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Bisphosphonates are one of the most effective medications widely used in the treatment of osteoporosis. In the last 15 years, descriptions, and observations of unusual low-energy femoral fractures with atypical localization for osteoporosis after prolonged use of these drugs have been published. A 78-year-old patient applied to the osteoporosis center. She received parenteral bisphosphonate therapy for severe osteoporosis for 4 years. In 2017, a spontaneous fracture of the middle third of the femoral shaft was registered (the fracture occurred while walking). Regarding the fracture, metal osteosynthesis with a plate was performed. Subsequently, there was a delayed consolidation of the fracture with the formation of a false joint and the need for repeated surgical intervention. Examination of the patient revealed vitamin D deficiency, and significant negative trend in densitometry. A feature of this case is poor fracture consolidation and long-term uncompensated vitamin D deficiency. Physicians should be aware of this rare but serious complication of bisphosphonate therapy, as it requires discontinuation of antiresorptive drugs and the appointment of bone anabolic therapy for osteoporosis, which, in addition to treating the underlying disease, also promotes consolidation fracture.

Background Vitamin D plays a critical role in skeletal development and maintenance, thus sufficiency is an important goal for public health programs. Given the absence of foods fortified in vitamin D in Armenia, we hypothesized that vitamin D insufficiency would be widespread. Methods We conducted a random modified cluster model survey of vitamin D status of women in the country. We measured 25-hydroxyvitamin D [25(OH)D] by liquid chromatography mass spectrometry in dried blood spot samples and utilized a questionnaire to assess lifestyle factors. Results In summer, we sampled 1206 participants from 40 communities in Armenia. Mean 25-OH D level among women aged 18–24 was 20 ± 8 ng/mL; aged 25–64 was 21 ± 7 ng/mL; and >65 was 18 ± 8 ng/mL. The country-wide mean of the entire female population was 20 ± 8 ng/mL. A majority (>54%) had 25-OH D levels p values 0.004, 0.0002, and 0.03 respectively) as did pre- vs. postmenopausal women (p = 0.01), pregnant vs. nonpregnant women (p = p = 0.004). Conclusion In Armenia, there is a high prevalence of vitamin D insufficiency. This information provides data that can be used to inform public health directives to address this pervasive threat to optimal health.

[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).

Introduction EQ-5D-3L preference-based value sets are predominately based on hypothetical health states and derived in cross-sectional settings. Therefore, we derived an experience-based value set from a prospective observational study. Methods The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) was a multinational study on fragility fractures, prospectively collecting EQ-5D-3L and Time trade-off (TTO) within two weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months thereafter. We derived an EQ-5D-3L value set by regressing the TTO values on the ten impairment levels in the EQ-5D-3L. We explored the potential for response shift and whether preferences for domains vary systematically with prior impairment in that domain. Finally, we compared the value set to 25 other EQ-5D-3L preference-based value sets. Results TTO data were available for 12,954 EQ-5D-3L health states in 4683 patients. All coefficients in the value set had the expected sign, were statistically significant, and increased monotonically with severity of impairment. We found evidence for response shift in mobility, self-care, and usual activities. The value set had good agreement with the only other experience- and preference-based value set, but poor agreement with all hypothetical value sets. Conclusions We present an experience- and preference-based value set with high face validity. The study indicates that response shift may be important to account for when deriving value sets. Furthermore, the study suggests that perspective (experienced versus hypothetical) is more important than country setting or demographics for valuation of EQ-5D-3L health states.

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 public health burden of osteoporosis estimated by the results of clinical and population-based researches in most of the former USSR is uncertain for today. The objective of this audit (Audit-2020) was the epidemiological, medico-social and economic analyse of current and future osteoporosis challenges for the future years for eight countries of the Eurasian region.Methods.We did a search and critical analysis of the publications, including of regional in English, Russian or national languages, did organize a structured survey among national osteoporosis societies members in Armenia, Belarus, Georgia, Kazakhstan, Moldova, Uzbekistan, Kyrgyz Republic, Russia, as well as explored the demographic trends in these countries.Results.Scientific researches including the wide population-based EVA project discovered that the expected number of patients with osteoporosis varies from 240,000 in Armenia to 16 million in Russia. All the countries should be categorized as a moderate risk of hip fractures for women (200–300 cases /100,000 per year). Belarus, Moldova, Armenia, Georgia and Kyrgyzstan have moderate risk for men (100–150/100,000), as well as Russia, Uzbekistan and Kazakhstan are distinguished by a high risk for men (over 150 cases/100,000). Population aging trends are predicting the future growth in the osteoporosis-associated health challenges throughout the region. It is likely the number of osteoporotic fractures to rise in Uzbekistan, Kazakhstan and Kyrgyzstan the most: 2.5–3.5 times by 2050. However current hospitalization rates for hip fracture persons are low in most countries (33–80%), the diagnostic equipment is insufficient (0.2–1.3 per million), DXA testing are expensive. Although modern treatments are available, the cure expenses remain high. Hereby, immediate action is required in each country of audit, including admit osteoporosis is a priority public health problem.Conclusion.Osteoporosis is a challenge for the countries of the Eurasian region. Its burden is about to get worse due to the expected demographic changes.

Precise population-based data on the osteoporotic hip fracture (HF) rate play an invaluable role in the assessment of burden of osteoporosis as well as in development of the national clinical fracture risk prediction tool (FRAX). Currently, these data in Uzbekistan is unavailable. Aim. To create a system for the all HF detection to calculate their incidence in Uzbekistan, and to assess the general physicians (GP) and primary care nurses role in this system. Materials and methods. Cohort study was carried out in 20112017 in the Pap district of Uzbekistan We had revealed the national trauma care records peculiarities and then organized the prospective study. The trauma care records were monitored. Besides, all medical specialists including GPs, GP nurses and the community leaders were actively involved into the search and verification of non-hospitalized hip fracture patients escaping trauma care statistics. Results. Overall, among HF patients, only 34% were hospitalized, and 26% took outpatient trauma care. Additional 29% of HF patients were found only with the help of GPs. GP nurses in collaboration with the community leaders disclosed additional 11% patients who had been staying at home without any medical care. The annual standardized HF incidence in people older than 40 years enriched 357.7 for women and 190.2 for men per 100 000. Conclusion. Collection of epidemiological information on HF incidence in Uzbekistan was possible only with the help of GPs and GP nurses as key figures of primary care. The obtained epidemiological data will be incorporated into the first created Uzbek national FRAX model to assess the 10-year risk of osteoporotic fracture in clinical practice.

