referred for densitometry without enough grounds and with a low risk of fracture. This makes highly relevant the use of the FRAX algorithm as a screening tool for diagnosis and timely administration of treatment for osteoporosis not only by specialists, but also by primary care physicians.

A summary of the draft federal clinical guidelines on osteoporosis developed by members of the Russian Association of Endocrinologists, the Russian Association for Osteoporosis, the Association of Rheumatologists of Russia, the Association of Traumatologists and Orthopedists of Russia, the Russian Association for Menopause and the Russian Association of Gerontologists and Geriatrics is presented. The recommendations were developed from the perspective of evidence-based medicine, in accordance with the requirements for compiling clinical recommendations of the Ministry of Health of Russia published in 2019. A significant place is given to screening of primary osteoporosis in adults, differential diagnosis with other metabolic diseases of the skeleton, modern methods of diagnosing osteoporosis, principles of prescribing pathogenetic treatment, features of sequential and combination therapy, disease prevention and rehabilitation. Clinical recommendations will be useful both to general practitioners and physicians, as well as to narrow specialists, primarily endocrinologists, rheumatologists, orthopedic traumatologists, nephrologists, obstetrician-gynecologists and neurologists, since osteoporosis is a multifactorial and multidisciplinary disease.

ЧАСТОТА СКАНИРОВАНИЙ ГЛИКЕМИИ ПАЦИЕНТАМИ С САХАРНЫМ ДИАБЕТОМ 1 ТИПА НА ПОМПОВОЙ ИНСУЛИНОТЕРАПИИ ПРИ ИСПОЛЬЗОВАНИИ

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ИСПОЛЬЗОВАНИЕ ДЕНОСУМАБА У БОЛЬНЫХ ПЕРВИЧНЫМ ГИПЕРПАРАТИРЕОЗОМ Крюкова И .В ., Древаль А .В ., Тевосян Л

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ДЕФИЦИТ ВИТАМИНА D У ПАЦИЕНТОВ С ПЕРВИЧНЫМ ГИПЕРПАРАТИРЕОЗОМ В МОСКОВСКОЙ ОБЛАСТИ Полякова Е .Ю ., Тевосян Л

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX®Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX®(B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).

Background: Numbers of patients with diabetes mellitus using insulin pumps have been increasing every year. Successful achievement of glycemic targets with continuous subcutaneous insulin infusion (CSII) is based on an adequate basal rate of infusion, carbohydrate coefficient and insulin sensitivity index. There are two approaches to basal insulin infusion rate, namely the flat one and the circadian; however, at present there is no convincing data on which one should be chosen at the start of insulin pump therapy.Aim: To compare two regimens of basal insulin infusion rate at initiation of insulin pump therapy in routine clinical practice.Materials and methods: We analyzed data from 120 patients with Type 1 diabetes mellitus, who were switched on insulin pump therapy in the Department of Endocrinology from 2017 to 2018. At initiation of CSII, 60 patients used the flat basal rate profile and the other 60 patients used the circadian basal rate, calculated with the Renner's scale. Safety of the two basal rate regimens was assessed based on glucose variability measured with continuous glucose monitoring during the first two days after the start of insulin pump therapy.Results: Mean (± SD) coefficients of variation in the groups with circadian and flat basal rate at Day 1 were 31.06±12.13 and 32.74±10.7, respectively (p=0.423); at Day 2, 26.78±11.27 and 28.83±10.7 (p=0.309). Median [Q1; Q3] areas under glucose curve (AUC) values above the glucose targets in the groups with circadian and flat basal rate at Day 1 were 0.37 [0.03; 0.89] and 0.48 [0.08; 1.75], respectively, at Day 2 0.44 [0.03; 1.57] and 0.31 [0.1; 1.5], respectively (p>0.05). Median glucose AUC values below the goal in groups with circadian basal rate and flat basal rate on the first day were 0.01 [0; 0.06] and 0.02 [0; 0.1], respectively (p=0.855), on the second day – 0.00 [0; 0.01] and 0.00 [0; 0.02], respectively (р=0.085). We also haven’t found any between-group differences in the prevalence of glucose deviations below and above the target, as well as in the time spent in normoglycaemia.Conclusion: The comparative analysis of two basal insulin rate regimens in Type 1 diabetic patients switched to insulin pump therapy has shown no significant differences between them. The use of Renner’s scale has no clinical advantages over the fixed basal insulin regimen at initiation of insulin pump therapy in adults.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ВОЗМОЖНОСТИ ПРИМЕНЕНИЯ ТЕРИПАРАТИДА В РЕАЛЬНОЙ КЛИНИЧЕСКОЙ ПРАКТИКЕ Красулина К .А ., Крюкова И .В ., Древаль А .В ., Полякова Е

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ЧАСТОТА ВЫЯВЛЕНИЯ ГИПОПИТУИТАРИЗМА У ПАЦИЕНТОВ С МАКРОАДЕНОМАМИ ГИПОФИЗА С РАЗЛИЧНОЙ ГОРМОНАЛЬНОЙ АКТИВНОСТЬЮ Кривошеева Ю .Г ., Иловайская И .А

