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Summary Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients. Purpose To analyze associations of osteoporosis with geriatric syndromes in patients aged 65 years and older in the Russian Federation. Methods A total of 4308 patients (30% men) aged 65–107 years were examined and distributed into 3 age groups (65–74 years, 75–84 years, and 85 years and older). All patients underwent a comprehensive geriatric assessment. In the “Falls and risk of falls” module, the number and circumstances of falls over the previous year were analyzed, as well as the history of fractures. The presence of osteoporosis was determined based on medical records. Physical examination included anthropometric measurements and standard enquiry, short physical performance battery (SPPB), dynamometry, measurement of gait velocity, Mini-Cog test, and orthostatic test. Results A total of 507 patients (11.8%) had evidence of osteoporosis; indications of low-energy fractures in history were recorded in 739 (17.3%) patients. Patients with osteoporosis were older, shorter, and predominantly women; had a lower body weight and a higher Charlson comorbidity index; and took more drugs. Patients with osteoporosis had lower gait velocity, hand grip strength, Barthel index value, and scores of the Lawton instrumental activities of daily living scale, the MNA (Mini Nutritional Assessment) short-form, and the SPPB. Osteoporosis is associated with almost all geriatric syndromes (GSs), and the occurrence of osteoporosis in patients over 65 years of age increases by 1.2–2.5 times. Conclusions Osteoporosis is associated with almost all GSs. The association of osteoporosis with advanced GSs aggravates the condition of these patients. Early diagnosis of osteoporosis and GSs is very important. Additional programs should be adopted by the state to introduce information about the possibilities of working with elderly patients: early detection and correction of osteoporosis.

[English] Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system. Screening to identify groups with a high probability of fracture is recommended using the FRAX® Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX® (B2). It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3). It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2). It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3). All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2). [Русский] В связи с непрерывным старением населения и увеличением количества лиц старшего и пожилого возраста остеопороз стал социально значимым заболеванием, приводя к инвалидности, повышая уровень смертности и создавая тем самым дополнительную нагрузку на систему здравоохранения. Скрининг для выявления групп с высокой вероятностью переломов рекомендован с использованием Алгоритма FRAX® среди всех женщин в постменопаузе и мужчин старше 50 лет (А1). При наличии патологических переломов крупных костей скелета (бедренной кости, тел(а) позвонков(-а), множественных переломов) в анамнезе рекомендовано устанавливать диагноз остеопороза и назначать лечение независимо от результатов рентгеноденситометрии поясничного отдела позвоночника и проксимального отдела бедренной кости или FRAX® (B2). Рекомендуется определение С-концевого телопептида при назначении антирезорбтивной терапии и исследование уровня N-терминального пропептида проколлагена 1-го типа (P1NP) при назначении анаболической терапии пациентам, получающим лечение остеопороза, исходно и через 3 месяца от начала терапии с целью ранней оценки эффективности лечения и приверженности к терапии (А2). Рекомендовано устанавливать диагноз остеопороза и назначать лечение пациентам c высокой индивидуальной 10-летней вероятностью основных патологических переломов (FRAX®) независимо от показателя рентгеноденситометрии поясничного отдела позвоночника и проксимального отдела бедренной кости (В3). Рекомендовано устанавливать диагноз «остеопороз» и назначать терапию при снижении МПК, измеренной при DXA, на 2,5 и более стандартных отклонения по Т-критерию в шейке бедренной кости, и/или в целом в проксимальном отделе бедренной кости, и/или в поясничных позвонках у женщин в постменопаузе и у мужчин старше 50 лет (А2). Для предупреждения патологических переломов и повышения МПК у пациентов с постменопаузальным остеопорозом, остеопорозом у мужчин, глюкокортикоидным остеопорозом рекомендуется прием бисфосфонатов, деносумаба или терипаратида (А2). Пациентам с остеопорозом без патологических переломов при достижении клинического эффекта терапии (МПК до -2,0 SD по Т-критерию в шейке бедренной кости и отсутствие новых переломов) рекомендовано на 1-2 года прекратить терапию бисфосфонатами с последующим динамическим наблюдением (B2). Пациентам с переломами тел позвонков, бедренной кости или множественными переломами в анамнезе рекомендуется продолжать непрерывное длительное лечение остеопороза (В3). Все препараты для лечения остеопороза рекомендуется назначать в сочетании с препаратами кальция и колекальциферола (А2). С целью своевременного назначения терапии остеопороза и обеспечения длительного наблюдения за пациентами в возрасте 50 лет и старше с патологическими переломами для снижения риска повторных переломов рекомендуется создавать Службы профилактики повторных переломов (В2).

