porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo12937porozendo-12937Research ArticleКлинические рекомендацииGuidelinesПроект федеральных клинических рекомендаций по диагностике, лечению и профилактике дефицита витамина DDraft federal clinical practice guidelines for the diagnosis, treatment, and prevention of vitamin D deficiencyhttps://orcid.org/0000-0002-8175-7886ДедовИ. И.DedovI. I.

Дедов Иван Иванович - доктор медицинских наук, профессор, академик РАН; eLibrary SPIN: 5873-2280.

Москва

Ivan I. Dedov - MD, PhD, Professor, Academician of the RAS; eLibrary SPIN: 5873-2280.

Moscow

dedov@endocrincentr.ruhttps://orcid.org/0000-0002-5634-7877МельниченкоГ. А.Mel’nichenkoG. A.

Мельниченко Галина Афанасьевна - доктор медицинских наук, профессор, академик РАН; eLibrary SPIN: 8615-0038.

Москва

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

Moscow

teofrast2000@mail.ruhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна - доктор медицинских наук, профессор, член-корреспондент РАН; eLibrary SPIN: 5624-3875.

Москва

Natalia G. Mokrysheva - MD, PhD, Professor, Corresponding Member of the RAS; eLibrary SPIN: 5624-3875.

Moscow

parathyroid.enc@gmail.comhttps://orcid.org/0000-0001-6539-466XПигароваЕ. А.PigarovaE. A.

Пигарова Екатерина Александровна - доктор медицинских наук; eLibrary SPIN: 6912-6331.

Москва

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

Moscow

kpigarova@gmail.comhttps://orcid.org/0000-0002-7634-5457ПоваляеваА. А.PovaliaevaA. A.

Поваляева Александра Александровна; eLibrary SPIN: 1970-2811.

Москва

Alexandra A. Povaliaeva - MD; eLibrary SPIN: 1970-2811.

Moscow

a.petrushkina@yandex.ruhttps://orcid.org/0000-0001-7041-0732РожинскаяЛ. Я.RozhinskayaL. Ya.

Рожинская Людмила Яковлевна - доктор медицинских наук, профессор; Researcher ID: B-6618-2017; Scopus Author ID: 55121221200; eLibrary SPIN: 5691-7775.

117292, Москва, ул. Дмитрия Ульянова, д. 11

Liudmila Y. Rozhinskaya - MD, PhD, Professor; Researcher ID: B-6618-2017; Scopus Author ID: 55121221200; eLibrary SPIN: 5691-7775.

11 Dmitriya Ul’yanova St, 117292 Moscow

lrozhinskaya@gmail.comhttps://orcid.org/0000-0002-6674-6441БелаяЖ. Е.BelayaZh. E.

Белая Жанна Евгеньевна - доктор медицинских наук; eLibrary SPIN: 4746-7173.

Москва

Zhanna E. Belaya - MD, PhD; eLibrary SPIN: 4746-7173.

Moscow

jannabelaya@gmail.comhttps://orcid.org/0000-0002-0327-4619ДзерановаЛ. К.DzeranovaL. K.

Дзеранова Лариса Константиновна - доктор медицинских наук; eLibrary SPIN: 2958-5555.

Москва

Larisa K. Dzeranova - MD, PhD; eLibrary SPIN: 2958-5555.

Moscow

dzeranovalk@yandex.ruhttps://orcid.org/0000-0002-1547-0123КароноваТ. Л.KaronovaT. L.

Каронова Татьяна Леонидовна - доктор медицинских наук, профессор; eLibrary SPIN: 3337-4071.

Санкт-Петербург

Tatiana L. Karonova - MD, PhD, Professor; eLibrary SPIN: 3337-4071.

Saint Petersburg

karonova@mail.ruhttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovaL. A.

Суплотова Людмила Александровна - доктор медицинских наук, профессор; eLibrary SPIN: 1212-5397.

Тюмень

Liudmila A. Suplotova - MD, PhD, Professor; eLibrary SPIN: 1212-5397.

Tyumen

suplotovala@mail.ruhttps://orcid.org/0000-0002-8520-8702ТрошинаЕ. А.TroshinaE. А.

Трошина Екатерина Анатольевна - доктор медицинских наук, профессор, член-корреспондент РАН; eLibrary SPIN: 8821-8990.

