BACKGROUND. Type 2 diabetes mellitus (T2DM) and diseases of the circulatory system continue to be one of the important health problems, given their high prevalence and comorbidity. Acute ST-segment elevation myocardial infarction (STEMI) in type 2 patients (T2DM) is characterized by a severe course with adverse clinical outcomes. Currently, the features of STEMI in patients with T2DM in different ethnic groups remain insufficiently studied.AIM. To determine the patterns of inflammatory response in patients with type 2 diabetes mellitus and acute ST-segment elevation myocardial infarction in the Buryat population.MATERIALS AND METHODS. An observational single-center simultaneous comparative study was conducted on the basis of the Department of Endocrinology of IGMAPO, a branch of the Federal State Budgetary Educational Institution of the Russian Ministry of Health, and the N.A. Semashko Republican Clinical Hospital in Ulan-Ude of the Ministry of Health of the Republic of Buryatia. The study included patients with T2DM and STEMI with the participation of a control group. Anamnesis was collected from all participants of the study, and a clinical and functional examination was performed. In all subjects, serum levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) were detected by the method of solid-phase enzyme immunoassay, while the immunoturbidimetric method was used to detect the level of high-sensitivity C-reactive protein (hs-CRP). In patients with T2DM and STEMI, venous blood sampling was performed on an empty stomach in the first 24 hours after the development of an angina attack.RESULTS. The study included 77 people who were divided into patients of the Russian and Buryat populations, depending on their ethnic status. The group of the Russian population consisted of 21 patients with T2DM and STEMI and 22 people in the control group. The Buryat population group included 14 patients with T2DM and STEMI and 20 people in the control group. Russian population showed an increase in inflammatory response parameters (IL-1β, IL-6, IL-10, TNF-α, hs-CRP) in patients with T2DM and STEMI relative to the control group of the Russian population (p<0.01). There was registered a significant increase in the levels of IL-1β, IL-6 and hs-CRP in patients with T2DM and STEMI in the Buryat population compared with the indicators of the control group of Buryats (p<0.05). Comparative analysis showed that patients with T2DM and STEMI in the Buryat population are characterized by a decrease in the inflammatory response with cytokine decrease, both pro-inflammatory (IL-6) and anti-inflammatory (IL-10) against the background of a decrease in hs-CRP, relative to patients with T2DM and STEMI in the Russian population (p<0.05).CONCLUSION. The results obtained indicate an imbalance of the cytokine system on the first day of the acute period in patients of the Buryat population with T2DM and STEMI against the background of a decrease in the anti-inflammatory link relative to patients with T2DM and STEMI in the Russian population.

