References

porozendo

Остеопороз и остеопатии

Osteoporosis and Bone Diseases

2072-26802311-0716

Endocrinology Research Centre

10.14341/osteo12930

porozendo-12933

Research Article

Клинические рекомендации

Guidelines

Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза

Federal clinical guidelines for diagnosis, treatment and prevention of osteoporosis

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Ж. Е.

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11 Dm. Ulyanova street, 117036 Moscow

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К. Ю.

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А. В.

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Ершова Ольга Борисовна, д.м.н., профессор. eLibrary SPIN: 8238-8201

Ярославль

Ol’ga V. Ershova, MD, PhD, Professor. eLibrary SPIN: 8238-8201

Yaroslavl

yarosteoporosis@list.ru

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Н. В.

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N. V.

Загородний Николай Васильевич, д.м.н., профессор, член-корр. РАН. eLibrary SPIN: 6889-8166

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Nikolay V. Zagorodniy, MD, PhD, Professor, Corresponding Member of the RAS. eLibrary SPIN: 6889-8166

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Дж. А.

Kanis

J. A.

Канис Джон А., доктор наук, профессор

Шеффилд

John A. Kanis, MD, PhD, Professor

Sheffield

w.j.pontefract@sheffield.ac.uk

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И. В.

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I. V.

Крюкова Ирина Викторовна, к.м.н., доцент. eLibrary SPIN: 7669-3010

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Irina V. Kryukova, MD, PhD, Assistant Professor. eLibrary SPIN: 7669-3010

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kiv200877@yandex.ru

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О. М.

Lesnyak

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Лесняк Ольга Михайловна, д.м.н., профессор. eLibrary SPIN: 6432-4188

Санкт-Петербург

Olga M. Lesnyak, MD, PhD, Professor. eLibrary SPIN: 6432-4188

St. Petersburg

olga.m.lesnyak@yandex.ru

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Е. О.

Mamedova

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Мамедова Елизавета Октаевна, к.м.н. eLibrary SPIN: 3904-6017

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Elizaveta O. Mamedova, MD, PhD. eLibrary SPIN: 3904-6017

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lilybet@mail.ru

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Л. А.

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Марченкова Лариса Александровна, к.м.н. eLibrary SPIN: 9619-8004

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Larisa A. Marchenkova, MD, PhD. eLibrary SPIN: 9619-8004

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marchenkovaLA@rncmrik.com

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Г. А.

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Мельниченко Галина Афанасьевна, д.м.н., профессор, академик РАН. eLibrary SPIN: 8615-0038

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Galina A. Mel’nichenko, MD, PhD, Professor, Academician of the RAS. eLibrary SPIN: 8615-0038

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teofrast2000@mail.ru

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Л. В.

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L. V.

Никанкина Лариса Вячеславовна, к.м.н. eLibrary SPIN: 2794-0008

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Larisa V. Nikankina, MD, PhD. eLibrary SPIN: 2794-0008

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larisanikan@rambler.ru

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О. А.

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O. A.

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Oksana A. Nikitinskaya, MD, PhD. eLibrary SPIN: 4372-8931

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nikitinskayaox@ya.ru

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А. В.

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A. V.

Петряйкин Алексей Владимирович, к.м.н., доцент. eLibrary SPIN: 6193-1656

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Alexey V. Petryaykin, MD, PhD, Assistant Professor. eLibrary SPIN: 6193-1656

Moscow

a.petraikin@npcmr.ru

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Е. А.

Pigarova

E. A.

Пигарова Екатерина Александровна, д.м.н. eLibrary SPIN: 6912-6331

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Ekaterina A. Pigarova, MD, PhD. eLibrary SPIN: 6912-6331

Moscow

kpigarova@gmail.com

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С. С.

Rodionova

S. S.

Родионова Светлана Семеновна, д.м.н., профессор. eLibrary SPIN: 3529-8052

Москва

Svetlana S. Rodionova, MD, PhD, Professor. eLibrary SPIN: 3529-8052

Moscow

rod06@inbox.ru

https://orcid.org/0000-0001-7041-0732

Рожинская

Л. Я.

