1Свердловская областная клиническая больница No1, Екатеринбург; 2кафедра семейной медицины ФПК и ПП Уральской государственной медицинской академии Минздрава РФ, Екатеринбург; 3кафедра сестринского дела и социальной работы СевероЗападного государственного медицинского университета им. И.И. Мечникова, Санкт-Петербург; 4отделение эндокринологии и остеопороза клиник Самарского государственного медицинского университета; 5кафедра терапии и амбулаторной медицины ФДППО Ивановской государственной медицинской академии Минздрава РФ; 6Камская больница филиал No15 Приволжского окружного медицинского центра ФМБА России, Пермь; 7Тюменская областная клиническая больница; 8Челябинская областная клиническая больница

Introduction: Adherence to treatment in osteoporosis (OP) remains poor. Educating patients is the possible way for improving the situation. Purpose: To evaluate the effect of different forms of educational programs on treatment adherence. Materials and methods: 479 patients (mean age 66.1±7.9 years, 98.1% were women) with osteoporosis from seven centers of Russia were included in the study. The patients were randomly assigned to two groups. Treatment group (241 subjects) was trained at the School of the OP for 4 classes using interactive teaching methods with 7-10 people at a time. Patients of the control group (238 subjects) received information on the OP as a booklet. The number of patients taking calcium and vitamin D, as well as antiosteoporotic medications was not significantly different between groups at baseline. Patients had four centers interim visits at 3 and 6 months. The final visit for all patients was 12 months. Adherence was assessed at 12 months. Results: After the educational program 78.6% of study group and 80.1% of the control group took calcium with vitamin D regularly during 12 months (p>0.05). Antiosteoporotic medications were taken regularly by 55.4% of intervention and 35.1% of the control group, p<0,001. Other factors affecting adherence were: maternal hip fracture (OR=3,09; 1,55-6,16), intermediate visits at 3 and 6 months (OR=2,41; 1,47-3,96), the presence of disability group (OR=2,03; 1,35-3,06). Conclusion: Patient education in the classroom in small groups using interactive methods more effectively influences adherence than getting the information from a booklet.

Objectives: to assess the absolute fracture risk in outpatients with osteoporosis (OP) at distant radius. Methods: individual absolute fracture risk was assessed using FRAX tool without hip neck bone mineral density (BMD) input in 3082 subsequent subjects (2911 females and 171 males) aged from 40 to 95 (median age 60), calculated by Finnish population data. Distant radius BMD was estimated in all patients by DTX200. Results: 774 (25.1 %) patients had had history of low traumatic fractures. BMD?-.5 SD was detected in 1659 cases, fracture history in 558 (33.6%) of them (OR = 2.21; 95 % CI 1.93-2.55). Median 10-year probability of a major osteoporotic fracture was 4.90 % (2575 %; 1.10 55.0) and 10-year probability of a hip fracture was 0.8 % (0 46), absolute risk 10 % and higher was detected in 434 (64,3 %) patients. Calculated 10-year probability of a major osteoporotic fracture > 10 % was associated with previous low traumatic fractures: OR = 4,55; 95 % CI 4,065,10, test sensitivity being 56.1 % with specificity 89.6 %. The same association was found for 10-year probability of hip fracture >3 %: OR = 3.57 (3.19 4.00), test sensitivity being 51,6 % with specificity 86,7 %. Conclusion: FRAX tool for individual absolute fracture risk assessment should be introduced into general practice for clinical decision making in prophylaxis of OP associated fractures.

Objectives: to assess the absolute fracture risk in outpatients with osteoporosis (OP) at distant radius. Methods: individual absolute fracture risk was assessed using FRAX tool without hip neck bone mineral density (BMD) input in 3082 subsequent subjects (2911 females and 171 males) aged from 40 to 95 (median age 60), calculated by Finnish population data. Distant radius BMD was estimated in all patients by DTX200. Results: 774 (25.1 %) patients had had history of low traumatic fractures. BMD≤- .5 SD was detected in 1659 cases, fracture history in 558 (33.6%) of them (OR = 2.21; 95 % CI 1.93-2.55). Median 10-year probability of a major osteoporotic fracture was 4.90 % (25- 75 %; 1.10 - 55.0) and 10-year probability of a hip fracture was 0.8 % (0 - 46), absolute risk 10 % and higher was detected in 434 (64,3 %) patients. Calculated 10-year probability of a major osteoporotic fracture > 10 % was associated with previous low traumatic fractures: OR = 4,55; 95 % CI 4,06- 5,10, test sensitivity being 56.1 % with specificity 89.6 % . The same association was found for 10-year probability of hip fracture >3 %: OR = 3.57 (3.19 - 4.00), test sensitivity being 51,6 % with specificity 86,7 %. Conclusion: FRAX tool for individual absolute fracture risk assessment should be introduced into general practice for clinical decision making in prophylaxis of OP associated fractures.

