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Twenty women with surgical menopause, 40-50 years of age, received hormonal replacement therapy with transdermic preparation Divigel during 24 months. On the background of therapy with Divigel we witnessed normalization of indeces of osteal remodelingconsiderable decrease pyridinoline and deoxypyridinoline, and elevation of alkaline phosphatase. Mineral density of bone tissue in the group of patients with surgical menopause waslowerin comparison with control (p0,01). Divigeltumedto exertprotective influence on the bone tissue inpatients with osteoporosis irrespective о f duration о f surgical menopause by the beginning of therapy.

[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).

Female reproductive aging is, in a way, a biological phenomenon that develops along canonical molecular pathways; however, it has particular features. Recent studies revealed complexity of the interconnections between reproductive aging and aging of other systems, and even suggested a cause-effect uncertainty between them. It was also shown that reproductive aging can impact aging processes in an organism at the level of cells, tissues, organs, and systems. Women at the end of their reproductive lives are characterized by the accelerated incidence of age-related diseases. Timing of the onset of menarche and menopause and variability in the duration of reproductive life carry a latent social risk: not having enough information about the reproductive potential, women keep on postponing childbirth. Identification and use of the most accurate and sensitive aging biomarkers enable the prediction of menopause timing and quantification of the true biological and reproductive ages of an organism. We discuss current views on reproductive aging and peculiarities of using available biomarkers of aging. We also consider latest advances in the search for potential genetic markers of reproductive aging. Finally, we posit the importance of determining the female biological age and highlight potential research directions in this area.

Young women with reproductive tract neoplasms who receive treatment leading to termination of ovarian function often suffer from menopause symptoms that contribute to dramatic drop in quality of life. Climacteric symptoms in women with iatrogenic menopause are more severe than in case of natural menopause, especially in women with reproductive tract neoplasms. They lead to dramatic drop in quality of life and are one of the main reasons to stop applying endocrine therapy in women with hormone-positive tumors, which leads to decrease in disease free survival and to decline the prognosis. The most effective treatment option for climacteric symptoms of moderate to severe degrees is menopause hormone therapy; however, such therapy is not suitable for patients with estrogen-dependent tumors in past medical history due to the likelihood risk of progression of cancer, as well as the risk of venous thrombosis, the frequency of which in cancer patients increases. Non-hormonal pharmacological and non-pharmacological correction methods are used as first-line therapy for menopause disorders in women with estrogen-dependent tumors of the reproductive system. Among non-hormonal non-pharmacological correction methods actively study such methods as acupuncture, yoga, exercise to control weight, and a diet rich in phytoestrogens. The most effective non-hormonal methods of correcting vasomotor symptoms are serotonin and norepinephrine reuptake inhibitors. However, currently in Russia these drugs can be prescribed only by a psychiatrist. The finding of effective and safe non-hormonal methods to correct menopause symptoms in women with hormone-positive reproductive tract tumors is the important task in practice among doctors in different specialties.

Aim. To conduct a comparative analysis of serum orexin A levels in women of different age periods with and without sleep disorder and vasomotor symptoms. To evaluate the dynamics of orexin A levels under menopausal hormone therapy. Materials and methods. The study included 50 postmenopausal women and 30 women of reproductive age with a regular menstrual cycle. Using block randomization, patients are divided into 3 groups: group 1 (main group), n=25, -STRAW+ 10 (+1b and +1c), patients with sleep disorder and vasomotor symptoms; group 2 (comparison group), n=25, STRAW+ 10 (+1b and +1c), patients with vasomotor symptoms without sleep disorder; group 3 (control group), n=30, STRAW+ 10 (-4), women of reproductive age without sleep disorder. Group 1 patients were given menopausal hormone therapy. A comparative analysis was carried out using the questionnaire for assessing menopausal symptoms severity by the Greene Scale (the Greene Climacteric Scale) and Rating Scale for subjective sleep characteristics. After 12 weeks of treatment, a control examination was performed. Results. In group 1 women, the serum orexin A levels were significantly higher compared to the women without the symptoms. The link between the orexin A levels and menopause syndrome severity was established. A significant decrease in the menopausal symptoms severity after 12 weeks of menopausal hormone therapy was shown. It was accompanied by a 1,3-fold decrease in orexin A levels. Conclusions. The obtained data indicate the possible role of orexin A and the orexin neuropeptide system in the pathogenesis of sleep disorder and vasomotor symptoms in postmenopausal women.

