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Myokines are hormone-like acting molecules produced in skeletal muscles during and immediately after exercise. They affect both paracrine (inside the muscles themselves) and endocrine manner (in adipose tissue, liver, endothelium, skin, mucosa etc.) implementing different effects on target tissues, mainly through regulation of metabolic processes (such as glucose and lipid metabolism, growth and division of neurons and endothelial cells and others). The examination of myokines is of great interest for researchers of different medicine departments, particularly for endocrinologists, because of myokines’ involvement in pathogenesis of abdominal and visceral obesity, diabetes mellitus type 2 and cardiovascular diseases that are all the components of metabolic syndrome. The most important issue for clinicians is a possibility of future therapeutic implication of the myokine’s signal pathways in treatment of widespread metabolic disorders.

Представлено краткое изложение клинических рекомендаций по диагностике и лечению остеопороза, разработанных членами Российской ассоциации эндокринологов при участии членов Российской ассоциации по остеопорозу (ревматологов, травматологов, терапевтов, гинекологов-эндокринологов). Рекомендации разработаны с позиций доказательной медицины, в соответствии с требованиями к составлению клинических рекомендаций Минздрава России, опубликованными в 2016 г. Значительное место в изложении отведено диагностике остеопороза у взрослых, дифференциальной диагностике с другими метаболическими заболеваниями скелета, а также принципам патогенетического лечения остеопороза. Клинические рекомендации полезны будут как врачам общей практики, так и специалистам, прежде всего эндокринологам, ревматологам, травматологам-ортопедам, гинекологам, нефрологам, гастроэнднрологам и неврологам, так как остеопороз является мультифакториальным и мультидисциплинарным заболеванием

The Wnt/β signaling pathway (Wnt-SP) is a phylogenetically ancient mechanism that regulates development and maintains tissue homeostasis through the control of cell proliferation, differentiation, migration, and apoptosis. The accurate regulation of the canonical Wnt/β-catenin signaling pathway (Wnt-SP) is critical for embryogenesis and postnatal development; and impaired signal transduction at one of its stages leads to various diseases, including organ malformations, cancers, metabolic and neurodegenerative disorders. The literature review discusses the biological role of the canonical Wnt-SP in the development of the skeleton and in the remodeling of bone tissue. The Wnt signal transmission changes observed during genetic mutations cause various human skeletal diseases. Understanding the functional mechanism involved in the development of bone abnormality could open new horizons in the treatment of osteoporosis, by affecting the Wnt-SP. The design of antibodies to sclerostin, a Wnt-SP inhibitor, is most promising now. The paper summarizes the studies that have investigated the canonical Wnt-SP and designed drugs to treat osteoporosis.

The article describes two clinical cases of severe primary hyperparathyroidism (PHPT) caused by parathyroid carcinoma in young female patients who underwent molecular genetic testing to rule out the hereditary forms of PHPT. In both patients, heterozygous germline nonsense mutations of tumor suppressor gene CDC73 encoding parafibromin (p.R91X and p.Q166X) were identified using next-generation sequencing with Ion Torrent Personal Genome Machine (Thermo Fisher Scientific — Life Technologies, USA). It is the first description of CDC73 mutations in Russia, one of the mutations is described for the first time in the world. Identification of germline mutations in the CDC73 gene in patients with PHPT necessitates regular lifelong screening for other manifestations of hyperparathyroidism-jaw tumor syndrome (HPT-JT), PHPT recurrence due to parathyroid carcinoma as well, and identification of mutation carriers among first-degree relatives.

Microribonucleic acids (miRNAs) are a class of noncoding RNAs that regulate posttranscriptional gene expression. These molecules are regulators of cell proliferation, metabolism, apoptosis, and differentiation. MiRNAs are not degraded by RNAases and their concentrations can be measured in different body fluids, including serum. The expression of miRNAs varies in intact tissues and tumors, including pituitary adenomas. Pituitary tumors are encountered in 22.5% of the population and, in a number of cases, may be asymptomatic, but in case of invasion or/and hormone overproduction, their clinical presentation is severe with multiple symptoms leading to disability and even death. The mechanisms for the development and progression of pituitary tumors and the markers for remission and recurrence have not been adequately investigated. This literature review discusses the biological significance of miRNAs in pituitary tumors and the potential value of circulating miRNAs as biomarkers.

Clinical symptoms of vitamin D deficiency may be quite misleading and masked as rare hereditary syndromes. We describe a family, sister and brother presented with the pain in lower extremities at the age of 14 and 16years accordingly, with severe vitamin D deficiency that was misdiagnosed in the course of the disease with pseudohypoparathyroidism and 1-alpha-hydroxylase deficiency. They benefited from treatment with alfacalcidol and ossein-hydroxyapatite complex supplement which were further discontinued due to socioeconomic factors. At presentation after 2 years without treatment extremely low 25(OH)D levels were revealed. The patients' family history was remarkable for the same clinical features in mother and her Indian ancestry. Thus we describe an uncommon manifestation of severe vitamin D deficiency in a familial setting which emphasizes the necessity of vitamin D testing in calcium or parathyroid disorders.