Bisphosphonates is a first-line therapy for treatment of osteoporosis. In the last decade, the number of atypical femur fracture (AFF) cases during long-term treatment with bisphosphonates has increased. The aim of this article was to analyze the literature data on this problem, to define the diagnostic criteria of AFF and to present the case of AFF in the patient who received treatment with alendronate for 3.5 years. A 78-year-old woman, receiving oral bisphosphonate for severe postmenopausal osteoporosis for 3.5 years, suddenly started feeling pain in her right thigh while walking. Three months later, she had got a fracture in middle third of the right femur after falling from her standing height. According to instrumental diagnostics, this fracture had all criteria of AFF. Blocking intramedullary osteosynthesis with shafts was performed. A retrospective analysis of soft tissue magnetic resonance imaging in the area of right thigh, done before the fracture, showed the presence of undiagnosed incomplete right femur fracture in the middle third, which subsequently led to a complete fracture. Presented clinical case demonstrates the complexity of AFF diagnostics. The purpose of the publication is to draw attention of medical specialists to the issue of this rare side effect of bisphosphonate treatment.

Age-specific intervention and assessment thresholds based on FRAX® were developed for eight Eurasian countries participating in the EVA study (Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan). The intervention thresholds (major osteoporotic fracture) ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for people at age 50 years, and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. These thresholds enable a substantial advance in the ease of detection of individuals at high fracture risk.The purpose of this study was to derive and compare FRAX-based intervention and BMD assessment thresholds for 8 Eurasian countries in the EVA study.The intervention threshold (IT) was set at a 10-year probability of a major osteoporotic fracture (MOF), calculated without BMD, equivalent to a woman with a prior fragility fracture but no other clinical risk factors, and a body mass index (BMI) of 25.0 kg/mThe age-specific intervention thresholds ranged from 3.6 (Armenia and Georgia) to 12.3% (Uzbekistan) for men and women at the age of 50 years and from 16 (Armenia) to 27% (Belarus) at the age of 90 years. The difference between countries was most evident at younger ages and become progressively less with advancing age.For the 8 Eurasian countries, the newly established FRAX-based intervention thresholds provide an opportunity to improve the clinical detection of both men and women with a high risk of fracture and improve treatment rates.

Summary Retrospective population-based survey in 2 regions of the Republic of Moldova determined the incidence of fractures at the hip, proximal humerus and distal forearm. The estimated number of such fractures nationwide for 2015 was 11,271 and is predicted to increase to 15,863 in 2050. The hip fracture rates were used to create a FRAX model to help guide decisions about treatment. Objective This paper describes the epidemiology of osteoporotic fractures in Republic of Moldova that was used to develop the country-specific fracture prediction FRAX® tool. Methods We carried out a retrospective population-based survey in 2 regions of the Republic of Moldova (Anenii Noi district and Orhei district) representing approximately 6% of the country’s population. We identified hip, forearm and humerus fractures in 2011 and 2012 from hospital registers and primary care sources. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Moldova. Fracture probabilities were compared with those from neighbouring countries having FRAX models. Results The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 3911 and is predicted to increase by 60% to 6492 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures. FRAX-based probabilities were higher in Moldova than neighbouring countries (Ukraine and Romania). Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Moldavan population and help guide decisions about treatment.

The audit provides a detailed analysis of the burden of osteoporosis and differences between Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan with regard to prevalence of osteoporosis and incidence of osteoporotic fractures, future demographic changes, diagnostic resources, and treatment availability. This paper describes the results of the Audit on Burden of Osteoporosis in Armenia, Belarus, Georgia, Moldova, Kazakhstan, the Kyrgyz Republic, the Russian Federation, and Uzbekistan. We carried out a review of the available literature and a survey of the representatives of the national osteoporosis societies. All the information available in English, Russian, or national languages including the publications of local or regional importance was analyzed. The expected number of osteoporosis patients varies from 240,000 in Armenia to 16 million in Russia. Low-energy fractures are a serious health problem in all countries with the highest incidence in Kazakhstan and Russia. The rate of hip fracture patients’ hospitalization in the majority of countries is low (33–80%). In the coming decades the populations, in particular, in Uzbekistan, Kazakhstan, and Kyrgyzstan, will continue to show increases in life expectancy with a corresponding increase in the number of fractures in older people. Thus, in 2050, the number of hip fractures in these countries will increase by 2.5–3.5 times. However, the availability of DXA devices in the region is low (0.2–1.3 per million), and DXA tests are expensive. Almost all modern treatments for osteoporosis are available, but the costs are high even for alendronate. Urgent action is needed at the national level in each country including recognition of osteoporosis as a priority health issue. Osteoporosis is an important health problem in the countries of the Eurasian region that will only get worse in the future due to expected demographic changes.