Rozhinskaya

L. Ya.

Рожинская Людмила Яковлевна, д.м.н., профессор. eLibrary SPIN: 5691-7775

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Liudmila Y. Rozhinskaya, MD, PhD, Professor. eLibrary SPIN: 5691-7775

Moscow

rozh@endocrincentr.ru

https://orcid.org/0000-0002-1763-0725

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И. А.

Skripnikova

I. A.

Скрипникова Ирина Анатольевна, д.м.н., профессор. eLibrary SPIN: 1514-0880

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Irina A. Skripnikova, MD, PhD, Professor. eLibrary SPIN: 1514-0880

Moscow

ISkripnikova@gnicpm.ru

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Н. В.

Tarbaeva

N. V.

Тарбаева Наталья Викторовна, к.м.н. eLibrary SPIN: 5808-8065

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Natalya V. Tarbaeva, MD, PhD. eLibrary SPIN: 5808-8065

Moscow

ntarbaeva@inbox.ru

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Ткачева

О. Н.

Tkacheva

O. N.

Ткачева Ольга Николаевна, д.м.н., профессор. eLibrary SPIN: 6129-5809

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Olga N. Tkacheva, MD, PhD, Professor. eLibrary SPIN: 6129-5809

Moscow

tkacheva@rambler.ru

https://orcid.org/0000-0003-4739-4302

Торопцова

Н. В.

Toroptsova

N. V.

Торопцова Наталья Владимировна, д.м.н. eLibrary SPIN: 5650-2058

Москва

Natalya V. Toroptsova, MD, PhD. eLibrary SPIN: 5650-2058

Moscow

toroptsovan@mail.ru

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Фарба

Л. Я.

Farba

L. Ya.

Фарба Леонид Яковлевич. eLibrary SPIN: 1767-1782

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Leonid Y. Farba, MD. eLibrary SPIN: 1767-1782

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farbasurg@mail.ru

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Т. Т.

Tsoriev

T. T.

Цориев Тимур Тамерланович, к.м.н. eLibrary SPIN: 7234-2499

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Timur T. Tsoriev, MD, PhD. eLibrary SPIN: 7234-2499

Moscow

timur.tsoriev@gmail.com

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Т. О.

Chernova

T. O.

Чернова Татьяна Олеговна, к.м.н. eLibrary SPIN: 4087-2160

Москва

Tatyana O. Chernova, MD, PhD. eLibrary SPIN: 4087-2160

Moscow

tatcher2@ya.ru

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Юренева

С. В.

Yureneva

S. V.

Юренева Светлана Владимировна, д.м.н. eLibrary SPIN: 3623-9149

Москва

Svetlana V. Yureneva, MD, PhD. eLibrary SPIN: 3623-9149

Moscow

syureneva@gmail.com

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Якушевская

О. В.

Yakushevskaya

O. V.

Якушевская Оксана Владимировна, к.м.н. eLibrary SPIN: 4037-8249

Москва

Oksana V. Yakushevskaya, MD, PhD. eLibrary SPIN: 4037-8249

Moscow

Ykushox83@mail.ru

ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава РоссииРоссияEndocrinology Research CentreRussian Federation

ГАУЗ ЯО «Клиническая больница скорой медицинской помощи имени Н.В. Соловьева»; ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииРоссияClinical Ambulance Hospital named after N.V. Solovyov; Yaroslavl’ State Medical UniversityRussian Federation

ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава РоссииРоссияMoscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation

ФГБУ «Национальный медицинский исследовательский центр профилактической медицины» Минздрава РоссииРоссияNational Research Center for Preventive MedicineRussian Federation

ГБУЗ МО «Московский областной научно-исследовательский клинический институт (МОНИКИ) имени М.Ф. Владимирского»РоссияMoscow Regional Research Clinical Institute named after M.F. VladimirskiyRussian Federation

ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России – обособленное структурное подразделение «Российский геронтологический научно-клинический центр»РоссияRussian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation – Russian Gerontological Research and Clinical CenterRussian Federation

ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииРоссияYaroslavl’ State Medical UniversityRussian Federation

ФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии имени Н.Н. Приорова» Минздрава РоссииРоссияCentral Research Institute of Traumatology and Orthopedics named after N.N. PriorovRussian Federation

ГАУЗ «Оренбургская областная клиническая больница №2»РоссияOrenburg Regional Clinical Hospital №2Russian Federation

Шеффилдский университет (Центр метаболических заболеваний костей)ВеликобританияThe University of Sheffield (Centre for Metabolic Bone Diseases)United Kingdom

ГБОУ ВПО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation

ФГБУ «Национальный медицинский исследовательский центр реабилитации и курортологии» Минздрава РоссииРоссияNational Medical Research Center of Rehabilitation and BalneologyRussian Federation

ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»РоссияResearch Institute of Rheumatology named after V.A. NasonovaRussian Federation

ГБУЗ города Москвы «Научно-практический клинический центр диагностики и телемедицинских технологий Департамента здравоохранения города Москвы»РоссияResearch and Practical Clinical Center for Diagnostics and Telemedicine TechnologiesRussian Federation

ГБУЗ «Городская клиническая больница №13 Департамента здравоохранения города Москвы»РоссияCity Clinical Hospital №13Russian Federation

ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава РоссииРоссияResearch Center for Obstetrics, Gynecology and PerinatologyRussian Federation

2021

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Copyright © Белая Ж.Е., Белова К.Ю., Бирюкова Е.В., Дедов И.И., Дзеранова Л.К., Драпкина О.М., Древаль А.В., Дубовицкая Т.А., Дудинская Е.Н., Ершова О.Б., Загородний Н.В., Илюхина О.Б., Канис Д.А., Крюкова И.В., Лесняк О.М., Мамедова Е.О., Марченкова Л.А., Мельниченко Г.А., Никанкина Л.В., Никитинская О.А., Петряйкин А.В., Пигарова Е.А., Родионова С.С., Рожинская Л.Я., Скрипникова И.А., Тарбаева Н.В., Ткачева О.Н., Торопцова Н.В., Фарба Л.Я., Цориев Т.Т., Чернова Т.О., Юренева С.В., Якушевская О.В., 2021

2021

Белая Ж.Е., Белова К.Ю., Бирюкова Е.В., Дедов И.И., Дзеранова Л.К., Драпкина О.М., Древаль А.В., Дубовицкая Т.А., Дудинская Е.Н., Ершова О.Б., Загородний Н.В., Илюхина О.Б., Канис Д.А., Крюкова И.В., Лесняк О.М., Мамедова Е.О., Марченкова Л.А., Мельниченко Г.А., Никанкина Л.В., Никитинская О.А., Петряйкин А.В., Пигарова Е.А., Родионова С.С., Рожинская Л.Я., Скрипникова И.А., Тарбаева Н.В., Ткачева О.Н., Торопцова Н.В., Фарба Л.Я., Цориев Т.Т., Чернова Т.О., Юренева С.В., Якушевская О.В.

Belaya Z.E., Belova K.Y., Biryukova E.V., Dedov I.I., Dzeranova L.K., Drapkina O.M., Dreval A.V., Dubovitskaya T.A., Dudinskaya E.N., Ershova O.B., Zagorodniy N.V., Ilyukhina O.B., Kanis J.A., Kryukova I.V., Lesnyak O.M., Mamedova E.O., Marchenkova L.A., Mel’nichenko G.A., Nikankina L.V., Nikitinskaya O.A., Petryaikin A.V., Pigarova E.A., Rodionova S.S., Rozhinskaya L.Y., Skripnikova I.A., Tarbaeva N.V., Tkacheva O.N., Toroptsova N.V., Farba L.Y., Tsoriev T.T., Chernova T.O., Yureneva S.V., Yakushevskaya O.V.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.osteo-endojournals.ru/jour/article/view/12933

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).

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).

Остеопорозостеопоротические переломыпереломы позвонковпереломы бедренной кости

Osteoporosisosteoporotic fracturesspinal fractureship fractures

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