Aim. To analyze and systematize the available information on pathogenetic mechanisms of hormonal carcinogenesis. Materials and methods. The review includes data from foreign articles published in PubMed and Medline and national works posted on elibrary.ru over the past 20 years. Results. Currently, the term estrogen is often used in the context of hormonal carcinogenesis. According to most researchers, it should not fit into the narrow framework of receptor-mediated proliferation induced by estrogens in target tissues. The concept of estrobiome as a combination of all mechanisms providing the realization of estrogen effects should include not only hormones and native receptors themselves, but also the enzymes involved in their synthesis, estrogen metabolites, intestinal microbiota, as well as genetic and epigenetic factors. Conclusions. When analyzing cancer risk, it is necessary to comprehensively assess contributing factors and hormonal-metabolic preconditions for neoplastic process.

Aim. To formulate a position statement on the management of the menopause in women with a past history of endometriosis from the point of view of evidence-based medicine. Materials and methods. Review of domestic and foreign literature, position of IMS and EMAS. Results. The article describes the main modes snd ways of introducing MHT and their advantages. The expert position on the management of patients with a history of endometriosis during surgical and natural menopause is highlighted. Information on the prevalence and methods of treatment of postmenopausal endometriosis is given.

Currently, women-specific risk factors for cardiovascular diseases (CVD) are of particular importance, one of which is hypertensive disorders during pregnancy (HDP). The effect of hypertensive disorders on the formation of arterial stiffness as a predictor of CVD development remains insufficiently studied. Aim. To study the relationship of indicators of arterial stiffness, risk factors and metabolic changes with the presence of HDP in the history of women of different age groups. Materials and methods. The study included women aged 30 to 65 years, with one or more risk factors of CVD, which were divided into two groups: 1st - with preserved menstrual function and 2nd group - in the postmenopausal period with the presence or absence of HDP. All patients underwent daily blood pressure monitoring with determining the dynamics of central arterial pressure, determining the velocity of the pulse wave from the carotid to the femoral arteries, non-invasive determination of vascular stiffness indicators using the volume sphygmography method. Results. 90 women were examined. The first group consisted of 45 women (mean age 41±5.9 years); the second group - 45 women (mean age 55.3±5.8 years). In both groups, women with HDP are more likely to have burdened CVD heredity (p=0.02). In the 1st group with HDP, the average body weight and body mass index were significantly higher (p=0.02); menstrual disorders occurred more than twice as often (p=0.01) than in women without HDP. In the 2nd group with HDP abortions were more frequent (p=0.05) in history. In the 1st group with HDP, a significantly higher augmentation index AI (p=0.01); the average value of the average daily rate of the pulse wave in the aorta was also exceeded (11.7 m/s), which is 0.8 m/s higher than in women without HDP (p=0.02). Conclusion. A change in the AI and the average daily pulse wave velocity in the aorta, along with the presence of CVD risk factors and hormonal and metabolic disorders, are early markers of subclinical damage to target organs in women of reproductive age with a history of HDP.

Twenty women with surgical menopause aged40-50years received parenteral hormonal replacement therapy with estradiol (preparation Divigel) for the period of 12 months. Twenty healthy women formed the control group. The following indeces were estimated during the study: menopausal Kuppermans index, and the leveloffollicle-stimulatinghormone and estradiol in blood serum. Kuppermans index remarkably decreased in the course of treatment (p0,05). Decrease of FSH level was associated with stable growth of estradiol level (p0,05). The absence of manifested side effects and considerable change of body build index, the possibility of choosingthe minimal effective doze individually allow to apply HRT with Divigel more widely.

