Background. Rheumatoid factor (RF) and antibodies to cyclic citrullinated peptide (ACCP) are associated with the progression of joint erosions in RA. Currently, the efficacy of anti-osteoporotic therapy for the prevention of erosive arthritis is discussing.The aim of the study. To evaluate the effect of denosumab on the erosion score progression in patients with RA and OP, taking into account the activity of the disease and RF or ACCP positivity.Materials and methods. The study included 66 postmenopausal women with determined diagnosis of RA and OP. Non-erosive arthritis was in 23 (35 %) patients, erosive – in 21 (32 %), ankylosis of the joints was diagnosed in 22 (33 %) people. RF (+) was detected in 47 (72 %) people, ACCP (+) – in 48 (74 %) people. Denosumab 60 mg was injected subcutaneously once every 6 months (two injections). The duration of follow-up was 12 months. RA activity was assessed by the DAS 28 index. The erosion was calculated according to the Sharp / van der Heijde (SVH) method.Results. RA patients were divided into four groups: RF (+) and RF (–), ACCP (+) and ACCP (–), comparable in basic clinical features. At the same time, in the RF (+) group, the duration of RA, the frequency of ankylosis of the joints and the erosion count were initially higher compared to the RF (–). After 12 months of therapy, 7 (14.9 %) patients in the RF (+) group and 8 (16.7 %) patients in the ACCP (+) group the number of erosions has increased. There was no increase in the number of erosions in the RF (–) and ACCP (–) groups. In the analyzed groups, there were no changes in the erosion count depending on RA activity.Conclusions. An increase in the erosion score was found in the RF (+) and ACCP (+) groups despite the treatment with denosumab. In the RF (–) and ACCP (–) groups this indicator did not change. The inclusion of denosumab in the complex therapy of RA and OP is reasonable for prevention of OP and erosions progression in women with seronegative RA.

The article provides a brief summary of bone remodeling, including its stages, disorders, and correction. Osteoporosis (OP) is a systemic skeletal disease in which bone resorption predominates over bone formation. OP is characterized by a decrease in bone mass and density, as well as a disturbance of bone microarchitecture. This leads to a decrease in bone strength and an increased risk of fractures. This paper describes a case of a woman with rheumatoid arthritis (RA) and OP complicated by low-trauma fractures. The authors emphasize that OP is a multifactorial disease and one of the most common bone diseases, particularly among the elderly. OP in RA is an immune- mediated secondary osteopathy and is considered both a comorbidity and complication of the underlying disease. Patients with RA have a higher bone mineral density (BMD) and a higher rate of fractures than the general population. Fractures can occur in individuals with osteopenia or normal BMD values. Therefore, it is important to carefully analyze the risk factors for OP and fractures when planning RA therapy. The ‘treat to target' strategy aims to achieve RA remission or reduce disease activity while also preventing complications, such as osteoporotic fractures. To manage bone metabolism disorders in patients with RA who also have osteoporosis and fractures, it is necessary to control RA activity and prescribe basic therapy for osteoporosis, such as ossein-hydroxyapatite complex and alfacalcidol, as well as pathogenic drugs that prevent bone resorption. Additionally, patients with osteoporosis and fractures require pain-reducing measures, restorative treatment, and rehabilitation. Effective management requires a multidisciplinary approach involving physicians from various specialties. KEYWORDS: bone tissue structure, resorption, rheumatoid arthritis, osteoporosis, fractures, pharmacotherapy of bone metabolism disorders, ossein-hydroxyapatite complex. FOR CITATION: Dydykina I.S., Kovalenko P.S., Kudinskiy D.M., Kovalenko A.A., Ivanova M.E. Optimizing bone repair in patients with rheumatoid arthritis and osteoporosis complicated by fractures. Russian Medical Inquiry. 2024;8(2):94–101 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-2-7.