To compare the effect of 12 months of treatment with moxonidine or bisoprolol on telomerase activity (TA) and parameters characterizing the arterial wall state in postmenopausal women with arterial hypertension (AH) and osteopenia. An open-label randomized study with 114 postmenopausal women with hypertension and osteopenia; pulse wave velocity (PWV), intima-media thickness (IMT), and TA were analyzed initially and after 12 months of therapy with moxonidine (n = 57) or bisoprolol (n = 57). Both medications effectively lowered blood pressure (BP) in both groups. After 12 months, the moxonidine group showed a significant increase in TA by 45.5% (from 0.87 to 1.15; p

Background: Falls in elderly–a multifactorial syndrome. One of the modifiable factors is polypharmacy. STOPP/START criteria are used for correction of polypharmacy in geriatrics.Aim: Assessment of the prevalence of polypharmacy, analysis and correction of pharmacotherapy using STOPP/START criteria in patients with falls.Materials and methods: The study included 655 patients hospitalized in the geriatric department over 60 years of age, who were divided into two groups. Group 1 (n=332, 50.7%)–patients with 1 or more falls, group 2 (n=323,49.3%)–patients without falls. The analysis of the received therapy before hospitalization was performed. After that, based on the indications, contraindications and STOPP/START criteria, drug therapy was corrected in patients with falls.Results: Patients of group 1 took 4.5±2.18 drugs, group 2–4.3±2.6. Polypharmacy was diagnosed in 150 (45.2%) patients with falls and in 122 (37.8%) patients without falls. Patients with falls were more likely to receive sleeping pills, NSAIDs. Univariate analysis showed that falls were associated with NSAIDs (OR 2.15, 95% CI 1.38–3.35, p=0.001) and sleeping pills (OR 2.03, 95% CI 1.02–4.02, p=0.047). An audit and correction of therapy was performed: in 108 (32.5%) patients the number of prescribed drugs was reduced. Patients with falls were prescribed statins, antidementia drugs, anticonvulsants and antidepressants as components of therapy for chronic pain syndrome, chondroitin sulfate and glucosamine sulfate for the treatment of osteoarthritis, calcium and antiresorbtive therapy, antianemic drugs, vitamin D. Antiplatelet agents, digoxin, sleeping pills and NSAIDs were less frequently prescribed. STOPP/START criteria and their frequency in patients with falls were analyzed. 141 cases of potentially non-recommended but prescribed medications were identified. STOPP criteria were for the administration of NSAIDs (n=53, 37.6%) and acetylsalicylic acid (n=62, 44%). There were 458 cases of potentially recommended but not prescribed medications. The most common START criteria were not for the administration of vitamin D and statins.Conclusion. Half of elderly patients with falls have polypharmacy. These patients are more likely to take sleeping pills and NSAIDs. STOPP criteria most often concerned the appointment of NSAIDs and acetylsalicylic acid, and the START criteria revealed the absence of the appointment of vitamin D and statins.

Background. To reduce the number of osteoporotic fractures in the world in recent years, — Fracture Liaison Service has been created. Since 2019, the development of a register of patients included in the Secondary Fracture Prevention named «Prometheus» has begun in Russia.Materials and methods. An information system for storing, searching and processing information has been created, and a registration card has been developed. Six FLS participate in the register management. As of 10.03.2021, data on 387 patients were introduced in the register.Results. Among the included patients, 46.25% received a fracture of the proximal femur, 20.41% — of the vertebral bodies and 16.80% of the proximal humerus, the rest had fractures of other localizations. The risk of fractures was assessed in all patients. A high risk of major osteoporotic fractures according to FRAX was determined in 160 (43.24%) people. Two-energy X-ray absorptiometry (DXA) was performed in 152 (39.28%) patients, and osteoporosis was detected in 103 (67.76%), osteopenia — in 42 (27.63%) patients. The risk of falls was assessed in 100% of the included patients, and the risk of falls was determined to be high in 343 (88.63%) patients. Evaluation of various laboratory parameters to find the causes of secondary osteoporosis was performed in most patients. After consultation with the FLS doctor, anti-osteoporotic drugs were prescribed to 241 (64.27%) people. Among the rest, 70 (52.24%) patients had contra-indications and 31 (23.13%) people needed further examination.Conclusions. Thus, the use of the register allows you to evaluate all the main sections of the organization of assistance within the FLS and compare them with international standards to identify «gaps» and improve the work of the service.

The world's population is aging rapidly, with increasing prevalence of many chronic diseases that are more common in older people. Osteopenia and osteoporosis are two chronic conditions often diagnosed in frail older patients, and both seem to be a significant public health burden. In Russia, osteoporosis (in accordance with the criteria of the World Health Organization) was detected in 33.8% of women and 26.9% of men aged 50 and over. Every minute in the country, 7 vertebral fractures happen, and every 5 minutes — a fracture of the proximal femur occurs. According to the latest data, about 34 million people in Russia are at high risk of developing low-energy fractures. The use of anabolic therapy in older patients with severe osteoporosis can achieve optimal results in the accumulation of bone mineral density and significantly reduce the risk of repeated low-energy fractures.

