BACKGROUND: The FRAX calculator is an accessible method for identifying patients at high risk of fracture. However, data on its practical use in primary health care settings are limited. AIM: To evaluate the correctness of calculating the 10-year fracture probability according to FRAX by primary care physicians and then analyze the impact of the results on patient routing. MATERIALS AND METHODS: The base of the study was the city polyclinic No. 25 of the Nevsky district of Saint Petersburg. The study included men and women aged 40 years and older. During 2017–2020, polyclinic doctors assessed the risk of fracture using the FRAX calculator for 11,013 people. A group of patients with significant differences (30% or more) in the obtained value of the risk of major osteoporotic fractures from the average was identified. A 10-year probability of fractures was recalculated for these patients. RESULTS: Major osteoporotic fracture risk scores were compared before and after recalculation. In most cases of patients (83%), the risk category did not change after recalculation. In 15% of patients changed to a higher risk. In the total group (11,013 people), errors in FRAX calculation led to an underestimation of high fracture risk in 41 patients (0.4%). CONCLUSIONS: The study showed that primary care physicians use the FRAX calculator correctly. The proportion of incorrect fracture risk calculations was low. Nevertheless, training of primary care physicians in the calculation and interpretation of the FRAX score is essential.

BACKGROUND: In the Russian Federation, high mortality and unsatisfactory treatment results of elderly and senile patients with low-energy fractures have been noted. Urgent implementation of a systematic approach to the treatment and prevention of osteoporotic fractures is needed, for which it is necessary to train a large number of medical professionals involved in care of these patients. AIM: To create a distance learning course demonstrating the importance and effectiveness of a multidisciplinary approach to the management of an elderly patient with a fracture and to evaluate its effectiveness. MATERIALS AND METHODS: The course used the TeleECHO technology based on the analysis of specific clinical cases by a multidisciplinary team of experts. Active interaction with the audience was carried out through interactive voting. The evaluation of the effectiveness of training was carried out using a questionnaire conducted before and after the course. RESULTS: The training was attended by doctors and health care managers from 208 regions of the Russian Federation, as well as 10 other countries, most of whom were orthopedic surgeons. A survey conducted before the course showed an unsatisfactory audiences understanding of current approaches to the care for elderly people with fractures. Upon completion of the training, most of the participants mastered the principles of the orthogeriatric approach and were ready to implement them into their practice. 94% of the attendees expressed their willingness to participate in future sessions on this topic. CONCLUSIONS: Distance learning of the principles of a multidisciplinary approach in the health care for elderly patients with low-energy fractures, based on participation of trainees in the discussion of specific clinical cases along with experts, will allow the widespread introduction of current principles of orthogeriatrics into clinical practice.

According to the European guidelines for osteoporosis, the same FRAX intervention threshold is suggested for men as for women. At the same time, in the Russian Federation, according to research data, an extremely low proportion of identified men who are subject to the initiation of osteoporosis therapy. The female intervention threshold identifies only 1.1 to 4% of men for treatment. Aim – to develop and evaluate various options for the intervention threshold using the FRAX calculator for men in the Russian Federation and adopt the most acceptable intervention threshold by consensus. Material and methods . Delphi voting was conducted among 18 Russian experts who have publications and personal reports about their experience with the FRAX calculator. For discussion, 5 intervention threshold options with the corresponding rationale based on the literature reference were presented, as well as the proportion of men of different ages to be initiated in each of the options (based on several Russian population-based studies). Anonymous voting was carried out using the Delphi method with questionnaire placed in the Google form. It was proposed to evaluate all options for intervention thresholds on a 9-point Likert scale. Consensus was considered reached if the intervention threshold reached a Likert score of 7 or more points in 80% or more of the experts. The rating of each intervention threshold option was expressed as mean and standard deviations. Results . In the first round of voting, the maximum rating and percentage of agreement is reached for the 9% fixed interference threshold option based on the FRAX calculation. The rating was 7.72±1.6 points, the percentage of experts’ agreement was 88.9%. A fixed threshold of 9% determined 13–19.5% of men aged 50 years and older to be treated for osteoporosis, while their proportion increased to 26–38% at the age of 85 years and older. Conclusion . The consensus of experts of the Russian association on osteoporosis suggests initiating treatment of osteoporosis in Russian men with a 10-year probability of major osteoporotic fractures according to FRAX of 9% or higher.

In recent years Fracture Liaison Services (FLS) have been established worldwide to reduce the number of fractures due to osteoporosis. Within the framework of the global campaign «Capture the fracture» by International Osteoporosis Foundation (IOF), some questionnaires have been proposed to assess the quality of FLS’ organization. Key Performance Indicators (KPIs) are used to analyze the effectiveness of the FLS working at the patient level. Thanks to their use, it is possible to identify areas that need improvement, evaluate the effectiveness of the changes being made, and compare the quality of work in various FLS at the regional or country level. This article discusses approaches to the use and calculation of each KPI in practical healthcare in the Russian Federation, taking into account epidemiological data, national clinical guidelines, and the specifics of the organization of the healthcare system in our country.

