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.

Objective: to investigate bone mineral density (BMD) status and the factors influencing the latter in reproductive-aged women with rheumatic diseases (RDs). Subjects and methods . The investigation enrolled 134 women (mean age, 35 [29; 43] years): 94 patients with RDs (rheumatoid arthritis (RA), systemic sclerosis (SS), and psoriatic arthritis (PsA)) and 40 people without RDs. The investigators conducted a survey using a unified questionnaire, spine and proximal femur bone densitometry by dual energy X-ray absorptiometry (Hologic Discovery A Bone densitometer, USA), serum vitamin D measurement, and daily dietary calcium intake estimation. Results and discussion. Reduced BMD was detected significantly more often in the group of patients with RDs compared with the healthy control (25 and 8%, respectively; p=0.0213). It occurred in 48% of patients with RA, in 21% of those with SS, and in 15% of those with PsA. Patients with RDs showed a direct correlation of BMD in all areas of measurement with height, weight, body mass index, and serum vitamin D concentration and an inverse correlation with the cumulative dose of glucocorticoids. In addition, an inverse correlation was found between proximal femur BMD and RD duration. The patients with SS displayed an inverse relationship between BMD of both proximal femurs and C-reactive protein level; and the women with RA had exhibited this relationship between lumbar spine and femoral neck BMD and ESR. Conclusion. In general, 25% of reproductive-aged women with RDs need osteoporosis monitoring and prevention, and, in the presence of fractures, antiosteoporotic treatment.

Genetic factors that are an important hereditary component determining a predisposition to osteoporosis (OP) are 60–80% responsible for bone mineral density (BMD). Some polymorphic genes have been previously shown to affect the efficiency of performed anti-osteoporotic therapy. Objective: to study the impact of farnesyl diphosphate synthase (FDRS) and geranylgeranyl diphosphate synthase (GGSPI) gene polymorphisms on BMD changes during 12-month therapy with bisphosphonates (BP) in women with postmenopausal OP. Subjects and methods. The investigation enrolled 53 women with OP. Spine and proximal femur BMD was determined using X-ray densitometry before and after BP treatment. The -99A/C and -8188T ins/del polymorphisms in the FDPS and GGPS1 genes were investigated using real-time polymerase chain reaction. Results and discussion. The BMD changes were less marked in women with the C allele of C/T -99/C polymorphism in the FDPS gene than those in carriers of the genotype AA: 2.3±3.6 and 4.4±3.8% (р = 0.062) in the spine; 0.6±3.1 and 2.8±4.5% (р = 0.075) in the femoral neck; 0.5±2.9 and 2.5±2.8% (р = 0.020) in the entire femur, respectively. Femoral neck densitometry showed a significantly weaker response to BP treatment in the patients carrying the mutant genotype del/del of GGSP1 -8188T ins/del polymorphism than in those with the wild-type genotype ins/ins (0.8±4.2 and 4.1±2.5%, respectively; р = 0.030). No significant differences for this polymorphism were found in other areas of BMD measurement. Conclusion. The described pilot study has indicated that the examined FDPS and GGSP1 gene polymorphisms may be predictors for a response to BP therapy in patients with OP. Further investigations that will contribute to the choice of the most effective therapy for this disease are needed to confirm our results.

The Russian model FRAX®, an algorithm for estimating the 10-year absolute risk of fractures, which is based on the identification of risk factors that increase fracture risk, was proposed in 2012 to detect people at high risk for fracture. Objective : to estimate the sensitivity and specificity of the Russian model FRAX® versus dual energy X-ray absorptiometry (DEXA) for predicting high fracture risk. Patients and methods. In 2013–2014, the FRAX® questionnaire was retrospectively filled in provided that all information was available in the initial documents on 224 women aged 50 years and older (mean age, 62±7 years), examined at the V.A. Nasonova Research Institute of Rheumatology in 2003–2004. The risk of major osteoporotic fractures was assessed in accordance with the guidelines of the Russian Osteoporosis Association both with and without regard for bone mineral density (BMD+/BMD-) in the femoral neck. The diagnosis of osteoporosis (OP) was based on the WHO criteria using DEXA values. Results. At a primary examination, 96 (43%) patients had a history of minimal trauma fractures, 105 (47%) had OP in the vertebral column and/or femoral neck; the FRAX® (BMD-) values higher than the therapeutic intervention threshold were seen in 70 (31%) patients. 71 (31%) women had no risk factors included in the FRAX® questionnaire. In accordance with the current guidelines, therapy should be recommended for 146 (65%) patients. Over the 10-year period, minimal trauma fractures occurred in 106 (47%) women, including in 46 (40%) of the 128 patients who had no history of fractures. The sensitivity of the FRAX® algorithm with BMD- and BMD+ was 41% (31–51%) and 38% (29–48%) and its specificity was 77% (68–84%) and 82% (74–88%), respectively. The area un-der the ROC curve (AUC) was 0.66 for FRAX® BMD- and 0.69 for FRAX® BMD+. The sensitivity of BMD values in the spine for predicting OP fractures was greater than that of the FRAX® algorithm and was as high as 53% (43–63%) with a lower specificity of 61% (52–70%) (AUC, 0.61) and these values in the femoral neck were as follows: a sensitivity of 25% (18–35%) with a specificity of 89% (82–94%) (AUC 0.64). Conclusion. The Russian model FRAX® for major OP fractures, which is calculated both with and without regard for BMD in the femoral neck, and DEXA fail to identify in full measure patients who need antiosteoporotic therapy, which calls for further investigations providing a pharmacoeconomic rationale for the application of these methods.

We report the results of a pilot study on physician awareness of modern diagnostic methods and drug therapy of osteoporosis (OP) and the use of this knowledge in daily practice. A pilot survey among physicians demonstrated that experts (rheumatologists, endocrinologists, etc.) have a high level of awareness of the OP problem and successfully use this knowledge in daily practice (modern diagnosis, prevention, and treatment methods). They widely prescribe original drugs and certain generics that were shown to be effective in post-marketing surveillance. Limitations of the study: 1) only physicians dealing with diagnosis and treatment of OP were surveyed; hence, the conclusions of this study are valid only for this group of physicians; 2) only physicians working in large cities who can use modern diagnosis methods (densitometry; determination of bone turnover markers) participated in the study; 3) Prolia medication, which has been used in Russia since 2013, was not taken into account in the questionnaire.

The incidence of osteoporosis (OP) is growing steadily. Practitioners who long follow up patients with OP frequently ask questions about the duration of treatment with this or that drug particularly in cases of severe OP and at high risk for new fractures when these agents have been used for years and about the possibility and necessity of switching of the patient from one to other therapy. Individual drug tolerance and longterm treatment adherence are of fundamental importance in organizing care to patients with OP are of fundamental importance. Low (<80%) compliance gives rise to the lower efficacy of antiosteoporotic drugs in preventing the risk of fractures, worsening the end result of treatment as compared to that obtained in the clinical trials proving the expediency of their intake. For the more qualitative prevention and treatment of OP, novel antiosteoporotic drugs are being designed and the frequency of their administration investigated. The paper gives data on denosumab, the first gene engineered drug for the treatment of postmenopausal OP, on the mechanism of its action, efficacy and safety during its long-term use, and on the possibility of switching to its usage after bisphosphonate treatment.