The need to follow an integrated approach when prescribing treatment for patients suffering from osteoarthritis (OA) is beyond doubt. It is clear that success depends on the implementation of recommendations for both lifestyle modification and the introduction of pharmacological agents with different compositions and mechanisms of action aimed at reducing pain, stiffness, inflammation, normalizing joint function, and preventing cartilage destruction. The arsenal of such drugs is increasing, and the evidence base of effectiveness and safety is being enriched. Considering the heterogeneity of OA patients seeking help in terms of gender, age, body mass index, financial wealth, comorbidity, clinical manifestations of the disease, radiological stage of the disease and its duration, experience of previous treatment, a reasonable and agreed upon choice with the patient not only of the drug is relevant, but also the method of administration. The article provides a clinical example of a justified and coordinated choice of treatment for a patient with a generalized form of OA, synovitis of the knee joint, suffering from obesity, depression, low adherence to treatment using the example of prescribing a chondroprotector, the active component of which is a bioactive extract from small sea fish. The treatment effect was confirmed by clinical and instrumental assessment methods over time.

Osteoarthritis (OA), the most common joint disease, coexists with obesity in most of the world’s population. According to the forecast of the World Health Organization, the number of patients with these diseases is expected to increase, which represents a serious medical and social problem due to increased disability, the need for surgical treatment, an increase in comorbid diseases, treatment complications and mortality in this group of patients. OA and obesity have common pathogenetic mechanisms, and the development of one disease increases the risk of developing the other, which can become the beginning of a vicious circle. In recent years, obesity is considered not only as a biomechanical factor (excessive load on the joint, destruction of articular cartilage), but also as a cause of metabolic syndrome and systemic inflammatory effects. Inflammatory cytokines, especially IL-1β and TNF-α, drive catabolic pathways and promote the progression of OA. There is compelling evidence that weight loss reduces pain and joint inflammation and improves prognosis in patients with OA. The review presents data on the prevalence of OA and obesity, the role of immune disorders in these diseases, and indicates methods of pharmacological and non-pharmacological treatment of OA. General principles and specific updated recommendations of the European League Against Rheumatism for non-drug treatment of OA of the hip and knee joints are outlined, and recommendations for weight loss through dietary interventions and exercise are formulated.

Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures. Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up. Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)). Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p < 0.05), with X-ray stage of RA at baseline (r = 0.280, p < 0.05) and over time (r = 0.819, p < 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p < 0.05) and over time (r = 0.308, p < 0.05), cumulative dose of GC initially (r = 0.239, p < 0.05) and over time (r = 0.268, p < 0.05), duration of GC use (r = 0.270, p < 0.05), history of low-energy fractures (r = 0.291, p < 0.05), and feedback with OP in SB (r = -0.190, p < 0.05). Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.

Ensuring a long-lasting effect of the therapy and its safety are important tasks in the treatment of patients with osteoarthritis (OA). Parenteral forms of chondroitin sulfate (CS) used for the background therapy of OA are characterized by proven efficacy and safety and, compared to oral forms, have greater bioavailability, faster onset of symptom-modifying effect and maintenance of more stable remission, which can significantly improve patients' quality of life. Objective : to evaluate the clinical efficacy and safety of two-month therapy with injectable CS and the duration of positive dynamics after the end of treatment in patients with knee OA (KOA). Material and methods . The open prospective observational study involved 35 patients (mainly women) aged 50–75 years with stage II–III KOA. All patients were prescribed intramuscular therapy with a CS solution (Mucosat® solution), with the first three injections of 1 ml, followed by 2 ml every second day (25 injections in total). Standard indices and questionnaires were used to assess the main clinical indicators at baseline and over time (14, 30, 60 days, 5 and 8 months after the start of treatment), as well as the results of ultrasound examination of the knee at baseline and at the end of treatment. Results and discussion . 14 days after the start of therapy, a statistically significant decrease in pain was observed applying the visual analogue scale (VAS), and after 2 months, 94% of patients had a significant decrease in knee pain according to VAS, Lequesne index and WOMAC index (total score and components). The KOOS parameters and quality of life according to EQ-5D-3L improved significantly. There was no pain or only minor pain (VAS ≤40 mm) in 54% of patients. The number of patients who had to take nonsteroidal anti-inflammatory drugs (NSAIDs) constantly fell threefold, while occasional use fell fivefold. The thickness of the synovial membrane of the knee joint and the number of patients with signs of synovitis decreased significantly. At 3 and 6 months after the end of therapy, most patients (60%) still had minor pain (≤40 mm according to VAS) and a significantly lower need for NSAIDs compared to baseline. The injectable CS was well tolerated and no adverse drug events were noted. Conclusion . We demonstrated both safety and efficacy and long-term maintenance of the clinical effect (6 months after the end of therapy) of injectable CS in the majority of OA patients, against the background of a low need for NSAIDs.