We recommend acromegaly to be ruled in all patients with characteristic changes in appearance (A3). In all patients without characteristic changes in appearance, we recommend to rule out acromegaly, if several clinical signs suspicious for acromegaly are present (B3). We recommend acromegaly to be ruled out in all patients with pituitary adenoma (B3). We recommend to rule out acromegaly in all patients with prolactin-secreting adenomas (C4). For laboratory confirmation of acromegaly, we recommend to measure serum insulin-like growth factor-1 (IGF-1, somatomedin C) level (A3). In patients without obvious clinical signs of acromegaly and/or with a moderate increase in IGF-1 levels (IGF-1 index less than 1.3), we recommend to assess the response of somatotropic hormone (GH) to hyperglycemia (GH during an oral glucose tolerance test) (B3). In all patients with biochemically confirmed acromegaly, magnetic resonance imaging of the pituitary gland with intravenous contrast is recommended to assess pituitary adenoma size, location and growth pattern (A3). We recommend to measure blood glucose and glycated hemoglobin in all patients with confirmed acromegaly (B3). We recommend to measure serum prolactin levels in all patients with acromegaly (B3).In all patients with acromegaly and pituitary adenoma, transnasal transsphenoidal adenomectomy is recommended as first-line treatment if the patient’s consent is given and there are no contraindications (A1). For all patients with acromegaly for whom neurosurgical treatment is indicated, surgical intervention is recommended in medical centers, specializing in pituitary diseases, by neurosurgeons who perform at least 50 such operations per year (A3). We recommend that morphological and immunohistochemical examination of the removed pituitary adenoma is performed in all patients with acromegaly (A3). We do not recommend routine medical therapy for acromegaly before surgery as a mean to reduce tumor size (B2).For patients with acromegaly in whom neurosurgical treatment is not indicated or ineffective or while patient awaiting for the effect of radiation therapy, we recommend medical therapy (A1). Long-acting first-generation somatostatin analogues are recommended as first-line drug therapy for acromegaly. In case of partial/complete resistance to or intolerance to somatostatin analogs, pegvisomant is recommended as a second-line medical therapy for acromegaly (A1). We recommend starting pegvisomant from a single dose of 40–80 mg per day subcutaneously, then continue injections at a starting dose of 10 or 15 mg per day with IGF-1 monitoring after 4–6 weeks and dose adjustment if necessary (B2). In patients with acromegaly and a moderate increase in IGF-1 levels, we recommend to initiate cabergoline as medical monotherapy or, if somatostatin analogs are ineffective, in combination with them (B2).In patients with acromegaly, if the disease remains active after surgical treatment, if drug treatment is unavailable, intolerable or ineffective, and repeated neurosurgical intervention is inappropriate, it is we recommend radiation therapy (A1). A multidisciplinary approach is recommended in the management of acromegaly complications (C3).

Известно что для больных больных острым инфарктом миокарда характерен дисбаланс цитокинового статуса. Закономерности воспалительных реакций взаимосвязаны со степенью выраженности нарушений углеводного обмена. ЦЕЛЬ: оценить этнические особенности воспалительной реакции у больных острым инфарктом миокарда с подъемом сегмента ST (ОИМпST) в зависимости от степени выраженности нарушений углеводного обмена. МАТЕРИАЛЫ И МЕТОДЫ: когорту пациентов с ОИМпST составили 35 больных сахарным диабетом 2 типа (СД2) и ОИМпST и 41 пациент с нарушенной толерантностью к глюкозе/ нарушенной гликемией натощак (НТГ/НГН) и ОИМпST. Все пациенты были разделены на группы в зависимости от этнического статуса. Группу СД2 и ОИМпST русской популяции составили 21 пациент (10 муж. и 11 жен.), медиана возраста 61,00 [52,00; 66,00] год. В группу СД2 и ОИМпST бурятской популяции вошли 14 пациентов (5 муж. и 9 жен.), медиана возраста 62,50 [53,00; 65,00] года. В группе НТГ/НГН и ОИМпST русской популяции было 26 пациентов (16 муж. и 10 жен.), медиана возраста 58,00 [55,00; 64,00] лет. В группе НТГ/НГН и ОИМпST бурятской популяции - 15 пациентов (11 муж. и 4 жен.), медиана возраста 64,00 [55,00; 66,00] года. Диагностические мероприятия включали стандартное клиническое обследование, а также определение уровней интерлейкина-1β (ИЛ-1β), интерлейкина-6 (ИЛ-6), интерлейкина-8 (ИЛ-8), интрелейкина-10 (ИЛ-10), показателей фактора некроза опухоли-α (ФНО-α), высокочувствительного С-реактивного белка (вч-СРБ). Забор венозной крови для исследований проводили утром натощак в первые сутки от момента развития ангинозного приступа. РЕЗУЛЬТАТЫ: в русской популяции у больных СД2 и ОИМпST зарегистрировано существенное повышение уровня вчСРБ медиана 12,60 [8,73; 15,78] мг/мл относительно группы пациентов с НТГ/НГН и ОИМпST - медиана 5,52 [3,03; 9,49] мг/мл (р<0,001). Одновременно у пациентов с СД2 и ОИМпST установлено снижение продукции провоспалительного цитокина ИЛ-8 относительно больных НТГ/НГН и ОИМпST (6,42 [2,16; 13,80] и 14,65 [5,88; 28,40] пг/мл соответственно) (р<0,05). Кроме этого, следует отметить, что у пациентов русской популяции с СД2 и ОИМпST относительно группы НТГ/НГН и ОИМпST активация неспецифического воспаления протекала на фоне повышения противовоспалительного цитокина – ИЛ-10 (медиана 6,99 [3,66; 12,00] пг/мл и 2,51 [0,53; 4,08] пг/мл соответственно) (р<0,001). Проведенный сравнительный анализ показателей ИЛ-1β, ИЛ-6 и ФНО-α между группами больных русской популяции с СД2 и ОИМпST и НТГ/НГН и ОИМпST не выявил различий (р>0,05). В бурятской популяции у пациентов с СД2 и ОИМпST по сравнению с больными НТГ/НГН и ОИМпST наблюдалось выраженное усиление воспалительного ответа (в 8,5 раз) за счет ИЛ-8 (р<0,001). Показатели ИЛ-1β, ИЛ-6, ИЛ-10, ФНО-α и вч-СРБ в группе больных СД2 и ОИМпST бурятской популяции не отличались от аналогичных данных группы НТГ/НГН и ОИМпST бурят (р>0,05). ВЫВОДЫ: для больных русской популяции воспалительная реакция при СД2 и ОИМпST характеризуется повышением концентрации вчСРБ и противовоспалительного ИЛ-10 на фоне депрессии провоспалительного ИЛ-8 относительно пациентов с НТГ/НГН и ОИМпST. Для больных бурятской популяции СД2 и ОИМпST показана малая выраженность воспаления, характеризующаяся снижением содержания ИЛ-8 относительно пациентов с НТГ/НГН и ОИМпST.