This review discusses the recent evidence showing that the skeleton itself produces at least two hormones: fibroblast growth factor 23 (FGF23) and osteocalcin. FGF23 is secreted by osteocytes in bone and acts on the kidney to inhibit 1-alpha-hydroxilation ofvitamin D and promote phosphorous excretion. The affinity of FGF23 to FGF receptor is low, but FGF23 binds to FGF receptor-Klotho complex with more affinity. Therefore, Klotho determines the kidney-specific action of FGF23. Increase in FGF23 or Klotho levels due to genetic defects or ectopic production results in low serum phosphorous levels in humans. Contrary to this, low FGF23 or Klotho levels lead to hypophosphatemia and ectopic calcification. Mouse genetics studies revealed that osteoblast product, osteocalcin, in its undercarboxylated stage acts on the pancreatic beta-cells to enhance insulin production and on peripheral tissues to increase glucose utilization as a result of increased insulin sensitivity and to reduce visceral fat. In addition to this, undercarboxylated osteocalcin may also have another hormonal role, this time as a mediator of testosterone secretion. Osteocalcin was shown to induce testosterone production in Leydig cells of the testes both in ex vivo and in vivo studies. In both localizations, at the pancreas and at the testes osteocalcin acts through the GPCR6A receptor, this activates the cAMP response element-binding protein signaling pathway. Thus, this review reports the recent studies indicating bone ’s role as an endocrine organ.

The article briefly reviews the specific features of target-organ lesions in multiple endocrine neoplasia type 1 (MEN1) syndrome and a clinical case of genetically confirmed MEN1 syndrome in a young female patient. Despite the relative rarity of this disease, timely diagnosis, treatment and screening for its main components are very important for the overall prognosis of patients with MEN1 and their first-degree relatives who are MEN1 gene mutation carriers. The described case is noteworthy for a number of specific features. The authors could find no account of optic chiasm glioma within the framework of MEN1 in the literature. Moreover, therapy-resistant somatoprolactinoma engages attention, which points to its aggressive nature with pituitary adenoma that is not been clearly visualized on magnetic resonance imaging. Of interest is the order of detection of neoplasms, in particular the manifestation of hypoglycemic episodes as a sign of organic hyperinsulinism, which have been initially regarded as epileptic seizures, after the use of sustained-release somatostatin analogues for the treatment of acromegaly.

Переломы при остеопорозе представляют собой крайне неблагоприятное осложнение заболевания, и нередко могут иметь, и что особенно ярко проявляется при переломах бедра, катастрофические последствия в пожилом возрасте. Терипаратид является принципиально новым по механизму действия, анаболическим, средством лечения остеопороза, который улучшает МПК, снижает риск вертебральных и невертебральных переломов, уменьшает болевой синдром и повышает физические возможности. Мы представляем описание двух клинических случаев эффективного применения терипаратида у пациентов с тяжелым остеопорозом с множественными переломами, получавших ранее длительное лечение антирезорбтивными препаратами.

This study estimates the recovery of bone mineral density (BMD), markers of bone remodeling and quality of life in patients with endogenous Cushing’s syndrome (CS) after 12 months of achieving remission. Materials and methods: 21 patients with CS were prospectively evaluated at active stage of the disease and after being in a full remission (substitutional therapy with hydrocortisone or normal 24 hours urinary free cortisol (24h UFC) and late-night cortisol) during 12 months.A thoracic and lumbar X-ray was performed to reveal vertebral fractures. Bone mineral density (BMD) was measured by DXA ((Prodigy, Lunar, GE, USA). The level of 24h UFC was measured on a VitrosECi. Late-night serum cortisol and markers of bone remodeling were assayed by ECLIA Cobas e601 Roche. Patients fulfilled EQ-5D, ECOS-16 questionnaires and performed "up-and-go ”, "tandem ” and "chair-rising ” tests. Results: Among enrolled patients 17 (80%) were females and 4 (20%) - males; median of age (Q25-Q75) - 41 (33-49) years old; in 10 cases (48%) low traumatic fractures were diagnosed: 7 patients suffered from vertebral fractures; in 3 cases - ribs fractures. After the achieving remission no new fractures were registered and significant improvement in Z-score was reviled at all regions: L1-L4 -1,8 [-2,6; -0.5] at active stage vs -1,2 [-2,2; -0.5] after 12 months of remission (p=0.05); Neck Z-score -0,9 [-1,7; - 0,8] vs -0,7 [-1,6; -0,3], (p=0,003). The level of both bone metabolism markers increased: osteocalcin from 8,2 (6,912,0) to 22,7 (12,1-36,5) ng/ml (p=0,01) and CTx from 0,35 (0,22-0,63) to 0,7(0,28-1,05) ng/ml (p=0,01); whereas 24hUFC decreased from 1449 (926,4-2371) nmol/24h to 66,4(54,2-76,4) nmol/24h (p=0,01). The quality of life significantly improved at all dimensions if measured by ECOS-16. According to the EQ-5D patients suffered less from pain 1,35 (0,49) vs 1,12 (0,34), (p=0,04) and reported the improvement in their health (visual analogue scale) from 49 (18,9) to 68 (10,9), (p=0,004), but did not differ in others dimensions. Although 100% of patients admitted the improvement in their functional ability, the difference in functional tests did not reach statistical significance. Conclusions: Achieving the remission of CS improves BMD and quality of life in patients with CS. However, longer time is needed for full recovery, including the functional performance.