Comorbid diseases and adverse events that occur in patients with rheumatoid arthritis (RA) negatively affect the outcomes of RA (radiological progression, joint function, the occurrence of low-energy fractures, thrombotic events, etc.). Objective: to study the structure of comorbid diseases and adverse events that occurred in patients with RA over the period of long-term prospective follow-up, to study the impact of these events on the dynamics of the functional status and working capacity of patients. Materials and methods. Аn open, cohort, prospective, long-term non-interventional study included 103 women with a definite diagnosis of RA (mean age 63.5 ± 8.3 years, follow-up period 8,5 ± 1,3 years). At baseline and in dynamics, standard laboratory and X-ray examinations were carried out. Results and discussion. There was a decrease in the DAS28 index and the number of patients with high or moderate activity [from 82 (85 %) to 67 (69 %), p = 0.02] against the background of an increase in the number of patients with remission or low activity [from 15 (15 %) to 30 (31 %), p = 0.012], at the same time there was an increase in the number of patients with ankylosis of joints [from 25 (24 %) to 41 (40 %), p = 0.017], functional class III [from 3 (3 %) to 15 (15 %), p=0.004], concomitant diseases [from 81 (79 %) to 94 (91 %), p = 0.015], thrombotic events [from 7 (7 %) to 18 (17 %), p = 0.027]. In 43 (42 %) patients 55 low-energy fractures were registered, in 24 (56 %) of them fractures occurred for the first time and in 19 (44 %) – repeatedly. Conclusion. As the prospective long-term follow-up shows, despite the decrease in RA activity, the number of patients with ankylosis, joint dysfunction and concomitant diseases increased. In the structure of concomitant diseases coronary heart disease and arterial hypertension dominated. A high incidence of thrombotic events, repeated and first-time low-energy fractures was noted. The number of disabled patients increased fivefold.

The article presents basic information about the role and structure of cartilage tissue and its components, the impact of an imbalance in the structure of nutrition on the well-being of the joints, evidence of the symptomatic and structural-modifying effect of chondroitin and glucosamine in the composition of original drugs and dietary supplements in the treatment of osteoarthritis. Particular attention is paid to the structure and synthesis of collagen, its biological role in the body in the formation of the cell structure of various tissues, especially cartilage. Found 28 types of collagen, differing in amino acid sequence and degree of modification, which are encoded by more than 40 genes. It was noted that the activity of enzymes involved in the synthesis of collagen depends on sufficient intake of products containing ascorbic acid (vitamin C), and the degradation and decrease in the amount of collagen is associated with the development and progression of osteoarthritis and other diseases of the musculoskeletal system. The use of type 2 collagen, including in combination with chondroitin and glucosamine, is considered as a promising method for preventing joint problems. It is emphasized that the main substances necessary for the syn thesis of cartilage components come from food. An imbalance in the structure of nutrition (reducing the consumption of proteins, microelements and vitamins, excessive consumption of fats and carbohydrates) negatively affects the state of the connective tissue and causes problems for all structures that form the joint. One way to correct eating behavior and replenish essential deficiencies is through the use of vitamin-mineral complexes and dietary supplements, which are gaining interest in the medical community as evidence accumulates for their effectiveness in supporting joint well-being.