Background: Osteoporosis and cardiovascular disease (CVD) are among the most common causes of morbidity, disability and death worldwide. In recent years, more and more data have been accumulating on the presence of an age-independent relationship and general pathogenetic mechanisms of a decrease in bone mineral density (BMD) and the development of CVD. It has been shown that a decrease in BMD is an important independent predictor of the risk of atherosclerosis of the great arteries and is associated with increased calcification of the aorta and other vessels. The strongest relationship between these parameters was observed in the study of the female population, in connection with which we selected a group of middle-aged women for analysis.Objective: to investigate the association between bone mineral density and carotid intima-media thickness in middle-aged women.Results: 35 women were included in the study. The mean age was 44,74±4,32 years. We found the following changes in arterial wall characteristics: atherosclerosis — 21,9% women, increased carotid intima thickness — 15,7% women. Low bone mineral density for chronological age (Z-criteria -2,0 and less) was found in 7 patients at the age of 35±2,7 years. We discovered a negative correlation between the markers of subclinical atherosclerosis and bone mass: Ccarotid intimamedia thickness negatively correlated with bone mineral density in hip (pConclusion: The findings about negative association between bone mineral density of hip with preclinical markers of atherosclerosis allow us to make a conclusion about their interaction.

Aim: to assess the most important metabolic factors in centenarians and their impact on prognosis Materials and methods. It was a longitudinal study, including 64 centenarians (95 years and older), who live in Moscow. Complex geriatric assessment (FRAIL, IADL-C, MNA, GDS-15 and МOCA scores) and blood tests (HbA1c, cholesterol, LDL, HDL and TG) were performed. In 3 years we contacted patients’ relatives or social workers to find out about patients’ status. Results. Mean age of the patients was 98,3±1,9 years. We found out that 34,4% of the patients were frail. Cognitive impairments of different severity were presented in 84,4% of the patients. The median lipids values were as follows: cholesterol — 4,8 [4,2 ;5,8], TG — 0.97 [0,8; 1.2], HDL — 1.3 [4.2; 5,8), LDL — 3,1 [2,6; 3,7], HbA1c — 5,8 [5,6; 6,1]. In 59% of the patients HbA1c was below 6%; 33% had concentrations between 6% and 6,4%, and only in 8% we found HbA1c higher than 6,5%. No correlation was also found between HbA1c values and lipids profile. Comparing survivors and non-survivors groups we did not find any significant differences in total cholesterol, LDL, HDL and HbA1c (pConclusions. In centenarians usual prognostic factors such as HbA1c and lipids do not have any impact on prognosis but they influence functional status and QoL. Further investigations of metabolic status in super old persons are needed to personalize their lifestyle and treatment goals.

BACKGROUND: Insulin resistance accelerates the aging process, but its speed depends on the individual characteristics of the metabolism. One of the reasons for the different aging rates in individuals with insulin resistance is the initially different “genetic protection” of cells, which many scientists associate with replicative cellular aging.AIMS: to study the relationship between the state of carbohydrate metabolism and markers of replicative cell aging in individuals with different sensitivity to insulin.MATERIALS AND METHODS: The observation study included 305 patients. The parameters of glucose metabolism and telomere biology were studied.RESULTS: The mean age of the patients was 51.5±13.3 years. Patients were divided into three groups depending on presence of insulin resistance: healthy, with insulin resistance and with type 2 diabetes. The mean age of healthy patients was 48.82±13.87 years, in insulin resistance group — 53.04±12.8, in 2 diabetes mellitus — 58.4±7.90. The median telomere length was 9.76. The median telomerase activity was 0.48. Both telomere length and telomerase activity progressively decrease as insulin resistance increases. In patients with diabetes, short telomere lengths and low telomerase activity predominated. The insulin resistance index has the greatest impact on the risk of detecting “short” telomeres. In patients with insulin resistance, an increase in glycated hemoglobin increases the likelihood of detecting short telomeres by 2.4 times, and in diabetes mellitus by 4.26 times, an increase in fasting plasma glucose by 90%, and an increase in HOMA-IR by 35%. An increase in insulin resistance increases the risk of detecting «low» telomerase activity by 53% and the risk of detecting «very low» telomerase activity by 92%. A decrease in synsulin resistance increases the chance of increasing telomerase activity to «very high» by 51%.CONCLUSION: Shorter telomeres are associated with more pronounced disorders of carbohydrate metabolism and a higher degree of insulin resistance. Further studies of metabolic status are necessary to personalize their lifestyle and treatment goals.

