OSTEOPOROSIS: ASSESSMENT OF A RISK FOR RECURRENT LOW-TRAUMA FRACTURES IN POSTMENOPAUSAL WOMEN

Objective: to assess a risk for new fractures in a cohort of postmenopausal women who have sustained low-trauma fractures, by using the FRAX® algorithm, and to compare the assessments with data on the fractures have occurred during a prospective follow-up study.Subjects and methods. The investigation enrolled 128 postmenopausal women (mean age, 64.9±8.3 years) who had sustained low-trauma fractures at five sites (the hip, forearm, humeral neck, vertebral column, and ankle). A ten-year fracture risk was assessed using the FRAX® algorithm with and without regard for bone mineral density (BMD). New osteoporotic fractures were recorded during a three-year prospective follow-up study.Results and discussion. The average FRAX® algorithm values for all new osteoporotic and hip fractures in the entire group were 18.0±5.6 and 3.7±3.7% (without consideration of BMD), 17.9±6.6 and 3.5±4.0% (with consideration of BMD) (p > 0.05). The true incidence of recurrent fractures over 3 years was 17.2%. During 3 years, the incidence of recurrent fractures in the women who had sustained low-trauma fractures of the proximal hip, humeral neck, and spinal column was 28.6, 25.0, and 22.8%, respectively, which exceeded the estimated 10-year fracture risk for these sites. The history of multiple low-trauma fractures versus single one increased the risk for subsequent fractures by 3.63 and 9.43 times among women with high or low estimated FRAX risk rate, respectively.Conclusion. The three-year prospective follow-up study has shown that the FRAX® algorithm underestimated the risk associated with the presence of recurrent fractures in the history; moreover, new fractures significantly more commonly occur in persons who have sustained low-trauma fractures in the proximal hip, humoral neck, and vertebral column

The frequency of sarcopenia and factors affecting appendicular muscle mass in patients with systemic sclerosis

Aim. To determine the frequency of sarcopenia (SP) and to identify factors associated with the muscle mass in women with systemic sclerosis (SSc).Materials and methods. The study included 64 women with SSc aged 40–70 years. Questionnaires, clinical, instrumental, laboratory examinations and absorptiometry. Linear regression analysis was performed to identify factors associat ed with appendicular muscle mass (AMM).Results. Probable SP was detected in 35 (54.7 %), and confirmed SP – 17 (26.5 %) women with SSc. The frequency of SP did not differ depending on the form of the disease. Univariate linear analysis revealed the relationship between the AMM and BMI, nutritional status; mid-upper arm, waist, hip and calf circumferences, skin Rodnan score, cumulative dose of glucocorticoids (GC) and BMD of the proximal hip. Multivariate linear analysis confirmed the presence of associations between the AMM index and BMI (b = 0.65; p <0.001), the Rodnan skin score (b = –0.19; p = 0.047), the cumulative dose of GC (b = –0.22; p = 0.021).Conclusion. The study demonstrated that more than a quarter of patients with SSc had a confirmed SP. Although age is the main risk factor for SP in the general population, in our study it did not differ between patients with low and normal AMM. The cumulative dose of GC and the Rodnan skin score were negatively, and BMI was positively associated with the value of AMМ

TREATMENT OF OSTEOPOROSIS IN REAL CLINICAL PRACTICE: FREQUENCY OF PRESCRIPTIONS AND THERAPY ADHERENCE WITHIN THE FIRST YEAR AFTER OSTEOPOROTIC FRACTURE

Objective: to estimate the frequency of prescription for antiosteoporotic agents in real clinical practice and treatment adherence within a year after experienced low-trauma osteoporotic fracture (LOF). Subjects and methods. A questionnaire survey was made in 192 subjects aged over 50 years (mean age 66±8 years) who had sustained fractures at different sites after a fall from standing height. Therapy and its compliance were assessed 4 and 12 months after LOF. Results. One hundred and five (55%) patients received therapy, including 80 (73%) took only calcium preparations and vitamin D; 9 (8%), 15 (14%), and 5 (5%) patients had calcitonin, bisphosphonates, and strontium ranelate, respectively. At the same time, 87 (45%) subjects were given no antiosteoporotic drugs for a year after fracture. Throughout the follow-up, 42% of the respondents received treat- ment; 18% interrupted it within the first 4 months after fracture, and 40% started therapy 4 months or later (mean 6.5 months) after it. The reason for the absence of treatment was no recommendations by a traumatologist or primary care specialists in 49% of cases. Among those taking the drugs, treatment was recommended by the specialists of the Osteoporosis Center, Research Institute of Rheumatology, Russian Academy of Medical Sciences, in 89% of cases and by primary care specialists in only 11%.Conclusion. The study indicated that after LOF, the patients did not receive adequate antiosteoporotic therapy, at the same time 49% had no respective recommendations made by traumatologists or primary care physicians. The frequency of prescription for pathogenic agents for the treatment of osteoporosis was considerably increased during patient observation in a specialized osteoporosis center