В статье представлен обзор современной литературы и результаты наших исследований, обобщающие экспериментальные и клинические данные о влиянии цинакалцета на гормонально-биохимические показатели фосфорно-кальциевого обмена, на маркеры костного метаболизма, минеральную плотность костей, также на гистоморфометрические показатели почечной остеодистрофии у гемодиализных пациентов с вторичным гиперпаратиреозом

The article presents a literature review summarizing the contemporary data on the effects of drug therapy on various parameters of renal osteodystrophy: phosphate binders, vitamin D preparations, bisphosphonates, denosumab, and calcimimetics. We discuss the results of pilot study of the efficacy of teriparatide and denosumab on parameters of bone metabolism in patients with chronic kidney disease.

This review of the literature has been dedicated to experimental and clinical studies of mechanism of action and efficacy of 1—34 amino acid fragment of parathyroid hormone — teriparatide as well as others contries experience of its prescribtion. Teriparatide is an osteoanabolic agent which stimulates bone formation by affecting bone modeling and by stimulating bone remodeling. The effects on modeling lead to increased bone formation whereas the effects on bone remodeling lead to increased bone turnover. Thus, in its mode of action teriparatide differs from all others medicines currently available to treat osteoporosis. Daily subcutaneous injections of teriparatide are proved to be effective to prevent low-traumatic vertebral and non-vertebral fractures in postmenopausal women with the history of vertebral fractures. Teriparatide is effective to treat osteoporosis in male and even more effective than alendronate to treat glucocorticoid-induced osteoporosis. Due to high cost and some restriction related to the duration of therapy (up to 18 months in Russia and 24 months in others countries) teriparatide should be recommended to treat severe osteoporosis in patients with a history >1 moderate clinical vertebral fracture or two or more vertebral fragility fractures or in case the previous treatment was not effective. Teriparatide should be prescribed after bisphosphonates or other antiosteoporotic treatment, but not in the combination with bisphosphonates. The prescribtion of bisphosphonates after teriparatide is effective to maintaine and further improve the effect. Thus, teriparatide is effective to treat severe osteoporosis and osteoporosis resistant to other therapy.

Постепенное увеличение продолжительности жизни человека, стремление к улучшению ее качества требует улучшения результатов профилактики и лечения остеопороза. Основную часть лиц, подверженных ОП, составляют женщины в менопаузе. Разносторонний подход к проблеме восстановления баланса костного метаболизма привел к внедрению в практику препаратов с различными механизмами действия. В последнее время крайне важным аспектом является повышение приверженности к лечению пациентов, получающих многолетнее лечение остеопороза. Инновационным шагом является внедрение в практику применения нового препарата моноклонального человеческого антитела к лиганду RANK деносумаб. В обзоре представлены результаты сравнительных многоцентровых слепых рандомизированных исследований эффективности деносумаба и пероральных бисфосфонатов. Показано более выраженное достоверно влияние деносумаба (подкожно 60 мг 1 раз в 6 мес.) на прирост МПК во всех отделах скелета (как богатых трабекулярной, так и кортикальной костной тканью), значимое снижение риска переломов при хорошей переносимости лечения.

In this critical review, we have summarized the specific evidence on ibandronic acid (Bonviva) efficacy, tolerability, feasibility and safety acquired from randomized controlled clinical trials, meta-analyses, bridging trials, long-term extension studies, observational studies and clinical experience. We have paid special attention to reviewing the surrogate endpoints, which are routinely used in clinical practice to estimate the treatment efficacy as well as those high technology methods that are currently used in research centers to predict anti-fracture efficacy. Although the only registered indication for Bonviva in Russia is for postmenopausal osteoporosis, we have reviewed the available clinical trials on the efficacy of ibandronic acid to prevent postmenopausal osteoporosis, to treat low bone mass in males, to treat and prevent glucocorticoid induced osteoporosis and other types of secondary osteoporosis and, in particular, in patients after organ transplantation. In addition to this, we have extensively discussed the currently available data on the safety of pharmacologic treatment for osteoporosis.