Elderly and senile people are characterized by a high prevalence of osteoporosis, which, in turn, increases the risk of fractures, including the repeated ones. Fractures in osteoporosis are an extremely unfavorable complication of the disease, leading to catastrophic consequences in old age. The prevalence of osteoporotic fractures progressively increases with age. At present, the cumulative frequency of hip fractures in women over 80 is about 30%. The proportion of vertebral fractures in women older than 80 years is up to 40% of all vertebral osteoporotic fractures. Despite the tremendous successes achieved in the diagnosis and treatment of osteoporosis, the disease itself and related fractures remain a serious medical, economic and social problem. Prevention of recurrent fractures in geriatric patients is a system of preventive, rehabilitative and therapeutic measures aimed at reducing the risk of falls, choosing an effective therapy, and reducing the risk of recurring fractures. A serious problem in the treatment of osteoporosis in older people is the inefficiency of the antiresorptive therapy due to an age-related decrease in bone formation. There are frequent cases of a continuing decrease in bone density, the occurrence of repeated fractures during ongoing therapy of osteoporosis. Often the therapy of choice in this case is bone-anabolic therapy with teriparatide, which allows one to achieve good results in the accumulation of bone mineral density. In this article, we will present the clinical case of an elderly patient with severe osteoporosis, in which teriparatide became the drug of choice.

Patient: Female, 28 Final Diagnosis: Primary hyperparathyroidism Symptoms: Clavate swelling of the tubular bones • deformation of ribs and pelvic bones • duck gait • gait disturbance • general weakness • joint restrictions • keeled thorax • lameness • muscle weakness • pain in the bones and joints • rachiocampsis Medication: — Clinical Procedure: C-section in the lower uterine segment by transverse incision • a thoracoscopic removal of ectopic formation of the parathyroid gland Specialty: Obstetrics and Gynecology Objective: Rare co-existance of disease or pathology Background: Primary hyperparathyroidism is most common in women during the menopause and its occurrence in pregnant women is rare. However, because neonatal mortality is associated with maternal hyperparathyroidism, early diagnosis is essential. This report describes the case of a late diagnosis of primary hyperparathyroidism in a 28-year-old pregnant woman and describes the effects on the mother and neonate. Case Report: During her second pregnancy, a 28-year-old woman presented with symptoms of general weakness, bone and joint pain, multiple fractures with bone deformity, muscle weakness, and gait disturbance. Due to the high risk of perinatal pathology, a cesarean section was performed. Several weeks later, she underwent thoracoscopic removal of an ectopic parathyroid gland located at the aortic arch. Hypocalcemia in the newborn infant required treatment with calcium and magnesium supplements. Conclusions: This case demonstrates that primary hyperparathyroidism during pregnancy requires timely diagnosis and treatment to reduce potential maternal and fetal complications. Screening for primary hyperparathyroidism should be undertaken in pregnant women with any symptoms associated with hypercalcemia. Treatment should be individualized and includes conservative management, parathyroidectomy in the second trimester, or parathyroidectomy performed in the early postpartum period.

BACKGROUND: Older adults with osteoporosis (OP) and high risk of falls are the most vulnerable group of patients with respect to the development of fractures. Falls and fractures in elderly patients with OP are associated with geriatric syndromes and worse functional status.AIM: To аssess comorbidity and geriatric status in elderly and senile patients with and without OP.MATERIALS AND METHODS: The study included 607 patients over 60 years of age hospitalized in the geriatric department. According to the presence of OP, the patients were divided into 2 groups: group 1 — patients with OP (n=178, 29.3%), group 2 — patients without OP (n=429, 70.7%). All patients underwent a general clinical study, an assessment of comorbidity ­according to the Charlson index, and a comprehensive geriatric score.RESULTS: OPs had 178 (29.3%) patients, more often these were women. 55.6% of patients with OP were disabled. Age-­related diseases such as Alzheimer’s disease, Parkinson’s disease, osteoarthritis, anemia, thyroid disease, varicose veins were significantly more common in patients with OP. With almost all of these diseases, a univariate analysis revealed an association with OP. Geriatric syndromes such as frailty, hypodynamia, malnutrition, polypharmacy, urinary incontinence were significantly more common in group 1 patients. Patients with OP were more likely to live alone and use mobility aids compared to patients without OP.The univariate analysis demonstrated that OP is associated (OR 1.54 to 2.00) with frailty, hypodynamia, the use of aids in movement, sleep disorders, sensory vision deficiency, urinary incontinence. The Functional status of patients with OP was worse compared to patients without OP. Patients with OP suffered more fractures, and vertebral fractures were significantly more frequent.CONCLUSION: Patients with OP have a high comorbidity, a burdened geriatric status. In elderly patients, it is necessary not only to screen and diagnose OP, to assess the risk of 10-years probability of major pathological fractures using the FRAX algorithm, but also to conduct a comprehensive geriatric assessment to diagnose geriatric syndromes that weaken the course of OP and lead to more serious consequences.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