Остеопороз и его осложнения:приверженность лечению и возможности ее повышения

Objective. To estimate patient adherence to treatment with antiosteoporotic drugs within the first year after experienced low-trauma osteoporotic fractures (LOF). Material and methods. The data of a questionnaire survey were analyzed in 172 women aged 50 years or older (mean age 66+8 years) who had sustained fractures at different sites after a fall from standing height, were analyzed. Therapy and its compliance were assessed 12 months after LOF. Results and discussion. Among the 172 respondents, 55% received therapy, including 73% took only calcium preparations and vitamin D; 8% calcitonin; 14% bisphosphonates; 5% strontium ranelate. At the same time, 45% of those asked were given no antiosteoporotic drugs within the first year of life after fracture. Only 42%> continued to receive treatment following 12 months; 18% interrupted it within the first 4 months after fracture. Conclusion. In real clinical practice, osteoporosis was not treated in the majority of patients within the first year after LOF. One of the major reasons why it is not treated is the high cost of pathogenetic drugs. This reason can be successfully eliminated using generic drugs.Цель исследования - оценить приверженность пациентов лечению противоостеопоротическими препаратами в течение первого года после перенесенного малотравматичного остеопоротического перелома (МОП). Материал и методы. Проанализированы данные анкетирования 172 женщин 50 лет и старше (средний возраст - 66+8 лет), перенесших переломы различных локализаций в результате падения с высоты собственного роста. Оценка назначения терапии и приверженности лечению осуществлялась через 12 мес после МОП. Результаты и их обсуждение. Среди 172 анкетированных 55% пациенток получали терапию, в том числе 73% - только препараты кальция и витамина D, 8% - кальцитонин, 14% - бисфосфонаты и 5% - стронция ранелат. В то же время 45% опрошенных не получали никаких противоостеопоротических препаратов в течение первого года после перелома. Через 12 мес продолжали получать лечение только 42%> опрошенных, а прервали его в течение первых 4 мес после перелома - 18%. Заключение. В реальной клинической практике в течение первого года после МОП у большинства пациенток лечение остеопороза не проводилось. Одна из основных причин отсутствия терапии - высокая стоимость патогенетических препаратов. Данная причина может быть успешно устранена в случае применения дженерических лекарственных средств

Inheritance of signs of «many-flowered» common wheat and evaluation of productivity of the spike of F2 hybrids

Parameters of spike productivity in plants varieties Novosibirskaya 67 (N67), Saratovskaya 29 (S29), Puza-4 and «many-flowered» line Skle 123-09 were assessed in two years with different weather conditions. It was shown that «many-flowered» line Skle 123-09 is significantly higher in the number of grains per spike and number of grains per spikelet than varieties N67, S29 and Puza-4, and that the expression of «many-flowering» depends on the environmental conditions and the genetic background. It was shown that the «many-flowering» is a genetic trait and is therefore workable. A study of hybrids F2 С29×Skle123-09, N67×Skle 123-09, P-4×Skle 123-09 isolated plants with fan-shaped cones and a high number of grains per spikelet as Skle 123-09 and having the best performance of other features as ear varieties recipients. The seeds of these plants will be used to secure «flowering». Two-factor analysis of variance showed that the number of grains per spike knotted depends on growing conditions, genotype and their interaction. Variability of grains per spikelet in drought-resistant varieties of S29 and Puza-4 is mainly dependent on the genotype and, to a lesser extent, on the «genotype×environment» interaction. In variety N67 created for West Siberia, only genotype is a factor. The weight of a grain per ear primarily is primarily affected by «genotype×environment» (almost 60 %), while the influence of «genotype×environmental» was half as strong. The variability of «masse of one grain» in F2 hybrids (S29, P-4×Skle123-09) is influenced by environmental factors, genotype and their interplay. Genotype accounts for the highest impact (> 70 %). F2 hybrids (N67×Skle 123-09) share the greatest variability in the «genotype×environment» interaction (77 %)