При сахарном диабете 2 типа (СД2) измерение только минеральной плотности костной ткни (МПК) может иметь недостаточно информативный характер для определения прочности. В последние годы для оценки микроархитектоники костной ткани шире используется трабекулярный костный индекс (ТКИ), ко- торый отражает структуру трабекулярной ткани поясничных позвонков и способен прогнозировать риск патологических переломов, что обосновывает необходимость его изучения у больных СД. ЦЕЛЬ: изучить показатели МПК и ТКИ у женщин, больных СД2, в постменопаузальном периоде с учетом этнического статуса. МАТЕРИАЛЫ И МЕТОДЫ: в исследование включены 22 женщины с СД2 русской популяции, медиана возраста 57,5 [55; 62] лет, длительность заболевания от 6 до 11 лет и 17 пациенток с СД2 бурятской популя- ции, медиана возраста 59 [57; 61] лет, длительность заболевания от 7 до 12 лет. Группу сравнения составили 42 женщины без нарушений углеводного обмена, из них 21 женщина русской популяции, медиана возраста 56 [52; 60] лет и 21 женщина бурятской популяции, медиана возраста 56 [52; 60] лет. Группы женщин с СД2 и группы сравнения по длительности постменопаузы были сопоставимы. Методом двухэнергетической рентгеновской денситометрии оценивали МПК в поясничном отделе позвоночника (LI-LIV), шейке бедра (Neck), в проксимальном отделе бедренной кости (Total hip). При помощи программного обеспечения TBS iNsight software (Medimaps, Merignac, France) рассчитывался ТКИ в поясничных позвонках одномоментно по полученным денситометрическим снимкам. Исследования проводили на аппарате Prodigy, LUNAR (GE, USA). РЕЗУЛЬТАТЫ: сравнительный анализ показал, что значения МПК Neck у пациенток с СД2 русской популяции выше относительно группы сравнения русской популяции (0,940 [0,886; 0,988] г/см2 и 0,864 [0,812; 0,935] г/см2, p<0,05). Кроме этого, у пациенток с СД2 русской популяции наблюдались низкие зна- чения ТКИ относительно аналогичной группы сравнения (1,314 [1,234;1,367] и 1,363 [1,316;1,430], p<0,05). Вместе с тем у женщин с СД2 бурятской популяции по сравнению с соответствующими данными группы сравнения женщин-буряток зафиксировано повышение показателей МПК Total hip (1,002 [0,913; 1,075] г/см2 и 0,897 [0,831; 0,966] г/см2, p<0,05) и МПК LI-LIV (1,072 [1,015; 1,191] г/см2 и 0,984 [0,893; 1,072] г/см2, p<0,05) на фоне депрессии ТКИ (1,191 [1,156;1,306] и 1,331 [1,272;1,392], p<0,05). Важно отметить, что у женщин с СД2 в постменопаузе бурятской популяции ТКИ ниже относительно пациенток с СД2 русской популяции (p<0,05). Сравнительный анализ показал, что показатели как МПК, так и ТКИ у женщин группы сравнения русской популяции не отличались от данных женщин группы сравнения бурятской популяции (p>0,05). ВЫВОДЫ: результаты исследования показывают, что важным фактором костных нарушений у женщин с СД2 постменопаузального периода являются изменения качественных характеристик костной ткани (ТКИ), а не МПК. В связи с этим низкие значения ТКИ у женщин с СД2 постменопаузального периода бу- рятской популяции могут свидетельствовать о выраженных нарушениях микроархитектоники костной ткани с высоким риском патологических переломов относительно пациенток с СД2 постменопаузального периода русской популяции.