A retrospective cohort study determined the high incidence of recurrent fractures in osteoporotic patients with high fracture risk during the observation. The strategy of starting treatment with more potent regimens (zoledronic acid, denosumab and/or teriparatide) seems to have the best secondary fracture prevention efficacy. This paper describes the various medical therapy regimens prescribed to osteoporotic patients with high fracture risk and the result of treatment. We carried out a retrospective cohort study in selected Osteoporosis Centers. Patients were considered to have high fracture risk in case of a history of a low-energy hip fracture or two or more vertebral or other site fractures. A total of 812 subjects (768 women and 44 men) aged 36–95 years were included. The observation period was 2285.1 patient-years. Demographic data, clinical findings, and BMD data obtained by DXA, as well as a history of fractures that had occurred during the follow-up, were included in the analysis. Overall, at baseline, there were 637 non-vertebral fractures including 104 hip fractures. A total of 590 patients had vertebral fractures; of these, 69% suffered multiple fractures. Being on treatment, 119 (14.7%) patients developed new vertebral and non-vertebral fractures. The incidence of new non-vertebral fractures and hip fractures was 39.4 and 13.1 per 1000 patient-years. The total number of vertebral fractures increased by 24.8% from 1353 to 1689. The best results of the treatment were achieved in patients who were started on zoledronic acid, denosumab, or teriparatide and had an adequate duration of treatment. Although these patients had significantly lower BMD values at the time of diagnosis compared with other patients, they showed a lower incidence of new vertebral and hip fractures, during the follow-up. Therapy of patients at high risk of fractures started with more potent treatment regimens (zoledronic acid, denosumab and/or teriparatide) of adequate duration was more effective in terms of prevention of new vertebral and hip fractures as compared with other treatment options. However, treatment appears to be challenging given the number of recurrent fractures in patients on treatment and the frequency of drug withdrawal or replacement.

Summary Changes in health-related quality of life (QoL) due to hip, humeral, ankle, spine, and distal forearm fracture were measured in Russian adults age 50 years or more over the first 18 months after fracture. The accumulated mean QoL loss after hip fracture was 0.5 and significantly greater than after fracture of the distal forearm (0.13), spine (0.21), proximal humerus (0.26), and ankle (0.27). Introduction Data on QoL following osteoporotic fractures in Russia are scarce. The present study evaluated the impact of hip, vertebral, proximal humerus, distal forearm, and ankle fracture up to 18 months after fracture from the Russian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study. Methods Individuals age ≥ 50 years with low-energy-induced humeral, hip, clinical vertebral, ankle, or distal forearm fracture were enrolled. After a recall of pre-fracture status, HRQoL was prospectively collected over 18 months of follow-up using EQ-5D-3L. Multivariate regression analysis was used to identify determinants of QALYs loss. Results At 2 weeks, patients with hip fracture (n = 223) reported the lowest mean health state utility value (HSUV) compared with other fracture sites. Thereafter, utility values increased but remained significantly lower than before fracture. For spine (n = 183), humerus (n = 166), and ankle fractures (n = 214), there was a similar pattern of disutility with a nadir within 2 weeks and a progressive recovery thereafter. The accumulated mean QoL loss after hip fracture was 0.5 and significantly greater than after fracture of the distal forearm (0.13), spine (0.21), proximal humerus (0.26), and ankle (0.27). Substantial impairment in self-care and usual activities immediately after fracture were important predictors of recovery across at all fracture sites. Conclusions Fractures of the hip, vertebral, distal forearm, ankle, and proximal humerus incur substantial loss of QoL in Russia. The utility values derived from this study can be used in future economic evaluations.

Transcutaneous electroneurostimulation is an effective method of chronic pain relief. Dynamic electrical neurostimulation is a type of transcutaneous electroneurostimulation based on the use of weak (200–400 mkA) low frequency (10–200 Hz) pulse currents. A feature of this type of physiotherapy is the pulse shape, which changes following the change of the total electrical resistance of underelectrode skin area, which enables prolonged use without “addiction”. A multicenter randomized double-blind placebo-controlled study with 132 patients was conducted. Dynamic electrical neurostimulation led to a rapid decrease in the intensity of pain in the knee joint by an average of 5–8 mm on a visual-analogue scale immediately after the end of the procedure in the absence of pain dynamics of the procedure performed by the placebo. After completing the course of treatment from 10 procedures during the month of follow-up, the intensity of pain according to visual-analogue scale in patients of the dynamic electrical neurostimulation group was lower than in placebo. The decrease in pain intensity was also accompanied by a decrease in the time of the “Get up and go” test and an improvement in the Leken index. The statistically significant difference between the groups in the time of the “Stand up and go” test appeared at the end of the course of therapy and persisted for a month after the end of the course of therapy. Dynamic electrical neurostimulation is an effective and safe method for reducing pain and improving the function of the knee joint in patients with osteoarthritis.

Modern medications for osteoporosis (bisphosphonates, denosumab, teriparatide) are well-tolerated drugs, which can significantly lower vertebral and non-vertebral fracture risk according to prospective and observational studies in up to 10-year period. Certain drugs (denosumab, teriparatide) are active only during the treatment period and do not prevent bone loss and fracture risk after discontinuation, while such protective effect is observed in bisphosphonates. Despite impressive success of continuous 10-year denosumab treatament of severe osteoporosis, some of the recently published data suggest that vertebral fracture incidence is increased after treatment discontinuation, along with multiple vertebral fracture incidence, especially in patients with previous fractures. Issues of osteoporosis treatment duration, sequential use of osteoporosis drugs and criteria for treatment discontinuation are now in focus of attention. European Medicines Agency (EMA) and European Calcified Tissue Society (ECTS) considered these issues in 2017. ЕМА considered fractures after denosumab discontinuation as a natural disease course and did not recommend any changes in product instruction. The main conclusion of ECTS is that the possibility of multiple fractures development after denosumab discontinuation exists, however, there is still not enough firm evidence, as well as effective countermeasures. Clinicians and patients should be aware of potential risk. Both EMA and ECTS suggest considering denosumab treatment or discontinuation after 5-year treatment period or possibly replacing with bisphosphonates. Recent data suggest that prolonged osteoporosis treatment can be done in accordance with the concept of treatment until target goal (for example, achievement of femoral T-score -2.0SD and higher). In our review, we focus on recent data concerning the issues stated above. This topic was also discussed on Russian Osteoporosis Association (ROA) expert meeting in Saint Petersburg on 24 may 2018, chaired by ROA president, professor Olga Lesnyak and Columbia University professor, J.P. Bilezikian. As a result, an Expert Council resolution was written and introduced in the article.

Summary This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. Introduction The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. Methods Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. Results Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. Conclusions Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.

