porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo12117porozendo-12117Research ArticleНаучный обзорReviewОстеомаляция в практике эндокринолога: этиология, патогенез, дифференциальная диагностика с остеопорозомOsteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosishttps://orcid.org/0000-0003-2320-1051ГолоунинаОльга ОлеговнаGolouninaOlga O.

cтудентка 3 курса Института клинической медицины

Student, Medical faculty

olga.golounina@mail.ruhttps://orcid.org/0000-0003-2144-8595РуноваГюзель ЕвгеньевнаRunovaGyuzel E.

кандидат медицинских наук, ассистент кафедры эндокринологии №1

MD, PhD

guzelvolkova@yandex.ruhttps://orcid.org/0000-0002-3026-6315ФадеевВалентин ВикторовичFadeyevValentin V.

д.м.н., профессор, член-корр. РАН

MD, PhD, Professor

walfad@mail.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation2019070220202222331Copyright © Голоунина О.О., Рунова Г.Е., Фадеев В.В., 20192019Голоунина О.О., Рунова Г.Е., Фадеев В.В.Golounina O.O., Runova G.E., Fadeyev V.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/12117

Остеопороз – наиболее распространенная причина низкой минеральной плотности кости (МПК) и возникновения низкотравматичных переломов у взрослых. Однако при проведении дифференциальной диагностики с другими метаболическими заболеваниями скелета необходимо также учитывать другие возможные причины снижения МПК, в том числе остеомаляцию, поскольку схемы лечения при данных состояниях будут значимо различаться. Остеомаляция – системный патологический процесс, характеризующийся снижением прочности костной ткани в результате избыточного накопления неминерализованного остеоида и несоответствием между образованием костного матрикса и его минерализацией. Наиболее часто остеомаляция у взрослых развивается вследствие выраженного дефицита витамина D любой этиологии, реже – на фоне патологии почек, мезенхимальных опухолей, секретирующих фактор роста фибробластов 23, наследственных метаболических заболеваний скелета. Клинические симптомы остеомаляции неспецифичны, проявляются генерализованными диффузными болями в костях, мышечной слабостью, скелетными деформациями и часто остаются незамеченными на начальной стадии заболевания. Гистоморфометрическое исследование является наиболее точным методом для установления диагноза остеомаляции, позволяющим оценить скорость костеобразования и кальцификации. Основными задачами при лечении остеомаляции любой этиологии являются устранение дефицита витамина D, гипокальциемии, гипофосфатемии, предотвращение прогрессирования деформаций костей и мышечной гипотонии.

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often – along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

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The authors declare that there are no conflicts of interest present.