Background. The organization of screening for osteoporosis is an actual problem due to the need for early detection of patients with high risk of fractures and initiation of their treatment.Aim. The aim of our study was to study the effectiveness of screening for osteoporosis (high risk of fractures) in postmenopausal men and women 40 years and older.Materials and methods. Screening was performed by outpatient doctors for all people aged 40 years and older who applied for various reasons. The doctor asked standard questions included in the FRAX questionnaire.Results. In 2017– 2020, 11,013 people were screened by outpatient doctors — 31.7% of the total attached population aged 40 years and older. According to the screening results, 21.9% people were identified with a high risk of fractures. The average 10-year probability of major osteoporotic fractures in these patients (19.0±7.9%) was statistically significantly higher compared to the rest of the screened (7.6±3.3%), p=0.0001. 60% (1,450 people) of the group of individuals with an identified high risk of fractures were patients with FRAX in the area of therapeutic intervention. Among them were patients with indications of a fracture and without a history of fractures. In the remaining 40%, the high risk was determined only on the basis of the fact of a previously suffered fracture (their FRAX index was below the intervention threshold). In general, using only the FRAX calculator, 40 men and 1410 women were identified as having a high risk of fractures, which accounted for 1.3% of the male and 17.7% of the female screened population, respectively. With the simultaneous use of FRAX and anamnestic data on a previous fracture, 13.3% of men and 25.3% of women in the screening population had a high risk of fractures.Conclusion. Screening in primary health care has allowed us to identify 21.9% of the screened population of men and women aged 40 years and older (postmenopausal women) as having a high risk of fractures. Screening with simultaneous calculation of the 10-year risk of fractures according to FRAX and clarification of the presence of a history of fractures was the most effective.

Bisphosphonates are one of the most effective medications widely used in the treatment of osteoporosis. In the last 15 years, descriptions, and observations of unusual low-energy femoral fractures with atypical localization for osteoporosis after prolonged use of these drugs have been published. A 78-year-old patient applied to the osteoporosis center. She received parenteral bisphosphonate therapy for severe osteoporosis for 4 years. In 2017, a spontaneous fracture of the middle third of the femoral shaft was registered (the fracture occurred while walking). Regarding the fracture, metal osteosynthesis with a plate was performed. Subsequently, there was a delayed consolidation of the fracture with the formation of a false joint and the need for repeated surgical intervention. Examination of the patient revealed vitamin D deficiency, and significant negative trend in densitometry. A feature of this case is poor fracture consolidation and long-term uncompensated vitamin D deficiency. Physicians should be aware of this rare but serious complication of bisphosphonate therapy, as it requires discontinuation of antiresorptive drugs and the appointment of bone anabolic therapy for osteoporosis, which, in addition to treating the underlying disease, also promotes consolidation fracture.

Background:The growing frequency of fractures associated with osteoporosis, the significant costs of their treatment, disability and increased mortality make it an important and urgent task to optimize the diagnosis and treatment of osteoporosis in the Russian Federation.Aim: The aim of this study was analyzed of using modern diagnostic criteria for osteoporosis by specialists when they making a clinical decision to initiate treatment for osteoporosis, including an estimate of the 10-year probability of fractures according to FRAX.Materials and methods: The study was conducted in the city consultative and diagnostic center for the prevention of osteoporosis, St. Petersburg. The register of the osteoporosis center for 2018–2021 was used to select patients for the study. Based on the analysis of registry data, a sample of 362 patients with newly diagnosed osteoporosis was obtained. In the resulting sample, the existing FRAX value was assessed on the therapeutic intervention threshold graph, all of them analyzed the primary medical documentation, as well as the available DXA densitometry data.Results: In this study, we assessed the place of FRAX 10-year risk of major osteoporotic fractures in the clinical decision of an osteoporosis specialist to start anti-osteoporosis therapy, in this case taken as the «gold standard». The study found that a positive FRAX score had a high predictive value of 100%. In contrast, the negative predictive value was very low (19.5%): a FRAX value below the intervention threshold did not guarantee a truly low fracture risk and no need to start osteoporosis treatment.Conclusion: Despite the fact that both densitometry and FRAX have significant limitations in use, and cannot identify all patients with a high risk of fractures, their combined use increases the prognostic value of the methods. FRAX technology in routine practice allows, in addition to clinical and instrumental methods for diagnosing high-risk fractures, to identify candidates for the treatment of osteoporosis, and should be used in accordance with clinical recommendations.

Статья посвящена обсуждению результатов, представленных в исследовании Ю.В. Серяпиной и соавт. «Заболеваемость переломами проксимального отдела бедренной кости пациентов в возрасте 60 лет и старше в Российской Федерации» (Медицинские технологии. Оценка и выбор. 2020;40(2):59-66). Авторы анализируют данные литературы об эпидемиологии переломов проксимального отдела бедренной кости, полученные в ранее проведенных в Российской Федерации исследованиях и в исследовании, выполненном авторами указанной статьи.