Purpose: to determine the incidence of proximal femur (PF) fracture in the inhabitants of the Republic of Belarus aged 50 years and over. The study was initiated by the Russian Association on Osteoporosis with support from International Osteoporosis Foundation. Material and methods. The data collection is performed by the protocol that assumes an active search of PF fracture cases for 3 years in all available sources with their subsequent verification within one city of the Republic of Belarus with population over 100 000 residents. Results. Standardized indices of PF fracture incidence in the Republic of Belarus for males and females aged 50 years and over made up 147 and 250 cases per 100 000 inhabitants, respectively. The obtained data are in line with the general information on PF fracture incidence in the neighboring countries. According to the population growth forecast the 25.8% increase of PF fracture cases in this age group is expected by 2050.

Summary The hip fracture rates from Kazakhstan were used to create a surrogate FRAX® model for the Kyrgyz Republic. Introduction The International Society for Clinical Densitometry and International Osteoporosis Foundation recommend utilizing a surrogate FRAX model, based on the country-specific risk of death, and fracture data based on a country where fracture rates are considered to be representative of the index country. Objective This paper describes a surrogate FRAX model for the Kyrgyz Republic. Methods The FRAX model used the incidence of hip fracture from the neighbouring country of Kazakhstan and the death risk for the Kyrgyz Republic. Results Compared with the model for Kazakhstan, the surrogate model gave somewhat higher 10-year fracture probabilities for men between 60 and 80 years of age and lower probabilities for men above the age of 80. For women the probabilities were similar up to the age of 75–80 years and then lower. There were very close correlations in fracture probabilities between the surrogate and authentic models (1.00) so that the use of the Kyrgyz model had little impact on the rank order of risk. It was estimated that 2752 hip fractures arose in 2015 in individuals over the age of 50 years in the Kyrgyz Republic, with a predicted increase by 207% to 8435 in 2050. Conclusion The surrogate FRAX model for the Kyrgyz Republic provides the opportunity to determine fracture probability among the Kyrgyz population and help guide decisions about treatment.

Summary A prospective population-based survey in a region of the Republic of Uzbekistan determined the incidence of fractures at the hip. The hip fracture rates were used to create a FRAX® model to facilitate fracture risk assessment in Uzbekistan. Objective This paper describes the epidemiology of hip fracture in the Republic of Uzbekistan that was used to develop a country-specific FRAX® tool for fracture prediction. Methods During a 1-year (2016/17) prospective population-based survey in the Pap district of the Republic of Uzbekistan, hip fractures were prospectively identified from hospital registers, trauma centres and primary care and community sources. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Uzbekistan. Fracture probabilities were compared with those from neighbouring Kazakhstan and Kyrgystan. Results Approximately 41% of hip fracture cases did not come to medical attention, and two thirds of patients overall were not admitted to hospital. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50 years for 2015 was 16,764 and is predicted to increase more than three-fold to 60,272 in 2050. FRAX-based probabilities were higher in Uzbekistan than Kazakhstan or Kyrgystan. Conclusion The FRAX model should enhance accuracy of determining fracture probability among the Uzbek population and help guide decisions about treatment.

To extend elderly patients’ active longevity, practitioners all over the world need a precise clinical instrument to assess the 10-year osteoporotic fractures probability and choose the optimal preventive intervention. The purpose of this research is to assess major osteoporotic (OP) fractures incidence in CIS countries and to create country-specific computing FRAX clinical prediction tools. Method. We carried out a cohort population-based study (EVA) in Russia, Belarus, Armenia, Moldova, Kazakhstan, and Uzbekistan in 2011-2018. The age- and sexspecific OP fracture incidence values were incorporated into the computing FRAX models. Results. We revealed that the highest standardized HP incidence was obtained in Kazakhstan (338 and 255 per 100 000 per year for women and men older than 50 years resp.) and Moldova (331, 0 and 155, 0 per year for women and men resp.), the lowest in Armenia (201 and 136 per 100 000 per year for women and men resp.). The FRAX models showed that in Kazakhstan, Uzbekistan, and Moldova, elderly people had the highest hip fracture probabilities. Estimates reveal that the OP fractures numbers in the EVA-project countries will grow by 1.5-3 times by 2050. Conclusion. The created national FRAX instruments should enhance the accuracy of determining fracture probability among older people, help clinicians to make decisions concerning OP prophylactic, and to step forward to reducing the burden of age-related diseases.

Background: Odanacatib, a cathepsin K inhibitor, reduces bone resorption while maintaining bone formation. Previous work has shown that odanacatib increases bone mineral density in postmenopausal women with low bone mass. We aimed to investigate the efficacy and safety of odanacatib to reduce fracture risk in postmenopausal women with osteoporosis. Methods: The Long-term Odanacatib Fracture Trial (LOFT) was a multicentre, randomised, double-blind, placebo-controlled, event-driven study at 388 outpatient clinics in 40 countries. Eligible participants were women aged at least 65 years who were postmenopausal for 5 years or more, with a femoral neck or total hip bone mineral density T-score between −2·5 and −4·0 if no previous radiographic vertebral fracture, or between −1·5 and −4·0 with a previous vertebral fracture. Women with a previous hip fracture, more than one vertebral fracture, or a T-score of less than −4·0 at the total hip or femoral neck were not eligible unless they were unable or unwilling to use approved osteoporosis treatment. Participants were randomly assigned (1:1) to either oral odanacatib (50 mg once per week) or matching placebo. Randomisation was done using an interactive voice recognition system after stratification for previous radiographic vertebral fracture, and treatment was masked to study participants, investigators and their staff, and sponsor personnel. If the study completed before 5 years of double-blind treatment, consenting participants could enrol in a double-blind extension study (LOFT Extension), continuing their original treatment assignment for up to 5 years from randomisation. Primary endpoints were incidence of vertebral fractures as assessed using radiographs collected at baseline, 6 and 12 months, yearly, and at final study visit in participants for whom evaluable radiograph images were available at baseline and at least one other timepoint, and hip and non-vertebral fractures adjudicated as being a result of osteoporosis as assessed by clinical history and radiograph. Safety was assessed in participants who received at least one dose of study drug. The adjudicated cardiovascular safety endpoints were a composite of cardiovascular death, myocardial infarction, or stroke, and new-onset atrial fibrillation or flutter. Individual cardiovascular endpoints and death were also assessed. LOFT and LOFT Extension are registered with ClinicalTrials.gov (number NCT00529373) and the European Clinical Trials Database (EudraCT number 2007-002693-66). Findings: Between Sept 14, 2007, and Nov 17, 2009, we randomly assigned 16 071 evaluable patients to treatment: 8043 to odanacatib and 8028 to placebo. After a median follow-up of 36·5 months (IQR 34·43–40·15) 4297 women assigned to odanacatib and 3960 assigned to placebo enrolled in LOFT Extension (total median follow-up 47·6 months, IQR 35·45–60·06). In LOFT, cumulative incidence of primary outcomes for odanacatib versus placebo were: radiographic vertebral fractures 3·7% (251/6770) versus 7·8% (542/6910), hazard ratio (HR) 0·46, 95% CI 0·40–0·53; hip fractures 0·8% (65/8043) versus 1·6% (125/8028), 0·53, 0·39–0·71; non-vertebral fractures 5·1% (412/8043) versus 6·7% (541/8028), 0·77, 0·68–0·87; all p

