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The objective of the study was to determine the main causes of osteoporosis in chronic kidney disease, chronic obstructive pulmonary disease, pulmonary sarcoidosis and understand how the disease develops in these conditions. Materials and Methods. To study the mechanisms of developing secondary osteoporosis, a literature review was conducted. Results. Secondary forms of osteoporosis account for approximately 15-20% of reported cases and result mainly from concomitant diseases or from using drugs that have a negative effect on bone tissue. Despite its inert and stable appearance, bone tissue is a metabolically active, continuously renewing system. Throughout life, it continuously undergoes remodeling cycles involving the two main processes: the first one is called bone resorption and involves the breakdown of old bone followed by the destruction and removal of both the mineral substance and the organic matrix from resorption sites; the second one is called new bone formation and involves bone matrix synthesis and its subsequent mineralization. The imbalance between these two processes, the predominance of bone resorption over bone formation, is the key link in the pathogenesis of osteoporosis. Such an imbalance reflects the impairment of the major mechanisms of systemic hormonal and local (cytokine) regulation of cellular activity and occurs in secondary osteoporosis. Conclusions. To date, at the stage of providing medical care to patients with chronic bronchopulmonary diseases and chronic kidney disease, inadequate attention is paid to timely diagnosis and treatment of concomitant osteoporosis. The latter often develops as a secondary condition due to systemic inflammation, severe hypoxia, low physical activity, taking inhaled and systemic glucocorticoids. Its signs are not clinically apparent; hence, it is referred to as the ‘silent epidemic. Since osteoporosis has no pathognomonic symptoms and its clinical presentation is rather vague, in patients with chronic bronchopulmonary diseases and chronic kidney disease, its early diagnosis by determining mineral bone density is recommended to prevent the development of severe complications, including low-energy fractures.

In order to improve the quality of studying of fourth-year students of the Medical Faculty and the Foreign Citizens Training Faculty, as well as to intensify the educational process at the Department of Internal Medicine, Clinical Immunology and Allergology of Ivano-Frankivsk National Medical University a modern class-discussion was introduced. For a successful discussion a clear organization of the class has been proposed. It implies careful planning, clear implementation of the rules of the discussion by all its participants, compliance with certain regulations. The class-discussion consists of the following main stages: entrance testing by QR-code for quick assessment of the level of knowledge and obtaining rating indicators from individual sections of the discipline; short summary multimedia presentation on modern methods of diagnosis and principles of treatment of the diseases of a certain profile; application of the elements of role-play (simulation): students’ role-playing of the patient, family doctor, laboratory doctor, doctor of functional diagnostics, doctor-specialist, the head of the hospital with the subsequent modeling of various clinical situations. Thus, the class-discussion in the proposed form with elements of interactive learning is a versatile type of practical lesson, which increases students' ability to think analytically; develops research, communication, heuristic, and leadership skills as well as the ability to make informed decisions about the patient's further clinical route. It contributes to the consolidation and integrated application of the knowledge obtained during the study of the discipline.

Systemic sclerosis (SSc) is a chronic progressive autoimmune disease characterized by immune inflammation, vasculopathy, and fibrosis. There are still numerous uncertainties in the understanding of disease initiation and progression. Pulmonary involvement in SSc, and particularly pulmonary fibrosis, is critical for all organ systems affections in this disease. This review is aimed to describe and analyze new findings in the pathophysiology of SSc-associated pulmonary involvement and to explore perspective diagnostic and therapeutic strategies. A myriad of cellular interactions is explored in the dynamics of progressive interstitial lung disease (ILD) and pulmonary hypertension (PH) in SSc. The role of exosomes, microvesicles, and apoptotic bodies is examined and the impact of micro and long non-coding RNAs, DNA methylation, and histone modification in SSc is discussed.