The objective of this study was to investigate the prevalence of low traumatic fractures, the factors influencing fractures in endogenous Cushing’s syndrome (CS) of various etiologies and their contributions into functional abilities and quality of life in patients with CS. Materials and methods: the retrospective data of patients, who had received treatment due to endogenous CS, (2001-2011), was evaluated. All enrolled patients underwent standard spinal radiographs in lateral positions of the vertebrae Th4-L4. Recent low traumatic non-vertebral fractures were recorded in the medical cards. Bone mineral density (BMD) was measured by DXA GE Lunar Prodigy. Serum samples on octeocalcin (OC), carboxyterminal cross-linked telopeptide of type I collagen (CTx), latenight cortisol in serum were assayed by electrochemiluminescence (ECLIA). 24h urinary free cortisol (24hUFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether). Functional assessment was performed using «chair rising», «up and go» and «tandem» tests. Universal pain assessment tool (verbal descriptor scale, Wong-Baker facial grimace scale, activity tolerance scale), EQ-5D and ECOS-16 questionnaires were given to patients and they self-reported their conditions. Results: Among 215 patients, 178 were females and 37 males, median age 35 (Q25-Q75 27-48); 88patients (40,9%) had low traumatic fractures, including vertebral fractures in 76 cases (in 60 cases multiple vertebral fractures) and non-vertebral fractures in 27 cases (17 patients had rib fractures, 3 -fractures of metatarsal bones, 2 fractures of radius, 2 fractures of tibia and fibula, 1 humerus, 1 breastbone; 1 hip fracture). Patients with fractures had higher 24hUFC, late-night cortisol in serum, lower OC, Total Hip BMD, but did not differ in age, BMI, CTx or etiology of CS. After applying the logistic regression analysis (adjusted for sex, age, BMI, BMD, OC), the main predictor of fractures was late-night serum cortisol level (p=0,001). Patients with late-night serum cortisol higher than 597 nmol/l were more likely to have low traumatic fractures (Odds ratio 2,86 (95%CI 1,55-5,28) p=0,001). Patients with fractures suffered from more pain and reported worse functional abilities. They had slightly worse results in «tandem» test, but did not differ in other functional tests, which assessed mainly muscle power. Conclusions: Patients with CS have very high risk of low traumatic fractures. The severity of hypercortisolemia is the best predictor of low traumatic fractures in patients with CS. Patients with fractures sufferedfrom more severe pain and because of this they restricted their daily activity even more than patients with CS without fractures. Consequently, patients with higher levels of late-night serum cortisol need earlier preventive treatment for osteoporosis.

The authors review the current literature data on the pathogenesis, clinical manifestations and treatment of glucocorticoid induced osteoporosis in patients with endogenous hypercortisolism. High levels of glucocorticoids lead to bone loss, bone quality deterioration and low traumatic fractures as a consequence of reduced bone formation. In addition to this, muscle weakness and sex steroids hormone abnormalities increase the risk of falls and fractures. The new available data on possible mechanisms of these changes including the involvement of RANKL/RANK/OPG, Wnt-betacatenin signaling pathway and pathogenesis of myopathy are discussed. This review also outlines the practical recommendation and new questions that should be evaluated in future research.

Purpose. Endogenous Cushing’s syndrome (CS), usually affecting young and otherwise healthy patients, is a good model to validate the effects of supraphysiological levels of glucocorticoids in humans. This study evaluates circulating levels of extracellular antagonists of Wnt/ß-catenin signaling pathway (sclerostin, Dickkopf1 (Dkkl), secretedfrizzled-related protein 1 (SFRP1)) along with osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa-beta ligand (RANKL) in patients with CS as compared to healthy individuals. Materials and methods. Forty patients with clinically and biochemically evident CS and 40 sex, age and body-mass index matched healthy individuals provided fasting serum samples (8:00-10:00AM) for measurement of sclerostin, SFRP1 and Dkkl, RANKL., OPG along with bone turnover markers. Serum samples on RANKL., OPG., Dkkl, SFRP1, sclerostin were frozen and then concurrently measured by an enzyme immunoassay (ELISA) using commercially available reagents. Serum samples on osteocalcin (OC), carboxyterminal cross-linked telopeptide of type I collagen (CTx), cortisol in serum and saliva were assayed by electrochemiluminescence (ECLIA) Cobas e601 Roche. Urinary free cortisol (24hUFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether) on a Vitros ECi. All participants were questioned regarding any recent low traumatic fractures. Patients with CS underwent standard spinal radiographs in anterior-posterior and lateral positions of the vertebrae Th4-L4 (Axiom Icons R200 "Siemens"). Results. Patents with CS (30 (26-40) years old with 24hUFC 2575 (1184-4228) nmol/l (Me (Q25-Q75)) had suppressed OC and normal CTx levels as compared to healthy subjects. A significant correlation, which we observed between OC and CTx (po=0.724 (p

Background. Secondary hyperparathyroidism (sHPT) is one of the serious complications in chronic kidney disease and is associated with progressive bone disease and vascular calcification.The objective of the study was to determine the impact of Mimpara (Cinacalcet HCl) on mineral disorder, bone turnover and bone mineral density (BMD) versus parathyroidectomy (PTx) in haemodialysis patients’ refractory to alfacalcidol. Materials and methods. 62 haemodialysis patients with sHPT were enrolled in this 6=months prospective study. All of them had surgical indications for PTx. Surgical indications was established according to clinical or biological assessment. 40 patients underwent Mimpara treatment. Dose of Mimpara was titrated every 4 weeks. Sequential doses included 30–180 (mean 59.1 ± 34.2) mg/day. 22 patients underwent PTx. The surgical technique was depended on quantity of hyperplastic parathyroid glands.Results. In 6 months mean iPTH, Ca, Са×Р, CTx and OC levels significantly decreased by 55.7%, 13.8%,34.3%, 21.4 and 1.4% in the Mimpara group vs. 90.7%, 14%, 55.5%, 58.7% and 26.9% in the PTx group. Median serum iPTH level decreased by 30% after initiation of Mimpara in 94.3% patients, from them by 50%in 74.3%. Achieved the KDOQI treatment targets for PTH in 28.6% patients.In 6 months after PTx median serum iPTH level was 100 pg/ml in 50% patients, achieved the KDOQI treatment targets in 27.3%, 300 pg/ml in 18.2%. Median serum 25(ОН)D after PTx significantly increase by 127.3% vs 6.72% in the Mimpara group. In 6 months active restoration of BMD was found in the PTx patients, and patients treated with Cinacalcet showed stabilization of BMD.Mimpara therapy led to a reduction in glandular volume during the course of the study: in both glands with a baseline volume 500 mm3 and with a baseline volume ≥500 mm3. Conclusions. PTx and Cinacalcet therapy improves phosphorus=calcium homeostasis, bone turnover, but bone resorption and formation markers decreased better in the PTx group compared to Cinacalcet group. The effectiveness and safety of Mimpara for secondary hyperparathyroidism were evaluated in dialysis patients’ refractory to alfacalcidol, which reduced the need for parathyroidectomy in patient without severe osteodystrophy.