Целью исследования явилась оценка влияния приверженности приёму альфакальцидола на риск падения в условиях реальной клинической практики. Материалы и методы. В проспективное когортное исследование на условиях добровольного согласия были включены 46 женщин в постменопаузе в возрасте от 52 до 78 лет, имевших факторы риска падений, низкую минеральную плот- ность кости, скорость клубочковой фильтрации от 65 до 30 мл/мин, не получавших ранее препараты кальция, вита- мина D, антирезорбтивные средства. Все участницы исследования получили рецепты на альфакальцидол в дозе 1 мкг в сутки, а также рекомендации по модификации образа жизни, питания, стереотипа движений и лечебной физкульту- ре согласно «Клиническим рекомендациям РАОП» и прошли обучение в «Школе остеопороза». Оценку индивидуального риска падения проводили с помощью «батареи тестов» по оценке физической функции (Guralnik et al., 1994). Результаты. В 28 случаях комплаенс в течение 12 месяцев составил 80% и выше (группа 1), у 15 женщин комплаенс оказался ниже 80% (группа 2). Ещё 3 женщины выбыли из исследования. За 12 месяцев наблюдения в когорте не было новых переломов и падений. Статистически значимое улучшение параметров физической функции отмечены только в группе 1, в группе 2 - значимого улучшения не было Заключение. в группе высокого риска падений и переломов, статистически значимые позитивные изменения в спо- собности к сохранению равновесия в статике и при ходьбе отмечены только у женщин, приверженность которых приёму альфакальцидола в течение 12 месяцев была выше 80%.

The study objective: to assess the influence of alfacalcidol treatment on risk of falling in real clinical practice. Methods. Prospective cohort study included 46 postmenopausal women aged from 52 to 78, who had high risk of falling, low bone mineral density, glomerular filtration rate from 65 to 30 ml/min, signed informed consent and were naïve to calcium, vitamin D and antiresorptive agents. All patients have participated in Osteoporosis Patients School Classes, received prescriptions for daily 1 mcg alfacalcidol and approved recommendations on lifestyle modifications including diet, exercises and movement patterns. Individual risk of falling was assessed with the help of Guralnik Short Physical Performance Battery Score. Results. There were no new cases of falling and fractures in the cohort during 12 months. During the study period 28 women showed compliance to alfacalcidol 80% or more (group 1), in 15 patients compliance was less than 80% (group 2) and 3 women decided to quit the study. Only group 1 demonstrated significant physical function changes for the better while there were no significant changes in group 2. Conclusion. In a group of postmenopausal women with high risk of falling and fractures, significant positive changes in lower extremity performance and balance tests were registered only in women with 80% or higher compliance to alfacalcidol consumption.

Aim: to assess the prevalence of subnormal bone mineral density (BMD) of the distal forearm among women living in Perm and the Perm Region, by taking into account the data of distal forearm X-ray densitometry and risk factors of osteoporosis (OP).Subjects and materials. This one-stage study included 1765 women aged 50-90 years (mean age 61.8 years, standard deviation 8. 1). All the participants filled in the questionnaire of the National Program of Osteoporosis Risk Factors Study. Radial BMD (of the radius) was estimated by X-ray absorptiometry on a DTX 200 unit.Results. Osteopenia was detected 593 (33.6%) females aged 50 years or older and OP was found in 391 (22.2%). The women with the osteopenic syndrome had lower body weight. Those with OP showed much more frequently vertebral fractures and essential hypertension. Irrespective of the BMD, the proportion of regular dairy produce was very small.Conclusion. In more than a half of the 50-year-old or more women residing in Perm and the Perm Region have lower distal forearm BMD and increased risk for fractures in minimal injury. The proportion of women with EH is statistically significant higher among the women with the osteopenic syndrome.