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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.

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.

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.