Guideline for diagnostic, prevention and treatment of postmenopausal osteoporosis

Background.Postmenopausal osteoporosis (PMO), which is developed due the estrogen deficiency in women after menopause, is the most common type of systemic osteoporosis. The latest Ukrainian recommendation for its management requires revision due to new data from high-quality research performed in recent years. Thepurposewas to develop a guideline on the diagnosis, prevention, and treatment of PMO based on an analytical analysis of modern literary sources in order to improve the awareness of the medical community of Ukraine. Methodology. To develop the guideline, an expert group of 13 leading Ukrainian scientists of various specialties was created who conducted a thorough review of modern literature on this topic, assessed the level of existing evidence using the GRADE system, proposed and voted on 15 recommendations of the guideline. Results. The guideline contains chapters on diagnosis and differential diagnosis of PMO, assessment of the osteoporotic fracture risk, the role of bone turnover markers in the management of PMO, and modern strategies of antiosteoporotic treatment.Conclusions. The Ukrainian guideline on the diagnosis, prevention, and treatment of PMO, which contains 15 main recommendations, created on the basis of a thorough analysis and synthesis of modern literature data, is an important tool for the management of PMO and is recommended by Ukrainian Association of Osteoporosis for use in Ukrainian medical community

Anti-relapse therapy of endometriosis: possible variations

Research aim: to determine the clinical efficacy and safety of bioavailable curcumin Longimin® in the complex anti-relapse therapy of patients with extragenital endometriosis after surgery. Materials and methods. Study involved 45 women with a mean age of 29.3 ± 3.6 years with a diagnosis of extragenital endometriosis. After surgical treatment of this disease all patients were prescribed dienogest 2 mg/day for 6 months with anti-relapse purpose. After that, 22 patients did not receive drug treatment (group 1) and other 23 women started a six-month course of 400 mg bioavailable curcumin (group 2). Results. After 12 months of observation 3 cases (13.6%) of newly formed foci of endometriosis were found among patients of group 1, two of which were multi-endometriomas, and the third was retrocervical heterotopia. There were no signs of recurrence in the group of sequential use of dienogest and bioavailable curcumin. In addition, 6 months after completion of hormonal treatment the number of women with chronic pelvic pain in group 1 was increased and average score on a visual analogue scale (VAS) was increased by 80% (p ≤0.05). It was accompanied by a stable moderately high level of anxiety throughout the observation period. At the same time the number of women who complained of intermenstrual pain in group 2 decreased from 15 to 13, and the average VAS score decreased by 13% (p ≥0.05) during the treatment period. Patients in group 2 noted an improvement in emotional control during treatment, which resulted in the average score decrease on the scale of personal and situational anxiety of the Spielberg-Hanin's questionnaire (25% and 30% respectively, p ≤0.05). Conclusions. The nature of the endometriosis development and progression is multipathogenetic. Blocking only its hormonal link, especially in cases of extragenital forms, may not be sufficient to stop the pathological process and prevent recurrence in the long term. Оbtained results of sequential course of dienogest and bioavailable curcumin Longimin® with anti-relapse purpose showed the wider clinical effectiveness of this therapy, which is probably based on additional inhibition of systemic inflammation, proliferation, stroma and psychogenic component of disease