[English] 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. [Русский] Представлено краткое изложение проекта федеральных клинических рекомендаций по остеопорозу, разработанных членами Российской ассоциации эндокринологов, Российской ассоциации по остеопорозу, Ассоциации ревматологов России, Ассоциации травматологов-ортопедов России, Российской ассоциации по менопаузе и Российской ассоциации геронтологов и гериатров. Рекомендации разработаны с позиций доказательной медицины, в соответствии с требованиями к составлению клинических рекомендаций Минздрава России, опубликованными в 2019 г. Значительное место в изложении отведено скринингу первичного остеопороза у взрослых, дифференциальной диагностике с другими метаболическими заболеваниями скелета, современным методам диагностики остеопороза, принципам назначения патогенетического лечения, особенности последовательной и комбинированной терапии, профилактики заболевания и реабилитации. Клинические рекомендации полезны будут как врачам общей практики и терапевтам, так и узким специалистам, прежде всего эндокринологам, ревматологам, травматологам-ортопедам, нефрологам, акушерам-гинекологам и неврологам, так как остеопороз является мультифакториальным и мультидисциплинарным заболеванием.

Objective: To assess the effect of moxonidine on bone metabolism and bone mineral density (BMD) in postmenopausal patients with arterial hypertension (AH) and osteopenia. Materials and methods: A randomized, open, clinical trial included 114 postmenopausal patients with AH. All participants were evaluated bone metabolism), BMD, telomerase activity (TA). Randomization was carried out into 2 groups (moxonidine and bisoprolol therapy) using simple envelopes. After 12 months of therapy, a dynamic examination was performed. Results: Both groups showed a positive effect of both moxonidine and bisoprolol on hypertension during treatment both as monotherapy and in the group of patients receiving combined antihypertensive therapy: a decrease in SBP and DBP in the 1st group was 13.6% and 12.8% respectively, and in the 2nd group - 13.7% and 15% respectively, while achieving normal values. In most patients of group 1, normalization of body weight was noted in comparison with group 2 (23.4% and 17.4%, respectively, p = 0.043), delta of body weight in the moxonidine group was -1.89%. The increase in the processes of bone formation in the form of increased markers of OC and Osteoprotegerin and a statistically significant increase in TA in patients receiving moxonidine were revealed, while in women who took bisoprolol there were no dynamic changes in bone metabolism rates, there was a tendency for a decrease in BMD and a significant decrease in AT. Conclusions: The detected pleiotropic effect of moxonidine on bone metabolism and replicative cell aging processes will reduce the risk of development or progression of osteopenia and osteoporosis in postmenopausal women with AH.

Aim. To investigate on the presence and relation characteristics of glycemia variability (GV) and vascular wall parameters, chronic inflammation, oxidation status, telomere biology in type 2 diabetes patients (DM2). Material and methods . Into the single-movement study, 50 DM2 patients included, with no signs of cardiovascular diseases. All participants were evaluated on the carbohydrate metabolism, glycemia variablity, underwent duplex scan of carotid arteries with intima-media complex (IMC) measurement, and assessment for atherosclerotic plaques; underwent carotid-femoral pulse wave velocity measurement, endothelium dependent vasodialtion, telomere length measurement and telomerase activity (TA). Results. The parameters of vessel wall, together with the classical CVD risk factors, independently related with the various carbohydrate metabolism parameters: glycated hemoglobin, fasting glucose plasma, HOMA-IR index, C-peptide, immune reactive insulin. The GV of moderate amplitude of glycemia (MAGE) was related to IMC increase in DM2 patients. There was significant relation of telomere length (TL) not just with a chronic hyperglycemia, but with glucose level fluctuations as well, e.g. with GV standard deviation (SD), MAGE, CONGA (continuous overall net glycemic action), and such relation is higher in the analysis of “the longest” telomeres. Relation of TL and GV is not dependent on the cardiovascular risk factors, chronic inflammation and TA, but depends on fasting plasma glucose. There was no significant relation of TA with GV in DM2. There was direct correlation of GV CONGA and oxidative stress marker malonic dialdehyde, and independent negative correlation of GV (MAGE, SD, CONGA) with TL. Conclusion. GV is related with subclinical atherosclerosis (IMC) and shorter TL in DM2 patients, which is mediated by activated oxidation stress under glycemia fluctuations.