Цель: оценить возможности маркёра костеобразования - остеокальцина (ОК) для диагностики эндогенного гиперкортицизма. Материалы и методы: В проспективной части работы ОК исследовался методом электрохемилюминисцентного иммуноанализа (ЭХЛА) на автоматизированном анализаторе Cobas e601 (Хоффман Ля Рош) у пациентов с ожирением (П=106), направленных для исключения эндогенного гиперкортицизма. В ретроспективной части оценивались возможности остеокальцина для диагностики вторичного остеопороза среди больных с постменопаузальным остеопорозом (ПМО) и эндогенным гиперкортицизмом (n=106). Пациентам с подозрением на эндогенный гиперкортицизм проводилось исследование уровня свободного кортизола в слюне в 23.00, малая проба с дексаметазоном (МПД). Тестом, подтверждающим генез эндогенного гиперкортицизма, было гистологическое исследование опухоли гипофиза, надпочечника или АКТГ-продуцирующего образования после хирургического лечения или данных аутопсии. Кривые операционных характеристик использовались для оценки и сравнения диагностических возможностей ОК. Точка разделения выбиралась с учётом максимальной суммы чувствительности и специфичности. Результаты: Среди 106 пациентов с ожирением (средний возраст 38±14 лет; ИМТ= 36±7 кг/м2) эндогенный гиперкортицизм был подтверждён у 42 пациентов. Точка разделения - уровень ОК 8,3 нг/мл: чувствительность 73,8% (95%CI 58,9-84,7%), специфичность 96,9% (89,3-99,1%); прогностическая ценность положительного результата теста 23,6 (95°%CI 5,9-93,5), прогностическая ценность отрицательного результата теста 0,27 (0,16-0,45), отношение правдоподобия для положительного результата теста 87,4 (18,2418,7). Площадь под кривой операционной характеристики теста (ОК)- 0,859 (95°%CI 0,773-0,945), что для данной категории пациентов имело меньшую диагностическую ценность по сравнению со свободным кортизолом в слюне и МПД (p

Обзор литературы посвящён патогенетической обоснованности, эффективности и безопасности применения деносумаба в терапии постменопаузального остеопороза. Обсуждается механизм действия препарата, сходства и отличия по отношению к другим препаратам для лечения остеопороза. Подробно представлены результаты II и III фаз клинических исследований деносумаба, в том числе в сравнении с алендроновой кислотой и возможности назначения деносумаба после лечения бисфосфонатами. Отдельное внимание уделяется безопасности и практическим аспектам терапии деносумабом

Calcium-sensing receptor (CaSR), a member of G proteincoupled receptors family, plays a key role in systemic calcium homeostasis regulation. It is expressed in a variety of tissues, and is responsible for maintaining plasma calcium concentration. In addition, the CaSR is known to regulate some important cellular processes such as apoptosis and proliferation. CaSR is a drug target for calcimimetics and calcilytics, agents used for modification of parathyroid cells function and treatment of some pathologic conditions. Inactivating or activating mutations of the CaSR gene cause different disorders of calcium metabolism. Polymorphic variants of the gene have been described in healthy populations.

Primary hyperparathyroidism (PHPT) is a common disorder often associated with reduced bone mineral density (BMD) and osteoporosis. The main goal in treating patients who refuse surgery is the correction of bone complications. The aim of this study is to evaluate safety and efficacy of alendronate treatment in patients with PHPT and osteoporosis. Eligible patients were postmenopausal women suffering from PHPT who did not meet surgical guidelines or ignored surgery due to different reasons. 55 osteoporotic or osteopenic women received alendronate 70 mg weekly and 43 were leaved under medical observation for the reasons of not being osteoporotic or financial unable to comply with treatment/ Results: After 2 years of treatment alendronate group showed statistically significant gain in BMD at L24 +4,0±4,2%, Neck +2,2±4,4%„ TH +2,3±4,5%. At the same time observational group showed decrease in BMD at L24 -4,2±4,0%, TH -3,5±3,8%, R33% -4,0±6,5%, [95% CI -7,6; -0,4]. On the whole BMD dynamics in groups differed at the following sites: L2 (p=0,00004), Neck (p=0,005), TH (p=0,001), R33% (p=0,006). ' Alendronate intake was accompanied by serum Ca decrease (at 1 year point -4,3±5,4%, p=0,00005, at 2 year -2,7±6,4%, p=0,04), 24 hours'Ca excretion decrease from (Me) 8,5 to 6,3 mmol/day at 1 year point, (p=0,007) without PTH elevation. As well as CTx fell at Me: 66% at 1 year and at 60% at 2 year point and OK at 39% and at 27%, correspondingly, p