Among the proteins of the human body, collagen accounts for at least 25–45% collagen; it is an essential structural component of skeletal tissues, connective tissue of internal organs (heart, intestines, lungs, liver, kidneys), as well as blood vessels. The variety of types of collagen is due to their role and function. The article presents information about the structure and synthesis of collagen, a high concentration of glycine, proline and hydroxyproline in the alpha chains of the collagen helix. Attention is drawn to the fact that cross-links and orientation of collagen fibers in the direction of the vector of external forces and loads provide protection to tissues and organs. The clinical significance of type II collagen is considered on the example of the cartilaginous tissue of the joints and tendons. It is emphasized that an imbalance in the structure of nutrition, genetic mutations, dysfunction of the endocrine and immune systems, especially in old age, are associated with the occurrence of one of the most common joint diseases – osteoarthritis (ОА). It has been established that the degradation or reduction of type II collagen in the cartilage matrix is accompanied by the progression of this disease. Due to the increasing prevalence of OA, signs of metabolic disorders and post-traumatic joint injuries, there is a growing interest in non-pharmacological and pharmacological interventions for the prevention and treatment of osteoarthritis. In recent years, convincing evidence has emerged of the successful use of drugs (biologically active food supplements) of collagen in osteoarthritis. The article presents the results of experimental and clinical studies, meta-analysis and systematic review, confirming the possibility of using these drugs (products) as part of the complex treatment of OA. The possibility of using compositions based on undenatured (native) collagen type II, with the inclusion of ascorbic acid, vitamin D, methylsulfonylmethane and boswellic acids promotes the synergy of these substances, slows down the rate of cartilage destruction, reduces the manifestation of pain and inflammation in the joints, improves functional joint and spinal conditions, promotes the synthesis of endogenous collagen.

The article deals with local injection therapy (LIT) in arthrological practice, the purpose of which is the introduction of a drug into the joint cavity or periarticularly, removal of excess synovial fluid from the joint cavity with subsequent analysis of its composition for differential diagnosis and decision-making on treatment tactics. The most commonly used in LIT are glucocorticoids, hyaluronic acid (GlK), autologous platelet-rich plasma. The method of introducing GLA into the joint cavity is considered by experts as a promising method for the treatment of osteoarthritis, the most common chronic joint disease. GlK-based preparations differ in concentration, molecular weight and production method. The article presents the results of studies using high- or low-molecular drugs GlK in the treatment of patients with osteoarthritis of the knee, hip and small joints. Attention is drawn to the fact that LIT with GlK preparations is used in the treatment of other diseases of the musculoskeletal system. Data are presented, including those of Russian authors, on the effectiveness of GlK in OA of the shoulder joints, in the syndrome of compression of the shoulder rotators. Thus, the restoration of range of motion and a significant reduction in pain in the shoulder area was achieved against the background of the use of 3 to 5 injections of the GlK preparation produced in the Russian Federation by bacterial fermentation. The unique production technology of the GlK preparation makes it possible to reduce the risk of bacterial endotoxins, completely purify the solution from hyaluronidase, increase homogeneity, and preserve the molecular weight. On the basis of the obtained evidence of efficacy and safety, HLA preparations are included by various medical associations and professional communities in Russian and international clinical guidelines for the treatment of OA.

Patients' adherence to drug therapy, medical support and implementation of the doctor's recommendations for lifestyle changes can affect the effectiveness of therapy and quality of life in patients with rheumatoid arthritis (RA).Objective: to analyze adherence to treatment, medical support and implementation of recommendations for changing the lifestyle in RA patients, including those with and without low-energy bone fractures.Patients and methods. The study included 88 women with a definite diagnosis of RA. All patients were followed up for a long time (on average 8.45±1.34 years) at V.A. Nasonova Research Institute of Rheumatology. All patients underwent clinical, radiological and laboratory examinations, and a questionnaire for the quantitative assessment of adherence to treatment was completed.Results and discussion. The integral indicator of adherence to treatment in 30 (34%) patients corresponded to a low level, in 51 (58%) – to an average level, and in 7 (8%) – to a high level. Low adherence to medical support was more often determined in patients with anxiety (p=0.02) and depression (p=0.04). The intake of oral glucocorticoids (GC) was associated with a high adherence to drug therapy (p=0.01). Adherence rates in the group of RA patients with and without bone fractures did not differ significantly. Functional disorders and the severity of radiological changes also did not differ significantly in patients with different levels of adherence.Conclusion. Patients with RA had predominantly an average level of adherence to drug therapy, medical support, and a low level of adherence to recommendations for lifestyle changes. Oral GC were associated with high adherence to drug therapy, while low adherence to medical support was associated with anxiety and depression. Treatment adherence rates in the group of RA patients with and without bone fractures did not differ.