Background Despite the growing interest to the theme, the gut microbiota (GM) composition and functional capacity in relation to cardiovascular diseases (CVD) have been poorly studied. It is not well studied in nonagenarians or centenarians who live much longer than others with postponed CVD. In this study, we assessed GM in association with different metabolic factors in healthy middle-aged adults and the elderly at the turn of a hundred years old. Purpose Our aim was to study GM in a healthy cohort (HC) with different metabolic risk factors and in an extremely elderly cohort (EC) of long livers from our city. Methods The study included HC of 104 untreated subjects aged from 25–76y (52±13) carefully selected through the exclusion of CVD and other chronic diseases by means of clinical (with different specialists consultations to exclude any factors of inflammation) and a wide range of laboratory evaluation, ECG, treadmill test, ECHOCG, carotid artery ultrasound and the second group of 20 long livers 97–100y (98±1). EC underwent a complex geriatric assessment, also a wide range of laboratory evaluation, ECG, ECHOCG, carotid artery ultrasound. GM composition was studied by the V3-V4 16S rRNA sequencing. Taxonomic units were identified with QIIME 1.9.1. Statistical analysis was done by using the Phyton v.3.2 programming language. Metabolic reconstruction was performed with PICRUSt algorithm. All GM analyzes performed with age, sex and FDR adjustments. Results One of the most pronounced differences in GM between groups was a significantly higher representation of antiinflammatory Bifidobacterium genus in long livers (p=0.026 (MaAsLin), LDA=4.304). Among risk factors, high body mass index (BMI) was associated with a high abundance of conditional pathogens of Prevotella genus in HC (p Butyrate synthesis potential in EC vs HC Conclusions The EC were unexpectedly healthy. Considering the GM analysis, we may propose that EC microbiota protected long livers from the low-grade inflammation and thus protected them from the development of metabolic disorders by producing a high amount of butyrate, one of the most important anti-inflammatory agents in the human body. Conditional pathogens (the inflammation initiators) associated with BMI and IMT as well as butyrate producers may subsequently become a target for cardiovascular prevention. Acknowledgement/Funding Governmental support

Age-associated arterial wall changes create an enzymatically and metabolically favorable environment for cardiovascular diseases development. Understanding the essence of the processes underlying the development of CVD can open up new opportunities for more effective preventive actions. Age, gender, blood pressure, lipid levels, type 2 diabetes mellitus are traditional cardiovascular risk factors used in the most popular models, such as Framingham and SCORE. However, these risk stratification systems have a number of limitations and explain no more than 50% reduction in mortality from cardiovascular diseases. There is not enough information on the association between signs of arterial wall aging and factors that determine the aging processes in general and in their interaction with cardiovascular risk factors. The aim of the work was to study the relationship between parameters of arterial wall aging, traditional risk factors, hormonal status, leukocyte telomere length. A total of 303 ambulatory participants (104 males and 199 females) were recruited. The subjects ranged between 23 and 91 years of age, with a mean age of 51.8 ± 13.3 years. Based on the results obtained, the following conclusions can be drawn: the value of traditional cardiovascular risk factors for the vascular wall changes is reduced in older age; carbohydrate metabolism disorders and hypertension are “universal” risk factors most closely associated with the arterial wall condition in both younger and older group. To predict changes in the vascular wall, it is advisable to study insulin resistance, growth hormone, insulin-like growth factor-1 activity and leukocyte telomere length along with conventional cardiovascular risk factors.

Gut microbiota is an up-to date theme that is widely studied. Now it is obvious that microbiota could be considered as one of the factors affecting aging process. Some reports suggested the potential mechanisms by which gut microbes may influence human health span. Aging-related conditions are accompanied by decline in immune system functioning and low-grade inflammation, and our microbes play a certain role in these processes. Gut microbiota composition changes during the aging process may indicate a more pronounced aging-related health loss.

Purpose: The aim of this cross-sectional study was to explore a profile of left ventricular (LV) strain parameters in healthy older and to examine their association with telomere length - accepted marker of cellular senescence.Methods: Echocardiography and 2-D speckle tracking analysis was performed on 303 healthy volunteers aged 23 to 91 years without history of cardiovascular diseases (CVD). LV myocardial deformations were obtained using off-line analysis program QLAB (Philips). Telomere length was measured in peripheralblood mononuclear cells by a real-time quantitative polymerase chain reaction method.Results: Global longitudinal LV strain was reduced in older people without CVD. Radial strain of LV, apical and basal rotation, LV systolic twist were increased (p

Effective control of arterial pressure (AP) is achieved only in ⅓ of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people. Combination of a thiazide diuretic and a calcium antagonist has been recommended by modern guidelines on arterial hypertension (AH) management but until recently it has not found wide application because of absence of a fixed preparation. Evidence base of indapamide-retard and amlodipine use in AH, their profiles of efficacy and safety are such that their combination can become an alternative variant for treatment of patients with AH. Appearance of a fixed indapamide-retard/amlodipine combination opens new perspectives of effective therapy of AH with high SAP and PAP in elderly and other patients with high stiffness of arterial wall.

It is known that glucose disturbances contribute to micro- and macrovascular complications and vascular aging. Telomere length is considered to be a cellular aging biomarker. It is important to determine the telomere length role in vascular structural and functional changes in patients with diabetes mellitus. We conducted a cross-sectional observational study in a high-risk population from Moscow, Russia. The study included 50 patients with diabetes and without clinical cardiovascular disease and 49 control group participants. Glucose metabolism assessment tests, measuring intima–media complex thickness and determining the presence of atherosclerotic plaques, pulse wave velocity measurement, and telomere length measurement were administered to all participants. Vascular changes were more dramatic in patients with diabetes than in the control group, and the telomeres were shorter in patients with diabetes. Significant differences were found in the vascular wall condition among diabetes patients, and there were no substantial differences in the arterial structure between patients with ‘long’ telomeres; however, there were statistically significant differences in the vascular wall condition between patients with ‘short’ telomeres. Vascular ageing signs were more prominent in patients with diabetes. However, despite diabetes, vascular changes in patients with long telomeres were very modest and were similar to the vascular walls in healthy individuals. Thus, long lymphocyte telomeres may have a protective effect on the vascular wall and may prevent vascular wall deterioration caused by glucose metabolism disorders.