ЭТНИЧЕСКИЕ ОСОБЕННОСТИ СТАТУСА ВИТАМИНА D У ПАЦИЕНТОК С САХАРНЫМ ДИАБЕТОМ 2 ТИПАБардымова Т

The aim of the research. To study the biomarkers of inflammation in acute ST-elevation myocardial infarction (STEMI) in patients of the Buryat ethnic group in comparison with Russian patients. Material and methods. In 109 patients with acute STEMI of Buryat (n = 43) and Russian (n = 66) nationalities, as well as in 42 healthy donors (20 Buryats and 22 Russians), serum levels of high-sensitivity C-reactive protein, interleukin-1β (IL-1β ), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α), as well as IL-6/IL-10 and IL-8/IL-10 ratios were evaluated and compared between the ethnic groups with consideration for the clinical data and STEMI severity, as well as in the groups of healthy patients and those with STEMI. Results. The study groups did not differ in gender and age. Compared to healthy subjects in the STEMI group, the concentration of all inflammation biomarkers was higher regardless of ethnicity, with the exception of IL-1β, which significantly increased in Caucasians only. According to the results of comparative analysis, patients with STEMI of the Russian group matched to that of the Buryat, had higher levels of IL-1β (1.46 [0.41-3.67] and 0.02 [0.01- 1.12] pg/ml, respectively), TNF-α (2.1 [1.4-3.0] and 0.9 [0.4-2.2] pg/ml), IL-6/IL-10 ratios (4.9 [3.5-7.8] and 3.4 [1.7-6.7]) and IL-8/IL-10 (37.6 [8.1-63.4] and 11.9 [5.8-30.7]), troponin T (2.5 [0.19-15.5] and 0.38 [0.11-2.7] ng/ml), creatine phosphokinase-MB (29.4 [17.3-89] and 19.0 [12-26] IU/l), and lower body mass index (24.9 [22.5-28.4] and 27.3 [25.1-31.0] kg/m2) and left ventricular ejection fraction (51.5% [44-57] and 55.0% [50-58]). After adjustment for gender, age, and body mass index, the association with ethnicity remained significant for IL-1β (F for the general regression model was 5.28; p = 0.024) and the IL-6/IL-10 ratio (F = 4.43; p = 0.037). Conclusion. The pro-inflammatory response against the background of STEMI in the Buryat ethnic group as compared to the Russian one is characterised by lower levels of IL-1β, TNF-α as well as lower IL-6/IL-10 and IL-8/IL-10 ratios. After adjustment for gender, age, and body mass index, differences in ethnic groups remained significant for IL-1β and IL-6/IL-10, which indicates a less pronounced proinflammatory response in STEMI patients of the Buryat nationality.