Background. Combined oral contraceptives (COCs) are the most common method of prevention of unwanted pregnancies in women from the early reproductive period to perimenopause, therefore their impact on quality of life, sexual function and general well-being remains the subject of active discussion. Some studies revealed various manifestations of sexual dysfunction in patients receiving COCs, therefore such questions, as well as the advantages / disadvantages of individual components (their type and dose) of drugs, are of interest to the clinician. Aim. Assess mechanisms of influence of COCs on female sexual function. Materials and methods. In order to write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, elibrary, etc.) for the last 2-15 years. Relevant articles from the peer-reviewed literature were included. Results. Many studies proved a beneficial effect of estradiol valerate (E2V) which is estrogen identical to natural one in a combination with dienogest (DNG) which is 4th generation progestin in a dynamic dosing regimen on quality of life and sexual function. This beneficial effect is achieved due to combined effects of both components of the drug as well as its reception mode. Conclusion. The combination of estradiol valerate (E2V) which is estrogen identical to natural one with dienogest (DNG) which is 4th generation progestin may be the optimal method of contraception for women of any age, including the young, with decreased libido while taking other COCs.

Currently, tamoxifen is the gold standard in the treatment of hormone receptor-positive breast cancer, which reduces recurrent tumor risk by more than 40%. Tamoxifen, which belongs to selective estrogen receptor modulators, can cause endometrial changes in women of different age groups and increase the risk of hyperplasia and endometrial cancer by several times. In clinical practice, the occurrence of various endometrial alterations during tamoxifen treatment often leads to groundless drug withdrawal. Oncology, gynecology and radiology community knowledge related to optimal methods and criteria for diagnosing different tamoxifen-induced endometrial conditions, as well as in choosing the optimal treatment tactics, will be instrumental in the unified and correct approach to managing patients with hormone receptor-positive breast cancer and maintaining tamoxifen therapy due to its high effectiveness.

The aim of the work is to conduct a systematic analysis of the available research results on the possibility of using menopausal hormone therapy (MHT) in patients who successfully completed the treatment of endometrial cancer (EC). Materials and methods. The review includes data from foreign articles published in PubMed and Medline, and domestic works published on elibrary.ru over the past 40 years. Results. The results obtained allow us to consider MHT as an independent method of medical rehabilitation for women who have undergone EC. A clear patient profile should be established, allowing the use of this method, with strict adherence to health monitoring. Conclusion Patients who have successfully completed the treatment of EC require the creation of special rehabilitation conditions in the interests of maintaining health and quality of life and should be under the close attention of the doctor. Argumented approaches to the appointment of MHT in such patients will avoid complications associated with estrogen deficiency after surgery, radiation with or without systemic (cytostatic) treatment methods.

The aim of the study was to investigate the dynamics of atrophic changes оn the use of low-dose regimens of local therapy with a druge containing only estriol and a druge containing estriol, progesterone and a culture of lactobacilli in patients with postmenopausal vulvovaginal atrophy on the basis of subjective and objective criteria. Materials and methods. 44 patients with vulvovaginal atrophy were randomized into 2 groups of 22 people. In the first group, a drug containing estriol in a dose of 0.5 mg was used, in the second group, a preparation containing a lyophilized culture of lactobacilli, estriol - 0.2 mg; progesterone - 2.0 mg was used. Methods of the study included questioning of patients, cytological examination of the vaginal wall with evaluation of the epithelial maturation index, pH-metrics of the vaginal secretion, definition of the vaginal health index (IVS), PCR diagnostics of the vaginal biocenosis. Results. The use of a low-dose regimen of local therapy with estriol contributed to the restoration of the vaginal epithelium, which was confirmed by a statistically significant increase in ISEV and IVS, in the number of lactobacilli and a decrease in pH, However, the use of a combination drug led to a more effective recovery of lactoflora and normalization of the vaginal microflora.

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.

The article reviews the literature data of the latest studies and expert conclusions on the relationship between menopausal hormone therapy and the risk of developing breast cancer.

[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.