Insulin resistance plays the main role in the pathogenesis of diabetes mellitus and its complications. It is also a major factor of the pathology associated with age, which leads to accelerated aging. Data about the role of insulin resistance and its correction in vascular aging are presented.

Aim. To study the relationship between changes in the artery structure and function and peripheral lymphocyte telomere length in patients with type 2 diabetes mellitus (DM2). Materials and methods. A total of 50 patients with T2DM and without clinical manifestations of cardiovascular disease (CVD) were included in the study; the control group consisted of 49 people. The following tests were conducted for all study participants: carbohydrate metabolism evaluation, carotid artery duplex scan to measure intima?media complex thickness (IMT) and to determine the presence of atherosclerotic plaques, carotid?femoral pulse wave velocity (PWV) measurement and lymphocyte telomere length measurement. Results. The vascular changes were more pronounced in patients with T2DM than in controls. The telomeres were shorter in patients with T2DM than in those without diabetes (9.53?0.1 vs 9.86?0.1, p=0.033). The participants were divided according to the telomere length. Among patients with T2DM, there were significant differences in the condition of the vascular wall [PWV: 10.58?0.1 m/s in patients with ?long? telomeres and 15.08?1.3 m/s in patients with ?short? telomeres; IMT: 0.80?0.09 mm in patients with ?long? telomeres and 0.87?0.05 mm in patients with ?short? telomeres (p=0.024)]. There were no significant differences in the arterial structure between the patient and control groups with ?long? telomeres [PWV: 10.58?0.1 m/s vs 10.5?0.5 m/s (p=0.913); IMT: 0.080?0.09 mm vs 0.73?0.03 mm (p=0.12). However, there were significant differences in the vascular wall condition between the patient and control groups with ?short? telomeres [PWV: 15.08?1.3 m/s vs, 10.7?0.5 m/s (p=0.015); IMT: 0.87?0.1 vs 0.78?0.1 (p=0.03)]. Conclusions. The signs of vascular ageing were more pronounced in patients with T2DM than in controls. However, despite diabetes, vascular changes were minimal in patients with ?long? lymphocyte telomeres, comparable with the state of the vascular walls in healthy individuals. Thus, enhanced lymphocyte telomere length may have a protective effect on the vascular wall and may prevent damage from carbohydrate metabolism disorders.

Introduction: Type 2 diabetes mellitus (T2DM) contribute to vascular aging. The telomere length (TL) and telomerase activity (TA) are considered as biomarkers of cellular aging. TL and TA are insufficiently studied in diabetic patients. Hypothesis: Telomere biology is associated with vascular aging in diabetic patients. Methods: The study group included 50 patients with T2DM (mean age 58.4±7.83 years) and 139 healthy patients (mean age 57.45±8.14 years). All subjects were measured for TL and TA by quantitative polymerase chain reaction; oxidative stress marked by malondialdehyde (MDA); inflammation marked by C-reactive protein (CRP); arterial stiffness evaluated by pulse wave velocity (PWV); carotid intima-media thickness (IMT), plaque presence (PP) and endothelial dysfunction evaluated by flow-mediated endothelium-dependent vasodilation (FMV). Results: All patients were divided into 4 groups by the median of TL (9.75): «short» telomeres (T2DM+ (n=15) and T2DM- (n=63) and «long» telomeres (T2DM+ (n=35) and T2DM- (n=76)). Patients with T2DM and «long» TL had the state of vessels, oxidative stress, inflammation, TA as similar as in healthy people: PWV 11.54±3.57 (T2DM+) vs 10.98±1.83 m/s (T2DM-) ((=0.58), IMT 0.83±0.13 vs 0.76±0.16 mm (=0.13), PP 1.36±0.33 vs 1.23±0.20 (=0.79); MDA 2.81±0.78 vs 3.24±0.78 mkmol/l (=0.08); CRP 3.59±0.58 vs 3.66±0.50 mg/l (=0.93); TA 0.51±0.09 vs 0.60±0.05 (p=0.36). FMV was higher in diabetic patients: 11.87±3.36 vs 10.18±2.79 % (=0.049). In contrast patients with «short» TL and T2DM had more pronounced vascular aging, inflammation and lower TA than healthy people: PWV 13.48±3.24 vs 11.59±2.03 m/s (=0.003), IMT 0.95±0.17 vs 0.78±0.14 mm ( Conclusion: In patients with short telomeres and T2DM signs of vascular aging, chronic inflammation and cellular aging were more pronounced than in healthy people. In contrast, in patients with long telomeres and T2DM vascular changes, oxidative stress, chronic inflammation and TA were as similar as in healthy people. Perhaps long telomeres protect patients with T2DM from accelerated vascular aging.