Background Objectives To investigate the influence of asymptomatic vertebral fractures on organ damage and to identify risk factors associated with critical organ damage in women with systemic lupus erythematosus (SLE). Methods 207 women with SLE were included in this study. Bone mineral density (BMD) measurements of the hip and spine were performed using the dual energy X-ray absorptiometry (DXA). Vertebral fracture assessment (VFA) was done for detection vertebral fractures using a method described by Genant. Accumulated damage was scored using the SLICC/ACR damage index (SDI). Critical organ damage was defined as SDI>3. Results Vertebral fractures were developed in 55 (26.5%) women with SLE. Half of all women with SLE (n=31, 15.0%) had asymptomatic vertebral fractures which were diagnosed for the first time in this study. 131 (63.3%) women with SLE had critical organ damage (SDI>3). Average SDI before and after morphometry was 4,5±2,1 and 5,4±2,5 respectively. Multivariate analysis showed age (p=0,01) and cumulative dose of glucocorticoids (p=0,00005) were significantly associated with critical damage in women with SLE. Conclusion Detection of vertebral fractures helps in counting accumulated organ damage correctly. VFA in the combination with DXA in women with SLE is an effective method for diagnostic asymptomatic vertebral fractures. Disclosure of Interests None declared

Summary: We performed a randomized clinical trial to evaluate the effect of a 12-month physical exercise program on quality of life, balance, and functional mobility in postmenopausal women with osteoporotic vertebral fractures. All three outcomes improved in the intervention group and were better than in the controls. Introduction: Th aim of this study was to evaluate the effectiveness of a structured physical exercise intervention on quality of life, functional mobility, and balance in patients with osteoporotic vertebral fractures and back pain. Methods: Seventy-eight postmenopausal women with vertebral fractures were randomized into an exercise group (n = 40) and a control group (n = 38). The mean age was 69.2 ± 7.7 years. All women had at least one osteoporotic vertebral fracture and suffered from chronic back pain. Patients with a history of vertebral and non-vertebral fracture within the past 6 months were excluded. The 40-min exercise program was conducted twice weekly for 1 year. Participants in the control group were instructed to continue their usual daily activities. Participants were assessed at baseline and at 12 months using the Quality of Life Questionnaire (QUALEFFO-41). Balance was measured with the Balance Master® System NeuroCom® and functional mobility was measured with the “timed up and go” test and “sit-to-stand” test. Results: Total QUALEFFO-41 score after 12 months was significantly better in the exercise group (44.2 ± 7.5) compared to the control group (56.6 ± 9.4), p

Summary: Fracture probabilities derived from the surrogate FRAX model for Armenia were compared to those from the model based on regional estimates of the incidence of hip fracture. Disparities between the surrogate and authentic FRAX models indicate the importance of developing country-specific FRAX models. Despite large differences between models, differences in the rank order of fracture probabilities were minimal. Objective: Armenia has relied on a surrogate FRAX model based on the fracture epidemiology of Romania. This paper describes the epidemiology of fragility fractures in Armenia used to create an Armenia-specific FRAX model with an aim of comparing this new model with the surrogate model. Methods: We carried out a population-based study in two regions of Armenia (Ararat and Vayots Dzor representing approximately 11% of the country’s population). We aimed to identify all low-energy fractures: retrospectively from hospital registers in 2011–2012 and prospectively in 2013 with the inclusion of primary care sources. Results: The differences in incidence between the surveys with and without data from primary care suggested that 44% of patients sustaining a hip fracture did not receive specialized medical care. A similar proportion of forearm and humeral fractures did not come to hospital attention (48 and 49%, respectively). Only 57.7% of patients sustaining a hip fracture were hospitalized. In 2013, hip fracture incidence at the age of 50 years or more was 201/100,000 for women and 136/100,000 for men, and age- and sex-specific rates were incorporated into the new “authentic” FRAX model for Armenia. Compared to the surrogate model, the authentic model gave lower 10-year fracture probabilities in men and women aged less than 70 years but substantially higher above this age. Notwithstanding, there were very close correlations in fracture probabilities between the surrogate and authentic models ( > 0.99) so that the revisions had little impact on the rank order of risk. Conclusion: A substantial proportion of major osteoporotic fractures in Armenia do not come to hospital attention. The disparities between surrogate and authentic FRAX models indicate the importance of developing country-specific FRAX models. Despite large differences between models, differences in the rank order of fracture probabilities were minimal.

To assess the influence of informing patients with postmenopausal osteoporosis about the their probability of 10-year absolute fracture risk calculated by FRAX tool on the patient ’s decision to start treatment and their adherence to therapy during 3 years of follow-up. Materials and Methods. Multicenter open randomized trial included 417 women (mean age 65.9 years). Patients of the 1 group (n=191) were informed about the value of their absolute risk of fracture by FRAX. Patients of the 2 group (the control; n=196) got usual advice and recommendations without calculating FRAX. All patients were recommended to take alendronate in a standard dose (70 mg a week) and calcium/vitamin D supplements. Results. During the first three months after initial visit 96.4% of patients started their treatment. The adherence to treatment at sixth month was 7% higher in the group 1; the compliance in the group 1 was 8% higher, than in the control group. 6.4% of patients developed adverse drug reactions, which led to cancellation of therapy in only 2.9% of patients.