Purpose of the study - to evaluate the effectiveness of black cohosh extract (Chi-Klim drug) and its combination with beta-alanine (Chi-Klim Alanine) for the treatment of menopausal symptoms in women in the early and late postmenopausal women. Materials and methods. A pilot randomized clinical trial included 60 patients aged 40 to 65 years with a duration of menopause not less than 12 months and with a frequency of vasomotor manifestations (tidal) not less than 10 per day. The study did not include women who received menopausal hormone therapy or alternative methods of therapy for the past 3 months. Results. The therapy there was a significant reduction in the severity of menopausal manifestations in both treatment groups, however, in the group 2 the decline was more effective. Acceptance of the drug based on the extract of black cohosh in combination with a dietary supplement on the basis of beta-alanine was 2 times more effective than monotherapy with black cohosh reduced hot flushes per day and had a more pronounced adjoint positive effect on the psycho-emotional symptoms.

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

Aim. To identify gene polymorphisms (OPG, RANKL, VDR, SOST) and evaluate their relationship with bone mineral density (BMD) and fractures for further optimization of diagnosis and treatment of postmenopausal osteoporosis (PMO). Materials and methods. The study included 236 postmenopausal women living in Moscow and the Moscow region. The main group (I) consisted of 174 patients, aged 50 to 83 years, with BMD < - 2.5 SD for the T-score. The comparison group (II) consisted of 62 postmenopausal women with BMD within the normal range and the lack of previous fractures, aged 50 to 77 years. Molecular genetic analysis of polymorphisms of VDR (rs10735810, rs1544410), RANKL (rs9594738, rs9594759) and OPG (rs3102735, rs3102735 and rs4355801), SOST (rs1230399) was performed by polymerase chain reaction in all subjects with PMO and in the control group. Results. In the presence of the T allele of the gene RANKL (rs9594759 and rs9594738) risk of reduced BMD at L1-L4 was increased by 2 times. Women with genotype C/C gene polymorphism of OPG (rs3102735) the risk of fractures of the distal radius (PR) was increased by 17 times, regardless of BMD. Genotype G/G rs1544410 polymorphism of VDR gene in patients with PMO is associated with an increased risk of fractures of the distal radius by three times. In patients with PMO genotype C/C in gene SOST (rs1230399) only cause differences in body mass index. According to an autosomal recessive pattern, homozygous genotype C/C was significantly associated with obesity in the PMO. Conclusions. Polymorphisms of genes RANKL (rs9594759 and rs9594738), OPG (rs3102735) and VDR (rs1544410) are associated with the risk of fractures and PMO. Gene SOST (rs1230399) had no statistically significant effect on BMD and fracture risk.