Introduction With advancing age the left ventricle (LV) undergoes structural and functional changes, thereby creating the substrate for the development of diseases. One possible mechanism of the ageing heart is a cellular senescence. Leukocyte telomere length (LTL) is a marker of replicative ageing. The purpose of this study was to evaluate the structure and function of the LV in people of different ages free of cardiovascular diseases (CVD) and regular drug medication and to assess their relationship with LTL. We hypothesized that age-related changes in LV myocardium are associated with telomere length. Methods The study population consisted of 150 healthy, non-obese volunteers aged 28 to 78 years without history of CVD, significant deviations by 12-lead electrocardiogram and negative exercise test (treadmill stress test). All the participants underwent standardized transthoracic echocardiography using an available system (iE33; Philips). The LTL was measured by real-time quantitative polymerase chain reaction. We determined the relative ratio of telomere repeat copy number (T) to single-copy gene copy number (S). Results In the older people there was a higher wall thickness than in the younger (1.03±0.09 vs. 0.88±0.10, p

Background Chronic inflammation and oxidative stress might be considered the key mechanisms of aging. Insulin resistance (IR) is a phenomenon related to inflammatory and oxidative stress. We tested the hypothesis that IR may be associated with cellular senescence, as measured by leukocyte telomere length (LTL), and arterial stiffness (core feature of arterial aging), as measured by carotid-femoral pulse wave velocity (c-f PWV). Methods The study group included 303 subjects, mean age 51.8 ±13.3 years, free of known cardiovascular diseases and regular drug consumption. For each patient, blood pressure was measured, blood samples were available for biochemical parameters, and LTL was analyzed by real time q PCR. C-f PWV was measured with the help of SphygmoCor. SAS 9.1 was used for statistical analysis. Results Through multiple linear regression analysis, c-f PWV is independently and positively associated with age (p = 0.0001) and the homeostasis model assessment of insulin resistance (HOMA-IR; p = 0.0001) and independently negatively associated with LTL (p = 0.0378). HOMA-IR seems to have a stronger influence than SBP on arterial stiffness. In all subjects, age, HOMA-IR, LTL, and SBP predicted 32% of the variance in c-f PWV. LTL was inversely associated with HOMA-IR (p = 0.0001) and age (p = 0.0001). In all subjects, HOMA-IR, age, sex, and SBP predicted 16% of the variance in LTL. Conclusions These data suggest that IR is associated with cell senescence and arterial aging and could, therefore, become the main target in preventing accelerated arterial aging, besides blood pressure control. Research in telomere biology may reveal new ways of estimating cardiovascular aging and risk.

It is known that telomere length (TL) shortening is a marker of cell aging, which accelerated and progresses in type 2 diabetes mellitus (T2DM), despite the patient’s age, leading to the vascular aging. The aim of the study was to compare the vascular and cellular aging in patients with and without T2DM. Methods. TL was assessed by quantitative polymerase chain reaction (PCR) in 35 patients with T2DM (mean age 61±2,6 years) and in 43 healthy patients in mean age of 51±1,8 years. IMT and PP were determined by ultrasonography in both left and right carotid arteries. AS was appreciated by aortic pulse wave velocity (PWV) measuring by SphygmoCor (AtCor Medical). Results. All patients were divided into 2 groups by TL – “long” and “short” telomeres. Comparison of vascular aging parameters was carried out in groups with and without T2DM. Results are summarized in Tables 1 and 2. T2DM+ (n = 15) T2DM− (n = 23) p TL 10.2 ± 0.05 10.4 ± 0.1 0.06 PWV (m/s) 10.58 ± 0.1 10.5 ± 0.5 0.913 IMT (mm) 0.904 ± 0.09 0.77 ± 0.03 0.1227 PP (number) 0.886 ± 0.4 0.782 ± 0.2 0.979 Table 1Comparison in patients with “long” TL. T2DM+ (n = 20) T2DM− (n = 20) p TL 9.24 ± 0.1 9.28 ± 0.06 0.735 PWV (m/s) 15.08 ± 1.3 10.7 ± 0.5 0.0151 IMT (mm) 0.87 ± 0,1 0.78 ± 0.1 0.1814 PP (number) 1.125 ± 0.29 0.789 ± 0.22 0.04 Table 2Comparison in patients with “short” TL. Conclusion: in patients with short TL and T2DM the severity of vascular disorders is higher than in healthy people. In contrast, in patients with long TL with T2DM there are no significant differences in the vascular structure as compared with healthy individuals.