Objective. Inflammation in rheumatoid arthritis (RA) leads to the development of local and generalized bone loss. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACCP) are believed to play a negative role in the radiological progression of RA. The use of such antiresorptive therapy as denosumab – monoclonal antibodies to RANKL (receptor activator of nuclear factor kappa-B ligand), reduces the activity of osteoclasts, increases bone mineral density (BMD), and also potentially affects the erosive process at RA. The aim of the study is to evaluate the effect of denosumab therapy on BMD and erosion count in patients with RA and osteoporosis (OP) in consideration of the positivity in the RF and ACCP in serum and the baseline RA activity. Materials and methods. The 12-month prospective study of the efficacy of denosumab therapy (60 mg subcutaneously every 6 months) in patients with RA and OP included 66 postmenopausal women; age – 59.4±7.5 years, duration of RA – 17.8±10.6 years, RF-positive – 47 (72%) patients, ACCP-positive – 48 (74%) patients. At baseline and after 12 months, dual-energy X-ray absorptiometry was performed with an assessment of BMD in the lumbar spine (L1– L4), proximal femur (hip neck and total hip), distal forearm; X-ray of the hands and distal parts of the feet in direct projection, followed by assessment of erosive-destructive changes according to the Sharp/van der Heijde method. Results. A significant increase in BMD was established in all studied sites of the skeleton despite the positivity of the RF and ACCP (for the hip neck p=0.05), while a significant increase in BMD in the RF- and ACCP-negative group was detected only in L1–L4 site. The progression of the increase in erosion count was noted in the RF- and ACCP-positive group while in the RF- and ACCP-negative group this indicator did not change. Regardless of the baseline activity of RA (by DAS28 (Disease Activity Score 28)) the BMD of most parts of the skeleton were stabilized. In patients with moderate RA activity, BMD increased significantly in L1–L4 in both groups: RF- and ACCP-positive and -negative , as well as in the total hip – in RF- and ACCP-positive group. The dynamics of the erosion count in RA patients did not depend on the baseline degree of DAS28 activity, no significant changes were detected in the analyzed groups. Conclusions. RF and ACCP positivity in serum in patients with RA and OP treated with denosumab did not have a negative effect on the dynamics of BMD, while the number of erosions increased. The baseline RA activity level did not affect the dynamics of the erosion count and the dynamics of BMD in most subgroups – BMD levels have been increased or stabilized.

The article presents current data on synovitis (inflammation of the synovial membrane), which is often the only clinical manifestation of osteoarthritis (OA), and considered to be one of the risk factors for the OA development. Synovitis severity correlates with the severity of OA symptoms. The assessment of the prevalence of synovitis presents significant difficulties and depends on the nature and severity of the disease, the cohort in question, diagnostic method, and therapy. The classification based on etiological, clinical and histological characteristics of synovitis is presented. Examination of synovial tissue characteristics and its changes during inflammatory response can significantly expand the possibilities for therapy and prognosis. The use of symptomatic delayed-action drugs (SYSADOA) is considered as the basic treatment of OA. Chondroitin sulfate (Chondroquard®) is one of the well established drugs, it has symptom- and structural-modifying properties. The article presents the results of studies confirming its effectiveness in reducing the severity of knee synovitis.

The article presents a review of cross-sectional studies and long-term prospective observations dedicated to changes in bone mineral density (BMD) in patients with rheumatoid arthritis (RA) and factors influencing it. The relationship between local bone loss (erosion count) and generalized BMD loss was noted. It is indicated that existing RA treatment strategies are aimed at suppressing inflammation rather than preventing bone resorption. There is evidence that anti-inflammatory therapy using glucocorticoids, methotrexate, and biologic DMARDs in combination with antiresorptive drugs (bisphosphonates and denosumab) helps prevent BMD loss and the progression of erosions. It is emphasized that osteoporosis in RA, which belongs to the immune-mediated secondary osteopathies, is one of the most frequent and serious complications of RA, which determine the unfavorable course and prognosis of the underlying disease.