A dangerous viral disease COVID-19, caused by a new RNA coronavirus SARS-COV-2, has been actively spreading in the world since December 2019. The main manifestations of this disease are bilateral pneumonia, often accompanied by the development of acute respiratory syndrome and respiratory failure. Patients with diabetes mellitus (DM) are at high risk of infection with the SARS-COV-2 virus, severe illness and death.Maintaining of target glycemic levels is the most important factor in a favorable outcome of COVID-19 in both type 1 and type 2 DM. The choice of antihyperglycemic therapy in a patient with DM in the acute period of COVID-19 depends on the initial therapy, the severity of hyperglycemia, the severity of the viral infection and the patient’s clinical condition.The article presents the recommendations of the board of experts of the Russian Association of Endocrinologists on glycemic control and the choice of antihyperglycemic therapy in patients with type 2 DM and COVID-19, and also on the use of glucocorticosteroids used in the treatment of COVID-19 in patients with type 2 DM.

Background. Acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM) is characterized by a severe course and unfavorable clinical outcomes. Accumulating information, which characterize the features of the development of AMI depending on the degree of carbohydrate metabolism disorders (CMD). Aim. To conduct a retrospective analysis of medical records with an assessment of the clinical profiles of the patients with T2DM and AMI. Materials and methods. A retrospective analysis of medical records of patients in the acute period of myocardial infarction over a five-year period was carried out. The exclusion criteria were: unstable or stable angina pectoris. The average values and standard deviations (MSD) were calculated. Comparison of quantitative variables between groups was carried out using the Student's t-test. Absolute (n) and relative (%) values were calculated to describe qualitative data. The value p0.05 was used as the level of statistical significance. Results. The total number of medical records is 7618, of them with AMI 2337 cards, of which 1114 (48%) patients with T2DM, type 1 diabetes mellitus, impaired glucose tolerance/impaired fasting glycemia (IGT/IFG) and AMI, as well as 1223 (52%) patients with AMI without CMD. Among patients with AMI, patients with T2DM and AMI accounted for 23%. Gender differences with female dominance were registered in the group of T2DM and AMI (63%), men dominated among patients with AMI without CMD. In the groups of T2DM and AMI, IGT/IFG and AMI, AMI without CMD, women were older than men (p0.05%). In patients with T2DM and AMI, compared with patients with AMI without CMD, repeated AMI and high mortality are more often registered. The presence of diabetes was associated with a higher incidence of concomitant diseases and the presence of severe complications of the disease. Conclusion. Clinical features of AMI in patients with T2DM are represented by gender-age parameters, characteristics of concomitant pathology and the nature of complications of acute ischemia, the frequency of repeated AMI with an increased risk of adverse outcomes.

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM.

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года КЛИНИЧЕСКАЯ ХАРАКТЕРИСТИКА ОСТРОГО ИНФАРКТА МИОКАРДА У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ БУРЯТСКОЙ ПОПУЛЯЦИИ 1 Бардымова Т .П

IV (XXVII) Национальный конгресс эндокринологов с международным участием «ИННОВАЦИОННЫЕ ТЕХНОЛОГИИ В ЭНДОКРИНОЛОГИИ» 22-25 сентября 2021 года ОЦЕНКА РИСКА РАЗВИТИЯ СТРУКТУРНО-МЕТАБОЛИЧЕСКИХ НАРУШЕНИЙ КОСТНОЙ ТКАНИ У ЖЕНЩИН, БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2 ТИПА 1 Бардымова Т .П ., 1 Мистяков М