Экономические аспекты осложненного остеопороза: стоимость лечения в течение первого года после перелома

Objective: to estimate the cost of treatment in patients with complicated osteoporosis (OP) in the first year after fracture under the conditions of the Moscow municipal healthcare system.Patients and methods. The investigation enrolled 196 women (mean age, 65.8±9.1 years) who had sustained fractures at five major osteoporotic sites (proximal hip (PH), distal forearm (DF), surgical humeral neck, vertebral column, and medial and/or lateral ankle). A unified questionnaire that included data on inpatient and outpatient treatment, patients' personal costs, and social benefits, as well as tariffs on services of the Moscow City Fund of Obligatory Health Insurance was used to estimate the cost of treatment for complicated OP during one year after fracture.Results. The direct cost of treatment for PH fracture amounted to 101,243 rubles and was significantly higher (p < 0.01) than that for fractures at other sites: DF (22,080 rubles); humeral neck (39,855 rubles), vertebral column (51,167 rubles), and ankle (43,345 rubles). The average cost of treatment in terms of indirect costs of treatment for complicated OP during a year was as high as 61,151 rubles. In the overall cost structure for the disease, hospital costs accounted for 44%; social benefits were 12% and the cost of antiosteoporotic drugs was only 7%, which was associated with the fact that the latter were rarely prescribed by primary healthcare physicians.Conclusion. Costs of treatment in patients with complicated OP in Moscow were estimated in relation to the site of low-energy fracture. The disease was shown to cause considerable economic losses regardless of the site of osteoporotic fracture; however, the cost of antiosteoporotic drugs has an insignificant share in the overall cost structure for treatment. At the same time, secondary prevention of OP requires that combination antiosteoporotic therapy should be performed in all patients who have sustained low-energy fracture.Цель исследования – оценка затрат на лечение больных при осложненном остеопорозе (ОП) в течение первого года после перелома в условиях муниципального здравоохранения Москвы.Пациенты и методы. В исследование включено 196 женщин (средний возраст – 65,8±9,1 года), перенесших переломы пяти основных остеопоротических локализаций: проксимального отдела бедра (ПОБ), дистального отдела предплечья (ДОП), хирургической шейки плеча, позвоночника и медиальной и/или латеральной лодыжки. На основе унифицированного вопросника, включавшего данные о стационарном и амбулаторном лечении, личных затратах пациенток и социальных выплатах, а также тарифах на услуги Московского городского фонда обязательного медицинского страхования, проведена оценка стоимости лечения осложненного ОП в течение 1 года после перелома.Результаты. Прямые затраты на лечение при переломе ПОБ составили 101 243 руб. и были достоверно выше (p<0,01), чем при переломах других локализаций: ДОП – 22 080 руб., шейки плечевой кости – 39 855 руб., позвоночника – 51 167 руб. и лодыжки – 43 345 руб. В среднем стоимость лечения с учетом косвенных затрат при осложненном ОП в течение 1 года достигала 61 151 руб. В общей структуре «стоимости заболевания» 44% приходилось на госпитальные затраты, 12% – на социальные выплаты и всего 7% – на противоостеопоротические препараты, что связано с их редким назначением врачами первичного звена здравоохранения.Выводы. Оценены затраты на лечение больных с осложненным ОП в зависимости от локализации НП в Москве. Показано, что заболевание приводит к существенным экономическим потерям независимо от локализации остеопоротического перелома, однако стоимость противоостеопоротических лекарственных средств занимает незначительную долю в структуре общих затрат на лечение. В то же время с целью вторичной профилактики ОП следует проводить комплексную противоостеопоротическую терапию всем пациентам, перенесшим НП

Физическая активность и композиционный состав тела у больных ревматоидным артритом