55 IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ПЕРВИЧНЫЙ ГИПЕРПАРАТИРЕОЗ В МОСКОВСКОЙ ОБЛАСТИ: ДАННЫЕ ВСЕРОССИЙСКОГО РЕГИСТРА НА НАЧАЛО 2020 ГОДА Крюкова И .В ., Тевосян Л .Х ., Древаль А

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ГИПОПАРАТИРЕОЗ В МОСКОВСКОЙ ОБЛАСТИ: СТАРТ ВЕДЕНИЯ ВСЕРОССИЙСКОГО РЕГИСТРА Красулина К .А ., Крюкова И .В ., Древаль А

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

В последнее время в мире появляется все больше данных о высокой распространенности патологии кальций-фосфорного обмена. Своевременное выявление отклонений в уровне кальция, являющегося основным диагностическим маркером нарушений минерального гомеостаза, направлено на раннюю диагностику тяжелых заболеваний и профилактику их инвалидизирующих осложнений. Не вызывает сомнений, что частота гипо- и гиперкальциемии в России недооценена, что связано с отсутствием определения общего кальция в рамках общетерапевтического биохимического анализа крови. ЦЕЛЬ ИССЛЕДОВАНИЯ Изучение частоты гипер- и гипокальциемии у взрослых жителей Химок и Коломны Московской области. МАТЕРИАЛ И МЕТОДЫ Проведено исследование с определением уровня общего кальция в крови у 674 пациентов, проходивших диспансерное обследование в лечебно-профилактических учреждениях Коломны и Химок в марте 2017 г. Лабораторные исследования выполнялись на базе НМИЦ эндокринологии. Гипокальциемия диагностировалась при значениях показателя менее 2,15 ммоль/л, гиперкальциемия — более 2,55 ммоль/л. РЕЗУЛЬТАТЫ Выявлена высокая частота гипокальциемии — 16,5% (95% ДИ 13,8—19,5%), медиана и квартили — 2,1 ммоль/л [2,06; 2,13], при этом гипокальциемия чаще выявлялась у пациентов 18—49 лет, чем в более старших возрастных группах (22 и 14% соответственно, p=0,014, χ2), и чаще у женщин до 50 лет по сравнению с мужчинами этого же возраста (29,8% против 10,5%, p=0,002, χ2). Статистически значимых различий в частоте гипокальциемии по полу в возрастных группах старше 50 лет не выявлено. Гиперкальциемия зафиксирована в 0,7% [0,2; 1,7] случаев и только у пациентов старше 50 лет. ЗАКЛЮЧЕНИЕ Высокая распространенность гипокальциемии (преимущественно у пациентов 18—49 лет) и гиперкальциемии (среди лиц старше 50 лет) подтверждает целесообразность массового определения общего кальция у населения Российской Федерации, а также включения оценки уровня общего кальция в общетерапевтический биохимический анализ крови.

BACKGROUND: The registry is the main source of information about patients with acromegaly for assessing the quality of medical care, effectiveness of treatment, determining the compliance of real clinical practice with existing standards and patient management protocols. AIMS: To evaluate epidemiological, demographic and clinical characteristics of acromegaly in Russian Federation and effectiveness of treatment modalities. MATERIALS AND METHODS: The object of the study was the database of the united Russian registry of patients with pituitary tumors with specific analysis of patients with acromegaly only. We analyzed the data of 4114 patients with acromegaly stored on the online system in February 2019. RESULTS: Based on the data 32% of patients had complete clinical and laboratory remission of acromegaly; the percentage of patients with no remission was 68%, among them 22.5% had significant improvements in clinical symptoms and a decrease in growth hormone (GH) and insulin-like growth factor-1 (IGF-1) without IGF-1 normalization. The average age of patients at the onset of the disease was 42.7 years and at diagnosis – 45.8 years. The ratio of men to women was 1:2.6. In patients with acromegaly hypopituitarism was registered in 14.7% of cases and among them hypothyroidism (66%) and hypogonadism (52%) were registered more often. Among other complications the leading were diabetes mellitus (15.7%) and acromegalic arthropathy (15%). The proportion of patients receiving neurosurgical treatment increased from 35.7% to 49.6% in 2012–2019; the portion of patients undergoing radiation therapy decreased significantly from 17.7% in 2012 to 0.8% in 2019. Remission was achieved in 40.47% after neurosurgery and 28.95% after medical treatment as a first line therapy p <0.01. The number of patients receiving medical treatment at the time of the study was 1209. Among them 51% of patients treated with long-acting lanreotide and 24% receiving long-acting octreotide achieved remission ( p <0.0001) CONCLUSIONS: The remission rate of acromegaly remains suboptimal despite increased surgical activity, which corresponds to global trends. Long-acting lanreotide was significantly superior versus long-acting octreotide in the rate of acromegaly remission, which does not correspond with clinical trials.