Objectives. This study is a part of GLUKOST study hosted and organized by the Russian Association of Osteoporosis. The aim was to estimate the incidence and risk factors of fractures in patients with chronic inflammatory diseases. Materials and Methods. A specially designed questionnaire was introduced to patients with chronic inflammatory diseases in different regions of Russia. The study included 2342 patients aged 18 to 89 years (mean age 53.02 ± 14.03 years, 591 men and 1181 women). The patients were allocated into two groups: group 1 (n = 1402) - patients never prescribed oral long acting glucocorticoids (OGC); group 2 (n = 929) - patients who received oral long acting glucocorticoids for more than 2 months or continue to take at the time of the survey. The median duration of OGC therapy was 3 years, the median daily dose - 10 mg of prednisone or equivalent. Results. Low-energy fractures of the skeleton were identified in 9.0% of patients not receiving therapy OGC, and 15.5% of patients receiving or previously treated with this therapy. Significant risk factor for fractures was the length of a chronic inflammatory disease. OGC therapy increased the risk (adjusted odds ratio (95% confidence interval (95% CI)) of osteoporotic fractures, regardless of their location by 2.2-fold (95% CI 1.63-3.02, p

The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment.

SummaryTo assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.

Introduction: The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. Methods: Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including prefracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. Results: In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13–18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. Conclusions: The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.

Postmenopausal osteoporosis is a widespread complex disease with strong genetic predisposition. The aim of this study was to fnd association of (CA)n polymorphism of calcitonin gene (CALCA) with the risk of postmenopausal osteoporosis and serum calcitonin level in Russian women from Volga-Ural region. DNA samples of 372 women aged from 48 to 77 years old (175 with fractures and 197 without fractures) were used in the study. Femoral neck BMD was measured in 185 women, lumbal spine BMD - in 203 women. The serum calcitonin was measured in 168 women. Eight alleles of (CA)n polymorphism were revealed: each allele contained 10, 11, 12, 15, 16, 17, 18 and 19 CA repeats. CALCA*10*10 genotype is a marker of the decreased risk of osteoporosis (OR = 0,21) and osteopenia (OR = 0,21). CALCA*10*10 and CALCA*17*17 genotypes were shown to be associated with high femoral neck BMD. Statistically signifcant association of CALCA*17 allele with the increased calcitonin level have been shown.

The analysis of −1997G/T, −1663indelT, and +1245G/T polymorphic loci of the 5′-region of COLIA1 gene in 124 females aged from 50 to 70 years old with low numbers of traumatic fractures as well as 150 healthy individuals from Volga-Ural region has been conducted. The association of −1663indelT and +1245G/T loci with the risk of osteoporotic fractures has been discovered. It has been shown that −1997*G*G/−1663*I*D/+1245*G*T genotype combination and −1997*G/−1663*D/+1245*T haplotype can be considered as markers for fracture development.

Objective. Amyloid A protein quantification in fat tissue is a new immunochemical method for detecting AA amyloidosis, a rare but serious disease. The objective was to assess diagnostic performance in clinical AA amyloidosis.Methods. Abdominal subcutaneous fat tissue of patients with AA amyloidosis was studied at the start of an international clinical trial with eprodisate (NC-503; 1,3-propanedisulfonate; Kiacta (TM)), an antiamyloid compound. All patients had renal findings, i.e. proteinuria (>= 1 g/day) or reduced creatinine clearance (20-60 ml/min). Controls were patients with other types of amyloidosis and arthritic patients without amyloidosis. Amyloid A protein was quantified by ELISA using monoclonal antihuman serum amyloid A antibodies. Congo red stained slides were scored by light microscopy in a semiquantitative way (0 to 4+).Results. Ample fat tissue (>50 mg) was available for analysis in 154 of 183 patients with AA amyloidosis and in 354 controls. The sensitivity of amyloid A protein quantification for detection of AA amyloidosis (>11.6 ng/mg fat tissue) was 84% (95% CI: 77-89%) and specificity 99% (95% CI: 98-100%). Amyloid A protein quantification and semiquantitative Congo red scoring were concordant. Men had lower amyloid A protein values than women (p Conclusions. Amyloid A protein quantification in fat tissue is a sensitive and specific method for detection of clinical AA amyloidosis. Advantages are independence from staining quality and observer experience, direct confirmation of amyloid AA type, and potential for quantitative monitoring of tissue amyloid over time.

The author revises the latest evidence in the literature regarding managing of osteoporosis in men. Osteoporosis is an important under-recognized problem threatening men. Among people over 50 years of age, a fifth of men will suffer a fragility fracture during their remaining lifetime. The leading risk factors of male osteoporosis are genetic predisposition, low sex hormones and secondary osteoporosis. The latter comprises up to 40% of all male osteoporosis cases. The most common causes of secondary osteoporosis in men are alcohol abuse, endogenic and exogenic hypercortisolism and hypogonadism. Treatment of the underlying disease may result in BMD increase and probably fracture risk improvement. Bisphosphonates (alendronate, risedronate and zoledronic acid), denosumab and teriparatide are approved for treatment of male osteoporosis. Non-pharmacological treatment including avoiding smoking and excessive drinking, health lifestyle and a diet rich in bone-healthy nutrients should also be considered.