Objective: to evaluate physical activity (PA) and its relationship with body composition in patients with rheumatoid arthritis (RA).Patients and methods. The study included 93 women with RA. A standardized questionnaire survey, anthropometric measurements, laboratory work up, and dual-energy x-ray absorptiometry were conducted to assess body composition and bone mineral density. The level of PA was determined using the International Physical Activity Questionnaire (IPAQ).Results and discussion. The IPAQ survey showed that 46 (49.5%), 41 (44.1%) and 6 (6.4%) patients had high, moderate and low levels of PA, respectively. The patients did not differ in clinical and anamnestic, laboratory and instrumental data depending on the level of PA. Correlations were found between total energy expenditure by IPAQ and daily food calcium intake (r=0.26, p=0.012), shoulder circumference (r=0.22, p=0.042) and postmenopausal duration (r=-0.27, p=0.016). The relationship between the sarcopenic phenotype (SP) and the time of vigorous physical activity less than 15 minutes per day was revealed (odds ratio, OR 6.31; 95% confidence interval, CI 1.75–22.71; p=0.004), between the frequency of moderate physical exercise and walking less than 4 times a week (OR 4.09; 95% CI 1.16–14.47; p=0.027 and OR 4.73; 95% CI 1.24–18.07; p=0.021, respectively), the presence of osteoporosis – OD (OR 9.41; 95% CI 2.73–32.47; p <0.001). The risk of obesity increased with vigorous exercise less than 15 minutes per day (OR 3.03; 95% CI 1.11–8.29; p=0.029). The osteoporotic phenotype (OPP) was associated with patient age (OR 1.12; 95% CI 1.05–1.19; p=0.001) and the presence of SP (OR 8.97; 95% CI 2.39– 33.60; p=0.001).Conclusion. Half of the patients had moderate and low level of PA, independent of age, RA duration and activity. SP was associated with insufficient PA and the presence of OPP. Obesity is also associated with lack of PA, while OPP is associated with age and the presence of SP.Цель исследования – оценить физическую активность (ФА) и ее связь с композиционным составом тела у больных ревматоидным артритом (РА).Пациенты и методы. В исследование включено 93 женщины с РА. Проводились опрос по унифицированной анкете, антропометрические измерения, лабораторное обследование и двуэхнергетическая рентгеновская абсорбциометрия для оценки композиционного состава тела и минеральной плотности кости. Уровень ФА определялся по Международному опроснику физической активности (IPAQ).Результаты и обсуждение. Опрос по IPAQ показал, что 46 (49,5%), 41 (44,1%) и 6 (6,4%) пациенток имели высокий, умеренный и низкий уровень ФА соответственно. Пациентки не различались по клинико-анамнестическим и лабораторно-инструментальным данным в зависимости от уровня ФА. Обнаружены корреляции суммарных энергетических затрат по IPAQ с суточным потреблением кальция с пищей (r=0,26, p=0,012), окружностью плеча (r=0,22, p=0,042) и длительностью постменопаузы (r=-0,27, p=0,016). Выявлена взаимосвязь саркопенического фенотипа (СФ) с временем интенсивной физической нагрузки <15 мин в день (отношение шансов, ОШ 6,31; 95% доверительный интервал, ДИ 1,75–22,71; р=0,004), частотой занятий с умеренной физической нагрузкой и пеших прогулок <4 раз в неделю (ОШ 4,09; 95% ДИ 1,16–14,47; р=0,027 и ОШ 4,73; 95% ДИ 1,24–18,07; р=0,021 соответственно), наличием остеопороза – ОП (ОШ 9,41; 95% ДИ 2,73–32,47; р<0,001). Риск ожирения увеличивался при интенсивной физической нагрузке <15 мин в день (ОШ 3,03; 95% ДИ 1,11–8,29; р=0,029). Остеопоротический фенотип (ОПФ) ассоциировался с возрастом пациенток (ОШ 1,12; 95% ДИ 1,05–1,19; р=0,001) и наличием СФ (ОШ 8,97; 95% ДИ 2,39–33,60; р=0,001).Заключение. Половина больных имела средний и низкий уровень ФА, не зависевший от возраста, длительности и активности РА. СФ ассоциировался с недостаточной ФА и наличием ОП. Ожирение также связано с недостатком ФА, а ОПФ – с возрастом и наличием СФ

Риск переломов и потребность в антиостеопоротическом лечении у больных системной склеродермией