Москва

Ekaterina A. Troshina - MD, PhD, Professor, Corresponding Member of the RAS; eLibrary SPIN: 8821-8990.

Moscow

troshina@inbox.ruФГБУ НМИЦ эндокринологии Минздрава РоссииРоссияEndocrinology Research CentreRussian FederationФГБУ НМИЦ им. В.А. Алмазова Минздрава РоссииРоссияNational Medical Research Center named after V.A. AlmazovRussian FederationФГБОУ ВО Тюменский государственный медицинский университет Минздрава РоссииРоссияTyumen State Medical UniversityRussian Federation202102042022244426Copyright © Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г., Пигарова Е.А., Поваляева А.А., Рожинская Л.Я., Белая Ж.Е., Дзеранова Л.К., Каронова Т.Л., Суплотова Л.А., Трошина Е.А., 20222022Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г., Пигарова Е.А., Поваляева А.А., Рожинская Л.Я., Белая Ж.Е., Дзеранова Л.К., Каронова Т.Л., Суплотова Л.А., Трошина Е.А.Dedov I.I., Mel’nichenko G.A., Mokrysheva N.G., Pigarova E.A., Povaliaeva A.A., Rozhinskaya L.Y., Belaya Z.E., Dzeranova L.K., Karonova T.L., Suplotova L.A., Troshina E.А.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/12937

Данный проект клинических рекомендаций по диагностике, лечению и профилактике дефицита витамина D является обновлением предыдущего документа 2016 г. Проведен анализ соответствующих литературных данных с особым вниманием к метаанализам, рандомизированным клиническим исследованиям и систематическим обзорам, опубликованным за последние 5 лет. Сформулированные обновленные рекомендации были обсуждены и скорректированы совместно с ведущими эндокринологами Российской Федерации, являющимися экспертами в данной проблеме.

Пересмотрена классификация уровней 25(ОН)D (в частности, конкретизирован целевой диапазон значений 25(ОН)D), разработаны рекомендации по скринингу ассоциированных с дефицитом витамина D заболеваний. Также внедрены понятие ассоциированной с витамином D токсичности и рекомендации по ее диагностике и профилактике, обозначены показания к исследованию других метаболитов витамина D, помимо 25(ОН)D — основного маркера статуса витамина D.

Раздел по лечению дефицита витамина D был расширен и претерпел ряд изменений. Основные дополнения коснулись восполнения дефицита и недостаточности дефицита витамина D у отдельных категорий пациентов (в частности, при хронической болезни почек, при аутоиммунных заболеваниях, у беременных), а также контроля эффективности и безопасности проводимой терапии; скорректированы показания к назначению препаратов активных метаболитов витамина D. Пересмотрены рекомендации по профилактике дефицита витамина D в общей популяции с учетом крупных рандомизированных клинических исследований, метаанализов и систематических обзоров последних лет.

Настоящая публикация представляет собой развернутую версию федеральных клинических рекомендаций.

This draft clinical practice guideline for the diagnosis, treatment and prevention of vitamin D deficiency is an update from a previous 2016 document. An analysis of the relevant literature data was carried out, with particular attention to meta-­analyzes, randomized clinical trials and systematic reviews published over the past 5 years. The updated recommendations were discussed and revised by the leading endocrinologists of the Russian Federation, who have expert status in this issue.

The classification of 25(OH)D levels has been revised (in particular, the target range of 25(OH)D values has been specified), recommendations have been developed for screening of the disorders associated with vitamin D deficiency. The concept of vitamin D-associated toxicity and recommendations for its diagnosis and prevention have been introduced. Also, indications for the assessment of other vitamin D metabolites besides 25(OH)D, the main marker of vitamin D status, have been indicated.

The section regarding treatment of vitamin D deficiency has been expanded and corrected. The major additions concerned the replenishment of the vitamin D deficiency and insufficiency in certain categories of patients (particularly, in the presence of the chronic kidney disease and autoimmune diseases, as well as in pregnant women) and monitoring of the effectiveness and safety of the therapy. The indications for prescribing active metabolites of vitamin D have been adjusted. Recommendations for the prevention of vitamin D deficiency in the general population have also been revised, taking into account large randomized clinical trials, meta-analyzes and systematic reviews of recent years.

This publication is an expanded version of the federal guidelines.

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