Цель: Изучить эффективность золедроновой кислоты в терапии постменопаузального остеопороза (ПМО) с учетом полиморфизма гена фарнезилдифосфат-синтетазы (FDPS). Методы исследования: клинический, определение биохимических маркеров костного метаболизма (БМКР) - электрохемилюминесцентным методом («Хоффманн-Ла Рош ЛТД», Швейцария). Измерение МПК проводили с помощью двухэнергетической рентгеновской абсорбциометрии позвонков поясничной области (L1-L4) и шейки бедренной кости (Neck left, Neck total left). Молекулярно-генетический (определение однонуклеотидного полиморфизма гена FDPS (rs2297480) - методом «примыкающих проб» с анализом кривых плавления (ЗАО «НПФ ДНК-Технология, Россия)). Результаты. Обследовано 225 женщин с постменопаузальным остеопорозом. Средний возраст составил 59 (5466) лет. Средняя продолжительность периода постменопаузы 7 (2-13) лет. ИМТ=27,2(23,6-29,05) кг/м2. Распределение аллелей (АА:АС:СС) составило 55,1(n=144):39,5(n=103):5, 4(n=14). Базальные уровни биохимических маркеров костного ремоделирования (БМКР) соответствовали периоду постменопаузы и статистически значимо не различались в зависимости от генотипа FDPS. Средние показатели МПК в поясничном отделе позвоночника и/или шейке бедра соответствовали остеопорозу. Всем пациенткам проводили терапию золедроновой кислотой (zol) в дозе 5 мг в виде внутривенной инфузии 1 раз в 12 месяцев в течение 2 лет. Дополнительно все пациенты получали кальций 1000 мг/сут и витамин Д3 800МЕ/сут. Реакция БМКР на инфузию zol различалась в зависимости от генотипа FDPS. Через 6 месяцев после 1-ой инфузии достоверно более выраженное снижение B-Crosslaps 92 (91-93)% отмечено у пациентов с С/С генотипом (p=0,056), по сравнению с 82% у носителей аллеля А (p=0.07). Через 9 месяцев после инфузии B-Crosslaps у носителей аллеля А повышались до 75%, остеокальцина - 44,4% от исходного. Тогда как у носителей генотипа C/C как B-Crosslaps - (87%), так и osteocalcine -(53,6%) оставались по-прежнему низкими (р=0,056). К 12 месяцу после инфузии уровни B-Crosslaps и osteocalcin у носителей аллеля A повышались и соответствовали премено-паузальным значениям, тогда как у носителей С/С генотипа оставались в пределах ниже нижней границы нормы для пременопаузы. У пациентов с СС генотипом на фоне выраженного снижения БМКР после 2ой инфузии золедроновой кислоты произошло снижение МПК на 5,6%. Выводы. Различная реакция на терапию золедроновой кислотой у пациенток с ПМО связана с полиморфизмом гена FDPS (rs2297480). Для пациентов с генотипом С/С характерно «гиперторможение» костного обмена в ответ на терапию золедроновой кислотой, что возможно, было причиной отрицательной динамики МПК в поясничном отделе позвоночника на втором году терапии золедроновой кислотой.

Osteoporosis and atherosclerosis are the most socially significant chronic non-infectious diseases. This is due to their high prevalence and medical, social and economic consequences from osteoporotic bone fractures and myocardial infarction and stroke as a result of cardiovascular diseases (CVD). The level of estrogen is essential for the formation and maintenance of bone mass in women. The sharp decline in estrogen levels after bilateral ovariectomy plays the role of trigger factor in the development of complex disorders of the bone and the cardiovascular system. Pathogenetically justified approach to the correction of the estrogen-deficient states is the use of hormone replacement therapy (HRT). To study the effect of HRT on the cardiovascular system and bone mineral density (BMD) we examined 50 women with surgical menopause which received HRT for more than a 10-year period. We studied the anthropometric and biochemical parameters (blood cholesterol and its fractions, fasting blood glucose), performed Doppler ultrasonography of head and neck vessels with measurement of pulse velocity, dual-energy x-ray absorptiometry (DEXA) for BMD estimation. Examination was carried out twice - in the early period after the operation (the first year) and after 10 years. Analysis of the cardio-vascular system and the BMD has demonstrated more severe atherosclerotic vascular changes and a greater decrease in BMD in patients who discontinued use of HRT. The severity of atherosclerosis and the level of the BMD were dependent on HRT use.

In considering the various aspects of menopause, not enough attention is paid to a significant reduction in the quality of life for women in transition and early postmenopause. Timely administration of menopausal hormone therapy is effective in reducing menopausal symptoms and improves quality of life at a given time, as well as the risk of developing diseases of aging, that can improve the quality of life related to health, and overall well-being of women in the more distant future. The choice of medication should be determined by its composition and clinical characteristics of the particular patient.

Modem conceptions concerning the role of OPG-RANK-RANKL system in a local paracrinic mechanism of the regulation of osteoclastogenesis and osteal resorption processes are presented in this article. Here, results of the first clinical researches of prognostic signification of ORG determinations for estimating disruption manifestations in osteal metabolism under estrogen deficiency conditions as well as data on the OPG use as an anti-resorbable agent at the treatment of post-menopausal osteoporosis.