Objective: to estimate the high and very high Frax® 10-year probabilities of fractures in patients with systemic sclerosis (SSc) to assess the need for anti-osteoporotic treatment.Patients and methods. The investigation enrolled 136 SSc patients (110 women and 26 men; mean age, 59.3±7.5 years). The patients underwent a questionnaire survey, by calculating the risk of major fractures with the FRAX® algorithm and dual-energy X-ray densitometry (DXA) of the lumbar spine and proximal femur.Results and discussion. There was a very high risk of fractures in 41.2% of the examinees, a high risk in 10.3%, and a low risk in 48.5%. Osteoporosis (OP) in at least one area was detected in 41.2% of the patients. Among the persons with a low risk of fractures, OP was diagnosed in 18.2%, whereas 10.6% had a history of fractures. A total of 65.4% of SSc patients needed anti-osteoporotic treatment.Conclusion. According to the comprehensive assessment, OP treatment and fracture prevention were indicated for 65.4% of SSc patients. The FRAX® algorithm is less informative in males who need therapy than in females.Цель исследования – определить частоту высокой и очень высокой 10-летней вероятности переломов по алгоритму FRAX® у больных с системной склеродермией (ССД) для оценки потребности в антиостеопоротическом лечении.Пациенты и методы. В исследование включено 136 больных ССД (110 женщин и 26 мужчин, средний возраст 59,3±7,5 года). Проведены анкетирование пациентов с подсчетом риска основных переломов по алгоритму FRAX® и двухэнергетическая рентгеновская денситометрия поясничного отдела позвоночника и проксимального отдела бедра.Результаты и обсуждение. Очень высокий риск переломов имелся у 41,2% обследованных, высокий риск – у 10,3%, а низкий – у 48,5%. Остеопороз (ОП) хотя бы в одной области выявлен у 41,2% больных. Среди лиц с низким риском переломов ОП диагностирован у 18,2%, а переломы в анамнезе – у 10,6%. Всего в назначении антиостеопоротического лечения нуждались 65,4% больных ССД.Заключение. По данным комплексной оценки, лечение ОП и профилактика переломов были показаны 65,4% больных ССД. Алгоритм FRAX® менее информативен у мужчин, нуждающихся в терапии, чем у женщин

Применение генерического препарата золедроновой кислоты для лечения остеопороза: фокус на переносимость и безопасность

Objective: assessment of safety and tolerability of a new generic drug of zoledronic acid (Osteostatics) in patients.Patients and methods. Clinical observation included 30 postmenopausal women aged 45 years and older (mean age 64±8 years). To determine the safety of the drug of zoledronic acid, all patients underwent biochemical blood test; to assess the tolerability, adverse effects (AE) associated with the administration of the drug were recorded. Fractures that may have occurred during follow-up were also required to be recorded as AE.Results and discussion. AE was reported by 15 (50.0%) patients. In 13 (43.3%) of them flu-like syndrome (FLS) was noted, including 12 with an increase in body temperature on average to 38.4 [38.0; 38.6] ° C, in 1 (7.7%) – with abdominal pain and nausea, 5 (38.5%) women noted myalgia and/or arthralgia, and 2 (15.4%) – redness and pain in the eyes. In patients who had not previously received bisphosphonate (BP) therapy, AEs were recorded in 62.5% of cases, and in those who had already received such treatment in 15.4%. In most cases, AEs occurred in the first 48 hours, and their duration averaged 2 days.Conclusion. The incidence of AE was 50.0%, which did not exceed that when using the original zoledronic acid in real clinical practice. The majority of AEs occurred in “naive” patients, developed in the first 2 days after drug administration, and resolved on average within the next 2 days.Цель исследования – оценка безопасности и переносимости нового генерического препарата золедроновой кислоты (Остеостатикс) у больных с остеопорозом (ОП).Пациенты и методы. В клиническое наблюдения включено 30 женщин в постменопаузе в возрасте 45 лет и старше (средний возраст 64±8 лет). Для определения безопасности препарата золедроновой кислоты всем пациенткам выполняли биохимический анализ крови, для оценки переносимости фиксировали нежелательные реакции (НР), связанные с введением препарата. Переломы, которые могли произойти во время наблюдения, также должны были регистрироваться как НР.Результаты и обсуждение. О НР сообщили 15 (50,0%) пациенток. У 13 (43,3%) из них отмечался гриппоподобный синдром (ГПС), в том числе у 12 с повышением температуры тела в среднем до 38,4 [38,0; 38,6] °С, у 1 (7,7%) – с болью в животе и тошнотой, по 5 (38,5%) женщин отметили миалгии и/или артралгии, а 2 (15,4%) – покраснение и резь в глазах. У пациенток, не получавших ранее терапию бисфосфонатами (БФ), НР зарегистрированы в 62,5% наблюдений, а у уже получавших такое лечение, – в 15,4%. В большинстве случаев НР возникали в первые 48 ч, а их продолжительность составляла в среднем 2 дня.Заключение. Частота НР находилась на уровне 50,0%, что не превышало таковую при использовании оригинальной золедроновой кислоты в реальной клинической практике. Большинство НР возникли у «наивных» пациенток, развились в первые 2 сут после введения препарата, а разрешились в среднем в течение последующих 2 дней