Objectives: evaluation of the clinical efficacy and safety of the healthy joints maintaining compound Artroflex® in knee osteoarthritis (OA) in postmenopausal overweight women in outpatient clinical practice.Patients and methods. An open, prospective observational single-center post-marketing study included 30 postmenopausal women 50–75 years old (mean age 62.3±6.3 years) with knee OA. Patient body mass index (BMI) was >25 (mean body weight 85.3±15.3 kg). Radiographically confirmed primary gonarthrosis stage II according to Kellgren–Lawrence was detected in 26 (87.0%) patients, stage III – in 4 (13.0%). The duration of knee OA ranged from 1 to 21 years (average 7.8±6.1 years).Artroflex® was prescribed 1 capsule 2 times a day for 3 months. During three visits (baseline, after 1 and 3 months), the need for analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) and the occurrence of adverse reactions (AR) were determined. Health status and pain level were also assessed using a visual analogue scale (VAS), the severity of pain and stiffness, limited function according to the WOMAC questionnaire, fatigue/fatigue according to the FACIT scale, the Charlson comorbidity index, satisfaction of the doctor with the results of treatment using the IMOS scale, and satisfaction of the patient with using the IMPSS scale.Results and discussion. A statistically significant decrease in the pain score according to the VAS, an improvement in health status, and the WOMAC index were found in the overwhelming number of patients, regardless of BMI. 90% of women noted decrease in fatigue/fatigue on the FACIT scale, and 93% of patients reported satisfaction with treatment, regardless of the Charlson comorbidity index. The need for NSAIDs after one month of use of the Artroflex® compound decreased by 7%, after 3 months – by 23%. A negative feedback was found between the baseline indicator of health status and the assessment of the effectiveness of therapy. No serious ARs were identified during the study.Conclusion. Feasibility of using the Artroflex® compound in real clinical practice in patients with knee OA and excessive body mass has been shown.

The article discusses the treatment of patients with primary generalized osteoarthritis (OA), a common joint lesion of different localization. Clinical guidelines are presented that provide guidance on various drug and non-drug approaches in the treatment of primary generalized OA. In accordance with the modern understanding of the pathogenesis of OA, the role of inflammation and the influence of various pro-inflammatory factors, the priority of anti-inflammatory therapy, primarily non-steroidal anti-inflammatory drugs (NSAIDs), is justified. A clinical case of a 5-year observation of a patient with primary generalized OA and low compliance to treatment with symptom-modifying slowacting drugs is described. For articular syndrome exacerbations etoricoxib (Kostarox®) was mainly used as an analgesic and anti-inflammatory agent at a dose of 60 mg / day for 7–14 days with a good effect. Due to self-isolation and inability to visit a doctor during COVID-19 pandemic, the patient took etoricoxib for a long time (up to 200 days) for severe neck- and backpain relief, the duration of some courses was up to3 months. We discuss the possibility of etoricoxib use not only in the «on demand» mode, but also for a long time – until the effect is achieved.

Objective: comparison of the accuracy of risk assessment of low-energy fractures in patients with rheumatoid arthritis (RA) using the prognostic model developed at V.A. Nasonova Research Institute of Rheumatology, and the Russian model of the FRAX algorithm.Patients and methods. A prospective long-term observational non-interventional study included 70 women aged 40–80 years with a definite diagnosis of RA (ACR, 1987). All patients underwent dual-energy X-ray absorptiometry at baseline and over time; clinical and anamnestic data were analyzed, including information on fractures that occurred during the observation period, confirmed by medical documents.Results and discussion. The sensitivity and specificity of the FRAX algorithm were 67 and 56%, the sensitivity and specificity of the prognostic model of V.A. Nasonova Research Institute of Rheumatology – 78 and 56%, respectively. The diagnostic accuracy of the FRAX algorithm and the predictive model was 58 and 61%, respectively.Conclusion. The predictive model developed at V.A. Nasonova Research Institute of Rheumatology, showed higher diagnostic accuracy and sensitivity, as well as comparable specificity with the FRAX algorithm in assessing fractures in RA patients.