Цель: провести анализ переносимости терапии золедроновой кислотой у постменопаузальных женщин с остеопорозом. Материал и методы. В открытое проспективное исследование в течение 36 месяцев были включены женщины с постменопаузальным остеопорозом, получающие терапию золедроновой кислотой (n=225). Проводились оценка соматического статуса, лабораторные и инструментальные исследования (клинический анализ крови, биохимический анализ крови, общий анализ мочи, биохимические маркеры костного ремоделирования (БМКР) сыворотки крови: B-CrossLaps - маркер резорбции, остеокальцин - маркер костеобразования, остеоденситометрия (двухэнергетическая рентгеновская абсорбциометрия) определение минеральной плотности кости (МПК) в поясничном отделе позвоночника (L1-L4) и шейке бедра (Neck). Результаты. 225 женщин с диагностированным постменопаузальным остеопорозом, получали антирезорбтивную терапию золедроновой кислотой (ЗК) (5 мг, в/в, капельно, 1 раз в год). Дополнительно из этой когорты были сформированы подгруппы женщин, которым проводили в/в инфузию во второй (n=90) и в третий (n=30) раз. Медиана возраста обследованных составила 59 (54-66) лет. Наиболее частыми нежелательными являются симптомы реакции острой фазы: гриппоподобный синдром, костно-мышечные проявления, гипертермия, слабость. Причем, у всех пациентов СРОФ развились, через 12-24 часа после инфузии ЗК. В день проведения внутривенной инфузии и последующие 2 дня 48,9% (n=110) пациентам проводили профилактику реакции острой фазы (РОФ) парацетамолом по схеме: 1000 мг х 3 р/д, 3 дня. Среди тех, кому не проводили профилактику, РОФ развилась у 65,3% (n=75) и у 34,7% (n=40) пациенток нежелательных явлений отмечено не было. В общей сумме, у 48,4% (n=109) пациенток были зафиксированы симптомы реакции острой фазы различной тяжести. В структуре РОФ преобладали слабость-26%, озноб - 23,4%, боли в костях и мышцах - 28,4%, гипертермия - 20,9%. Продолжительность симптомов РОФ у пациенток без профилактики СРОФ до 3 дней отмечена у 68% (n=51), 3-7 дней у 25,3% (n=19), более 7 дней у 6,7% (n=5). У большинства пациенток без профилактики (77,3%) отмечалась легкая степень тяжести симптомов, 2-средняя степень тяжести диагностирована у 16% (n=12) пациенток и 3-тяжелая степень проявлений РОФ была отмечена у 6,7% (n=5). Симптомы РОФ (СРОФ) на фоне профилактики развивались в 1,7 раз реже и отмечались у 39% (n=43) пациенток. У пациенток, которым проводили профилактику, продолжительность СРОФ до 3 дней, наблюдалась у 67,4% (n=29) и 3-7 дней у 32,6% (n=14). После проведения профилактики нами была зарегистрирована в основном легкая 62,8% (n=27) и умеренная степень тяжести СРОФ - 34,9% (n=15). Тяжелая степень РОФ отмечена только у 1 пациентки (2,3%). В структуре РОФ преобладали слабость, озноб, боли в костях и мышцах, гипертермия (р

The results of large studies have shown that women with the onset of menopause significantly increase the risk of developing cardiovascular disease. This is associated with the loss of the cardioprotective effect of estrogens and the formation of the so-called menopausal metabolic syndrome, which includes changes in the metabolism of lipids and lipoproteins, insulin and carbohydrates, as well as hemostasis and fibrinolysis. Simultaneous shutdown of ovarian function in women of reproductive age after total oophorectomy causes the early development of delayed climacteric disorders, including cardiovascular diseases. Timely administration of hormone replacement therapy can prevent the development of adverse metabolic changes and reduce cardiovascular risk.

To study the clinical features of affective disorders of the depressive spectrum, the authors examined 63 women who underwent surgery to remove their uterine appendages. Based on the evaluation of the severity of depressive and anxiety manifestations, the study substantiated the feasibility of treating post-ovariectomy syndrome with antidepressants against the background of hormone replacement therapy.