Despite the relatively low incidence of acromegaly (60-70 cases per I million inhabitants), this disease has a special place among the heterogeneous group of diseases that lead to the defeat of the locomotor apparatus. The slow growth of the clinical manifestations of acromegaly and as a consequence, late diagnosis, the cause of early disability and premature death of patients. In order to improve the quality of life and social adaptation of patients to date is an obvious need to identify groups of patients with acromegaly, requiring additional therapy for osteoporosis and osteoarthritis. We performed the search in bibliographic bases MEDLINE and Cochrane Collaboration from 2000 on 2009. Key words were the following: acromegaly, acromegaly and arthropathy, osteoporosis and acromegaly, the bone mineral density and acromegaly, fractures and acromegaly. In this article the data about role of risk factors for the defeat ofosteoarticular apparatus, the dynamics of the articular syndrome and the state of bone tissue in acromegaly.

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that affects bones, urinary tract, cardiovascular system, gastrointestinal tract, and another organs and tissues. The most cases of PHPT are mild forms and those patients have nonspecific symptoms, which require careful diagnostic considerations and choice of treatment. There is not enough data about prevalence of PHPT, especially it's mild forms, in Russian Federation, and future epidemiological research needs to be done. Present literature review includes information about etiology, pathogenesis, clinical findings, diagnostic and differential diagnostic, indication for surgery and medical treatment of PHPT. The review is based on data of studies from the different countries and few studies from Endocrine science center.

Central diabetes insipidus is a rare pituitary disease due to impairment of synthesis or/and secretion of vasopressin (AVP), characterized by polyuria, polydipsia, low urine osmolality and hyperosmolality of plasma. Main therapy for CDI is substitutive therapy with desmopressin. Lately, it has been shown that AVP stimulates bone formation through the induction of PG synthesis in mesangial cells, contributing to prevent osteoporosis. Pivonello et al. (1998) found that patients with CDI even on nasal desmopessin therapy had a significant impairment in BMD and serum osteocalcin. The aim of this study was to assess the biochemical parameters of bone metabolism and the bone mineral density (BMD) in patients with idiopathic variant of CDI, treated with oral desmopressin. In 24 patients with idiopathic CDI, treated with oral desmopressin and 24 healthy controls we evaluated BMD (analyzer Prodigy, Lunar, DXA), serum osteocalcin (OK) and C-terminal telopeptide of type I collagen (CTx), (ECLIA, Roche Elecsys 1010/2010) as well as calcium total, ionized calcium and alkaline phosphatase (analyzer Hitachi 912, commercial kits Roche). Anterior pituitary dysfunction and concomitant conditions associated with osteoporosis were eliminated on clinical and laboratory basis. The results showed no significant differences between study groups with the exception for ionized calcium which was higher in the group of CDI (p=0,02). We were not able to confirm detrimental effects of idiopathic CDI on BMD and biochemical markers of bone metabolism.

Приведены 2 клинических случая поздней диагностики тяжелых форм первичного гиперпаратиреоза. повлекшие за собой неоправданные врачебные манипуляции, и развитие тяжелых осложнений заболевания. В первом случае из-за ошибочного диагноза остео... и нерасп ПГПТ пациентки подверглись многократным операциям на нижней челюсти. Во втором случае поздний диагноз ПГПТ у молодого пациента, несмотря на успешное хирургическое вмешательство привел к прогрессирующей ХПН и развитию вторичного гиперпаратиреоза.

В представляемой работе обобщен первый опыт применения Бивалоса в терапии ПМО в России. Целью настоящего исследования являлось изучение влияния терапии Бивалосом в течение года на МПК позвоночника, МПК шейки бедра и бедренной кости в целом, уровень маркеров костного метаболизма, а также на качество жизни и переносимость длительной терапии у пациенток с ПМО. В исследование включено 60 женщин от 55 до 75 лет с ПМО, проходивших лечение в 3 медицинских центрах г. Москвы (ЭНЦ, ИР РАМН, ЦИТО - по 20 пациенток в каждом центре). Через год применения Бивалоса отмечено достоверное увеличение МПК в поясничных позвонках на 4,68±4,94%, в шейке бедра на 2,0±4,29% и по общему показателю МПК проксимального отдела бедренной кости на 3,10±3,34%. Оценка динамики маркеров костного метаболизма выявила статистически значимый прирост КЩФ на 19,5% и снижение СТх на 16,4%, что подтверждает разнонаправленный эффект Бивалоса на костеобразование и резорбцию костной ткани. Терапия Бивалосом повышает качество жизни пациентов: расширяет двигательную активность, снижает уровень депрессии, повышает самооценку, уменьшается количество пациентов с болью в спине, снижаются уровень боли и частота ее возникновения. Бивалос хорошо переносится пациентами, частота НЯ, связанных с приемом препарата, не превышает 15%, а отмена препарата из-за НЯ составила 5%. Не наблюдалось серьезных побочных явлений. Наши результаты сходны с данными многоцентровых двойных слепых плацебо-контролируемых исследований с большой статистической мощностью.