Major aims of the 5th Central and Eastern Europe (CEE) Summit on Osteoporosis held in Bratislava, Slovakia, on 2 and 3 December 2011, were to provide participants with state-of-the-art knowledge in the fields of osteoporosis research, diagnosis, and therapy and to evaluate, compare, and discuss the very heterogeneous health care situations and related challenges in the different countries in CEE and elsewhere. The summit was attended by 70 delegates from 15 countries. State-of-the-art lectures given by international authorities on osteoporosis covered a broad spectrum of topics ranging from osteoporosis in the male population, novel therapies in osteoporosis such as cathepsin K and sclerostin inhibitors, and the implementation and use of FRAX® in CEE, to an update on denosumab for the management of osteoporosis. Workshops organized to enable the exchange of individual experiences addressed the importance and current availability of osteology training for physicians and the impact of patient training programs on therapy compliance. Furthermore, the availability of and need for standardized quality controls and therapy guidelines in different CEE countries were discussed. Finally, based on a questionnaire, a very up-to-date analysis of all participating countries regarding incidences of osteoporosis, commonly used diagnostic and therapeutic measures, the number of specialists and specialized hospitals, and differences in the reimbursement situation in the different countries was generated and presented. On the whole, the very authentic contributions and the synergistic exchange of ideas allowed the identification of both positive developments as well as still existing issues and needs in diagnosis and therapy of osteoporosis.

Динамическая электронейростимуляция (ДЭНС) - вид ЧЭНС, основанный на применении слабых (200-400мкА), низкочастотных (10-200 Гц) импульсных токов, изменяющих форму в зависимости от электрического сопротивления (импенданса) в подэлектродном участке кожи, для воздействия на биологически активные зоны и точки. Цель исследования: изучить клиническую эффективность терапии аппаратом ДиаДЭНС-ПК в лечении остеоартроза коленных суставов (ОА КС). Материалы и методы. Проведено многоцентровое рандомизированное двойное слепое плацебо-контролируемое исследование. Включено 132 пациента с ОА КС с интенсивностью болевого синдрома более 40 мм по ВАШ, с индексом Лекена > 4 и < 12. Группа ДЭНС (66 чел.) получала лечение аппаратом ДиаДЭНС-ПК с помощью выносного электрода - аппликатора на область коленного сустава- мишени в режиме стимуляции - «Терапия», частотой 77 Гц, уровнем мощности - 15 единиц. Курс лечения - 10 процедур, по 30 минут. Группы были исходно сопоставимы по оцениваемым показателям кроме возраста: пациенты группы плацебо были старше группы ДЭНС в среднем на 3,2 года. Осмотр и опрос пациентов проводился до и после 1,3,6,10й процедур лечения, опрос на визитах наблюдения через 2 и 4 недели после окончания курса терапии. Первичная конечная точка исследования: интенсивность боли по ВАШ (мм), вторичные: тест «Встань и иди» (сек), альгофункциональный индекс Лекена, индекс WOMAC. Результаты. Статистически значимое различие в уменьшении боли по ВАШ в сравниваемых группах наблюдалось после первой процедуры лечения (р=0,014) и далее сохранялось по окончании 3й (р=0,018), и 6й процедур (р=0,047) и на визите наблюдения через 2 недели после окончания лечения (р=0,003). Индекс Лекена статистически значимо различался между группами на 10м последнем визите лечения (р=0,001) и через 4 недели на визите наблюдения (р=0,001). Статистически значимая разница между группами показателя теста «Встань и иди» наблюдалась после 6й процедуры лечения (р=0,041), перед 10-й процедурой (р=0,010), и на визитах наблюдения через 2 недели (р=0,018) и через 4 недели (р=0,025). Индекс WOMAC статистически достоверно не различался между группами. Суточная потребность пациентов в нестероидных противовоспалительных препаратах статистически значимо не различалась между группами. Врачи и пациенты достоверно положительно оценили эффективность лечения в конце курса терапии в ДЭНС группе: при оценке пациентами (р=0,004), при оценке врачами (р

Системная красная волчанка (СКВ) представляет собой хроническое аутоиммунное заболевание, с наибольшей частотой возникающее у женщин в репродуктивном возрасте. В связи с совершенствованием методов лечения продолжительность жизни больных СКВ существенно увеличилась, поэтому на первый план стали выдвигаться проблемы осложнений как самого заболевания, так и его терапии. У женщин с СКВ в постменопаузе стал чаще выявляться остеопороз (ОП) и ассоциированные с ним переломы. Наиболее частым осложнением ОП при СКВ являются компрессионные переломы позвонков, которые в ряде случаев носят бессимптомный характер. Вопрос о влиянии различных факторов (пол, возраст, наличие менопаузы и др.) на частоту развития компрессионных переломов остается открытым. Следует ожидать, что у женщин с СКВ в постменопаузе частота компрессионных переломов позвонков может быть существенно выше, чем в популяции. Цель. Изучение частоты и особенностей локализации бессимптомных компрессионных переломов позвонков у женщин с СКВ в постменопаузе. Материал и методы. Обследовано 86 женщин (средний возраст 59±7,9 лет) в постменопаузе с установ ленным диагнозом СКВ в соответствии с критериями SLICC (The Systemic Lupus Collaborating Clinics) 2012 г. Средняя длительности заболевания и менопаузы составили 15±8,3 лет и 12,8±7 лет соответственно. Все пациентки с СКВ получали терапию глюкокортикоидами (ГК) на протяжении более 12 месяцев (средняя длительность ГК-терапии 159,7±90,9 месяцев) в дозе 15±5 мг/сут в пересчете на преднизолон и имели при обследовании невысокую активность заболевания (средний индекс SLEDAI -2K 5,1±3,9 баллов). Индекс повреждения СКВ (ACR Damage Index) составил 5,5±2,6 баллов. Всем пациенткам была выполнена морфометрия позвоночника (Vertebral Fracture Assessment, VFA) на костном денситометре (Hologic Explorer) с целью выявления компрессионных переломов позвонков в грудном и поясничном отделах . При этом рассчитывали и сравнивали между собой переднюю, среднюю и заднюю высоты позвонков Th4-L5, а также высоту каждого позвонка с нижележащим позвонком. Если различия в высотах позвонков составляла более 20-25% в переднем, среднем или заднем размерах, то такую деформацию считали компрессионным переломом. Результаты. Компрессионные переломы позвонков методом VFA были выявлены у 40 (46,5%) пациенток с СКВ, при этом у половины из них (n=22, 25,6%) впервые, поскольку не имели клинических проявлений. Наиболее часто компрессионные переломы встречались в среднегрудном отделе позвоночника (Th 6-9). В среднем на одну пациентку пришлось 1,7 переломов позвонка (от 1 до 4). При анализе частоты бессимптомных переломов позвонков в различных возрастных группах (до 50 лет, от 50 до 70 лет и старше 70 лет) в группе женщин с СКВ моложе 50 лет частота бессимптомных переломов позвонков оказалась самой высокой (71,4%). С возрастом доля пациенток с бессимптомными переломами уменьшалась. В возрастных группах от 50 до 70 лет и старше 70 лет бессимптомные переломы позвонков были выявлены в 21,7% и 20% случаев соответственно. Все пациентки с бессимптомными переломами позвонков имели перелом только одного позвонка. Выводы. У пациенток с СКВ в постменопаузе локализация компрессионных переломов позвонков отличается от женщин с компрессионными переломами позвонков на фоне постменопаузального ОП. Половина компрессионных переломов позвонков у женщин в постменопаузе с СКВ может носить бессимптомный характер, что диктует необходимость проведения скрининговых методов обследования для их выявления, своевременной диагностики ОП и антиостеопоротической терапии.