Background: Structural and metabolic disorders of bone tissue in women with T2DM have no clinical manifestations, but they are accompanied by the risk of fractures. Aim: To study the parameters of bone metabolism, BMD and microarchitectonics in female patients with T2DM in the Buryat population. Materials and methods : The observational single-center one-stage controlled study included 73 women with T2DM, which were divided into 2 groups depending on the functional state of the ovaries (reproductive and postmenopausal periods). In each group, subgroups of the Buryat and Russian populations were identified. The first group included 34 patients with T2DM of the reproductive period: 16 from the Buryat population and 18 from the Russian population. The second group consisted of 39 postmenopausal patients with T2DM: 17 from the Buryat population and 22 from the Russian population. The study of BMD in the lumbar spine (L1-L4), femoral neck (Neck), in the proximal femur (Total hip), trabecular bone score (TBS), serum osteocalcin (OC), N-terminal propeptide type 1 procollagen was carried out (P1NP), vitamin D 25 (OH), blood plasma type I collagen C-terminal telopeptide (β-Cross laps) and ionized calcium (iCa). Results: In female patients with T2DM of the reproductive age of the Buryat population, an increase in both markers of osteosynthesis P1NP (p=0.035), OC (p=0.047), and bone resorption β-Cross laps (p=0.040) was found relative to the similar group of the Russian population. In women with T2DM in the postmenopausal period of the Buryat population, there was also an increase in P1NP (p = 0.016), OC (p = 0.048), β-Cross laps (p = 0.020) compared with the group of postmenopausal women in the Russian population. Structural disorders, characterized by a decrease in TBS, were detected only in the postmenopausal period in female patients of the Buryat population compared to women in the Russian population (p = 0.029). Comparative analysis among women with T2DM of the Buryat population, depending on the functional state of the ovaries, showed that activation of bone remodeling with an increase in P1NP (p = 0.019), OC (p = 0.004) and β-Cross laps (p = 0.004) is characteristic of postmenopausal women accompanied by a decrease in BMD Neck (p = 0.006), BMD Total hip (p = 0.003), BMD L1-L4 (p = 0.049) and TBS (p = 0.020) relative to female patients with T2DM in the reproductive period. Conclusion: In women with T2DM in the Buryat population, both in the reproductive and postmenopausal periods, an increase in bone remodeling markers and BMD stability was found when compared with the corresponding groups of patients in the Russian population. The postmenopausal period was characterized by an additional decrease in TBS in patients with T2DM in the Buryat population relative to women in the Russian population.

Public organization “Russian Association of Endocrinologists”. Clinical guidlines.

BACKGROUND: In most countries, there is a rapid increase in the population of patients with type 2 Diabetes Mellitus (DM). Bone changes in postmenopausal women with type 2 DM are associated with increased bone mineral density (BMD). The study of metabolic processes in bone tissue in comorbid pathology in different ethnic groups is continuing. AIMS: To study the concentration of markers of bone remodeling and indicators of BMD in postmenopausal women with type 2 DM of the Buryat population. MATERIALS AND METHODS: Thirty-nine postmenopausal women with type 2 DM (22 Russian population and 17 Buryat population) were examined. The comparison group consisted of 42 postmenopausal women (21 Russian population and 21 - Buryat population). The study of BMD in the lumbar spine (L1-L4), the femoral neck (Neck), and the proximal femur (Total hip) was performed using dual-energy X-ray absorptiometry. Parameters of osteocalcin (OC), type 1 N-terminal procollagen propeptide (P1NP), C-terminal telopeptides of type I collagen (-Cross laps), 25(OH) vitamin D and ionized calcium were evaluated. RESULTS: The presented study revealed a simultaneous increase in osteosynthesis: ОС (p=0.048) and P1NP (p=0.016) and in the bone resorption marker -Cross laps (p=0.020) accompanied by the absence of changes in BMD in women with type 2 DM in the postmenopausal period of the Buryat population relative to women with type 2 DM in the postmenopausal state of the Russian population. A decrease in osteosynthesis parameters (ОC, p=0.021; P1NP, p=0.029) with an increase in BMD L1-L4 (p=0.024) and BMD Total hip (p=0.039) in postmenopausal women with type 2 DM of the Buryat population was found relative to the women of the Buryat population in comparison group. CONCLUSIONS: The state of bone tissue in postmenopausal women with type 2 DM of the Buryat population is characterized by the activation of bone remodeling processes.

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.