Цель исследования. Оценить эффективность препаратов кальция и витамина Д для профилактики снижения МПК у женщин в постменопаузе с остеопенией и субклиническим тиреотоксикозом. Материалы и методы. 20 женщин в постменопаузе 60 (56-66) лет с остеопенией и субклиническим тиреотоксикозом (70% получали супрессивную терапию после операции по поводу дифференцированного рака щитовидной железы) были рандомизированно разделены на две группы: 1-11 человек получили рекомендации по расширению содержания кальция в рационе питания до 1000 мг; 2-9 человек получали 1000 мг кальция и 800 МЕ витамина Д3 (Кальций-Д3-Никомед форте - 2 жевательные таблетки в сутки). Всем пациентам давались рекомендации по расширению физической активности. Биохимические показатели крови (кальций общ. и иониз., фосфор, креатинин, щелочная фосфатаза, ХС, ТГ, ЛПВП, ЛПНП, ХС/ЛПВП); кальций/креатинин в утренней моче; маркёры костного метаболизма (остеокальцин и СТх), МПК в поясничных отделах позвонков, проксимальном отделе бедра и лучевой кости оценивались в начале и через год лечения. Результаты. Исходно пациенты 1 и 2 групп не отличались ни по каким показателям за исключением уровней маркёров костного метаболизма, которые были статистически значимо выше во 2 группе ((p=0,03 (ОК) иp=0,0035 (СТх)). Через 12 месяцев наблюдалось статистически не значимое снижение маркёров костного метаболизма преимущественно во 2 группе, при этом 1 и 2 группы перестали статистически значимо отличаться по уровню маркёров костного метаболизма. В обеих группах не наблюдалось изменений в уровнях кальция как в крови, так и в моче и не было выявлено снижения МПК. Выводы. Назначение препаратов кальция и витамина Д и рекомендации по расширению потребления кальция с продуктами питания одинаково эффективны для предотвращения потери МПК у пациентов с субклиническим тиреотоксикозом. Однако назначение 2 таблеток Кальций Д3 Никомед форте приводит к большему снижению маркёров костного метаболизма и, следовательно, может быть более эффективным для длительной профилактики.

The aim was to estimate the effects of treatment with alendronate (Fosomax 35 mg) in postmenopausal women with osteoporosis and subclinical hyperthyroidism. Thirty postmenopausal women (64 (60-69) years old) with osteoporosis (T-score ≤ -2,5) and subclinical hyperthyroidism (77% with endogenous subclinical hyperthyroidism and 23% on L-thyroxine suppres-sive therapy after thyroidectomy due to differentiated thyroid cancer) were randomly assigned into two groups: 1-14 women received Fosamax 35 mg a week in combination with 500 mg of calcium and 400 UI of Vitamin D3 (VD) daily; 2-16 women received 1000 mg of calcium and 800 UI of VD daily. Euthyroidism was achieved in all women with endogenous subclinical hyperthyroidism. An increase in physical activity was recommended to all patients and a hypolipidemic diet was given to those who had had high cholesterol level. Biochemical parameters (calcium (Ca), phosphorous (P), creatinine (Cre), alkaline phosphatase (ALP), cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), cholesterol/HDL ratio) in fasting serum as well as calcium/creatinine ratio in fasting urine (U-Ca/U-Cre); biochemical markers of bone metabolism: osteocalcin (OC) and C-terminal telopeptide of type I collagen (b-CTx) serum ("ECLIA", Roche Elecsys 1010/2010), BMD (DXA; Prodigy, Lunar) at the lumbar spine (L1-L4), femoral neck (FN), total hip (TH) and radius total (RT) were measured at the baseline visit and after 1 year of treatment. At the baseline visit there were not found any differences between the 1 and the 2 groups. After 12 months of treatment the markers of bone metabolism as well as ALP decreased significantly in both groups, though the decreases were significantly greater (p

The aims of the reported multinational open study were to estimate the influence of subcutaneous injections of 20 mkg daily Teriparatide on bone mineral density (BMD) at the lumbar spine and proximal femur, the markers of bone metabolism, the quality of life as well as the safety of treatment. Duration of the treatment period was one year. Fifty postmenopausal women with osteoporosis (L1-L4 T-score mean -3,2±0,6 SD) were enrolled in the study. 70,8% of patients had fragility fractures. Forty four patients (78%) remained until the end of the study. BMD was detected by dual energy X-ray absorptiometry (DXA) («Prodigy», Lunar and «Hologic» 4500 W) at the lumbar spine (L1-L4) and proximal femur with converting to the standardized BMD. Bone alkaline phosphatase (BAP) and osteocalcin (OC) were measured as markers of bone formation and C-terminal cross-linking telopeptide (CTX) were measured in serum as a marker of bone resorption. The significant increase in BMD was found at the lumbar spine (L1-L412,5±6,6%), whereas BMD at the proximal femur did not change significantly. The levels of markers of bone metabolism were increased after 3 months of the treatment and to the end of the study were 192,2%; 385%; 526,3% higher versus the baseline levels for BAP, OC., CTX consequently. There was also found a significant improvement in the quality of life of the patients which was estimated by EQ-5D inquirer at the baseline visit and at the end of the study. The adverse effects, which were related to the teriparatide injections, were observed in 44% of the patients. Due to the adverse effects Tereiparatide was cancelled for 6 (12%) patients. In other cases the adverse effects were slight and the cancellation of treatment was not required. Conclusions: The daily injections of Teriparatide (20 mkg) during 1 year provide the significant increase in BMD at the lumbar spine for postmenopausal women with osteoporosis as well as the early increase in the bone turnover rate. Treatment with Teriparatide improves the quality of life for women with postmenopausal osteoporosis. The daily injections of Teriparatide during 1 year are well tolerated and safe.