Медико-социальную и экономическую значимость остеопороза определяют его неуклонно нарастающая распространенность, а также затраты на лечение собственно остеопороза и его прямых осложнений - переломов, приводящих к развитию хронической боли, деформации скелета и потере трудоспособности. В Российской Федерации данные об экономических и социальных последствиях остеопоротических переломов практически отсутствуют, и имеют ограниченную ценность для применения в экономике здравоохранения. Исследование проведено в рамках международного многоцентрового исследования ICUROS. Целью исследования являлось единообразное (с использованием единой методологии сбора и анализа данных) изучение странах экономических и социальных последствий остеопоротических переломов. В Российской Федерации в исследовании участвовали 9 центров. В тезисах впервые использована окончательная версия базы данных. Материал и методы. Всего включено 1143 пациента от 50 лет и старше, перенесших низкоэнергетический перелом, из них 251 (21,96%) - с переломами шейки бедра, 255 (22,33%) - с переломами запястья, 219 (19,16%) - с переломами позвонков, 182 (15,92%) - с переломами плечевой кости, и 236 (20,65%) - с переломами лодыжки. Опрос пациентов проводился непосредственно после перелома и касался информации о качестве жизни (КЖ) до перелома и непосредственно после перелома (Фаза I). Далее сбор информации осуществлялся через 4 (Фаза II), 12 (Фаза III) и 18 месяцев (Фаза IV) после перелома. Средний возраст включенных пациентов составил 65,2 года (95% доверительный интервал (ДИ) от 64.65 до 65,72). Одним из интегральных параметров КЖ исследовании был опросник EQ-5D, включающий данные по подвижности, самообслуживанию, повседневной активности, боли и дискомфорту, выраженности тревоги и депрессии. Отдельные шкалы данного опросника были преобразованы в общий балл, стандартизованный к шкале от нуля до единицы. Результаты. Ретроспективные данные о КЖ по стандартизованному суммарному баллу EQ-5D составили 0,824 (95% ДИ: 0,812-0,836). На момент перелома у пациентов значимо падало КЖ - 0,290 (95% ДИ: 0,273-0,307) (р0,05). Выводы. Таким образом, если общая субъективная оценка здоровья по ВАШ возвращается к значениям «до перелома» уже к 4 месяцам после перелома, то суммарный балл по EQ-5D) достигает значений, близких к исходным, только к 12 месяцам, и продолжает улучшаться и через 18 месяцев. Эти данные свидетельствуют о важности изучения отдельных компонентов качества жизни пациентов, входящих в EQ-5D, а не только суммарных результатов.

The article describes the experience of cooperation of different countries in osteoporosis studies, that allowed to create international project devoted to osteoporotic fractures

The use of glucocorticoids in the treatment of medical disorders can lead to rapid bone loss and increased risk of fragility fracture. Updated clinical guidelines are needed that accommodate recent advances in fracture risk assessment and new pharmacological interventions to reduce fracture risk. This document serves as an appendix to the 2012 IOF–ECTS guidelines for the management of glucocorticoid-induced osteoporosis.

UNLABELLED: This paper provides a framework for the development of national guidelines for the management of glucocorticoid-induced osteoporosis in men and women aged 18 years and over in whom oral glucocorticoid therapy is considered for 3 months or longer. INTRODUCTION: The need for updated guidelines for Europe and other parts of the world was recognised by the International Osteoporosis Foundation and the European Calcified Tissue Society, which set up a joint Guideline Working Group at the end of 2010. METHODS AND RESULTS: The epidemiology of GIO is reviewed. Assessment of risk used a fracture probability-based approach, and intervention thresholds were based on 10-year probabilities using FRAX. The efficacy of intervention was assessed by a systematic review. CONCLUSIONS: Guidance for glucocorticoid-induced osteoporosis is updated in the light of new treatments and methods of assessment. National guidelines derived from this resource need to be tailored within the national healthcare framework of each country.

The incidence of hip, forearm and humeral fractures was studied in two cities from the Russian Federation. Fracture rates were used to create a FRAX model for Russia and to estimate the current and future burden of fracture.There is scant information on the epidemiology of fracture in Russia. The aim of the study was to determine the incidence of major fractures in order to populate a new FRAX model and to characterise the burden and future burden of fractures.The number of hip, forearm and humeral fractures was determined in two Russian cities with a well-defined catchment population over a 2-3-year period. Incidence rates for the two cities were merged and used to populate a FRAX model for Russia. Incidence rates were also applied to the general population in 2010 and 25 years later in 2035.A total of 6,012 fractures were documented. For hip fracture, 27 % of cases in Pervouralsk and 1.8 % in Yaroslavl were not registered in the hospital data base. The incidence of index fractures increased with age and was higher in women than in men. The lifetime probability of hip fracture at the age of 50 years was 4 % in men and 7 % in women. The total number of hip fractures estimated in 2010 (112,000) is expected to rise to 159,000 in 2035. The estimated number of major fractures will rise from 590,000 to 730,000 over the same time interval.Fragility fractures pose a serious health care problem in Russia. Urgent steps are needed to improve the acute management of hip fracture and long-term care of other osteoporotic fractures.