An open clinical trial evaluating effects of Pravastatin (P) 20 mg, Fluvastatin (F) 40 mg versus Calcium-D3 Nycomed Forte (1000 mg calcium and 800 ME cholecalciferol - CaD3 ) on bone metabolism, bone mineral density (BMD) and lipid metabolism have been conducted. We studied 80 osteopenic women from 60 to 80 years old, divided into three groups: 30 participants were treated by CaD3 during 12 months, at the same time 30 ones applied P, and 20 women were treated by L for the 6 months. All of the remedies showed similar influence on the spine BMD (the basal BMD remained intact). CaD3 and L were able to prevent proximal hip from BMD loss whereas patients treated P proceeded to lose bone mass (up to 1.3-1.5%). We have found that CaD3 provides an antiresorptive action (СТх became 27.2% lower and OC -4.1%), that P doesn't touch bone metabolism indices and dual action of L: it suppress a bone resorption (СТх was 14,1% reduce) and show an invigorative action on bone formation (ОК 25,5% raised). The CaD3 treatment was the less expensive, and the highest cost had P course. Our comparative study reveals that CaD3 is preferable in solitary osteoporosis prevention. However when osteopenia or validity OP risk factors coexist with dyslipidemia, type II particularly, use of L may be rational because of it's 6th month therapy had rather equal effect to one of year CaD3 consumption.

Aim. To investigate efficacy, tolerance and safety of the drug vitrum osteomag one tablet of which contains 600 mg calcium (1500 mg calcium carbonate), 200IU of cholecalcepherol, 40 mg of magnesium, zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 meg) in women with osteopenia for prevention of osteoporosis Material and methods. Л multicenter comparative open trial ofvitrum osteomag influence on mineral bone density (MED), change of pain syndrome in bones, index of calcium-phosphorous metabolism covered 334 postmenopausal women with osteopenia. MBD was measured in low-back spine and proximal part of the hip with DEXA method. All the patients were divided into 3 groups: 125 women taking 2 tablets ofvitrum osteomag daily for 12 months (group 1); 111 women taking 1500 mg calcium carbonate (group 2); 96 women - control group (only observation). Results. Vitrum osteomag relieved pain in the back and joints, had a positive effect on bone density (+1.5%) and proximal parts of the hip (0.6-0.93%) exceeding the effect of calcium carbonate only which preserves the initial MBD in low back spine but does not prevent bone loss in the hip. MBD dynamics in patients given vitrum osteomag differs essentially from one in the control group (from -1.9 to -2.91%) which demonstrates a reliable preventive anti-osteoporotic effect of this medication. The drug increases the level of general and ionized calcium in blood but does not cause hypercalcemia lowering the level of parathormone in blood. The rate of side effects in group 1 was 14,4% and did not differ much from that in group 2 (16.2%). Conclusion. The results of the study allow to recommend vitrum osteomag for prophylaxis of a rapid loss of bone tissue mineral density.

Прошло несколько десятилетий с момента выделения из общей хирургии и утверждения в реестре медицинских специальностей кардиохирургии, нейрохирургии как самостоятельных дисциплин. Сейчас это покажется странным, но в свое время острые споры вызывало отделение от хирургии таких специальностей, как урология и оториноларингология. Необходимость организации специализированных хирургических служб в те уже далекие времена аргументировалась следующим: • огромным количеством больных, нуждающихся в специализированной помощи, появлением большого числа специалистов; • отсутствием и несоблюдением отраслевых стандартов лечения хирургами, выполняющими эти операции время от времени; • невозможностью осуществить статистический учет больных и объективно оценить результаты лечения; • стагнацией развития науки в этих областях. С нашей точки зрения, наступило время для того, чтобы рассмотреть через призму вышеперечисленных проблем необходимость организации службы эндокринной хирургии в России.

Schwartz-Bartter Syndrome (synonyms: syndrome of inappropriate secretion of antidiuretic hormone syndrome of inappropriate secretion of vasopressin, anti-diabetes insipidus) - this is a rare disease characterized by excessive secretion of antidiuretic hormone (ADH) from the posterior pituitary, or other source, resulting in developing hyponatremia and water intoxication. Hyponatremia dilutions at Schwartz-Bartter Syndrome is usually non-specific symptoms, such as headache, nausea, vomiting and confusion. Marked reduction in blood sodium levels may lead to seizures or even coma.