KAChESTVO LEChENIYa POSTMENOPAUZAL'NOGO OSTEOPOROZA V MOSKOVSKOY OBLASTI

Aim of the study. To examine the quality of treatment of postmenopausal osteoporosis (OP), the level of commitment to therapy and the factors on which it depends, and the amount of social and economic costs associated with the treatment of OP in the Moscow Region (MR). Material and Methods. The study was conducted by questionnaire of 362 postmenopausal women aged 55 and older (median 65 (59, 70) years) from 17 districts and municipal entities of MR with verified diagnosis of postmenopausal OP. The questionnaire included a survey “Attitudes to the therapy of OP” and the scale of attitudes «Factors hindering receive quality medical care for OP. « Results. During the past year, respondents appealed to the medical facilities for OP treatment up to 15 times inclusive (an average of 2 (1, 4) times), 30.4% of patients were hospitalized or were unable to work due to the OP, in 14.3% of respondents disability leaf has lasted for more than six months. OP therapy in most cases was not assigned due to lack of adequate advice from the doctor, who did not insist on compulsory treatment (in reply to 50% of respondents) did not give clear recommendations (43.8%) or did not explain the specific instructions for the drug use ( 25.0%). When choosing a method of treatment 84% of respondents relied on the recommendations of the endocrinologist and the remaining 16% - of a gynecologist, rheumatologist, orthopedist, or trauma specialists who are not directly related to the treatment of OP. The major part in the treatment of postmenopausal OP is occupied by well-known brands of combination therapy with calcium and vitamin D, whereas strontium ranelate was used only by 13.9% of respondents, alendronate - 11.1°%, zoledronic acid — 8.8%. Despite the identified high adherence to therapy, most patients treated previously believe that efficient and convenient for the administration drug for the treatment of OP does not exist (39.1% and 34.8% respectively). Average monthly costs for patients treated OP are 1700 (300, 2000) rubles, while the high cost of antiosteoporotic drugs is the most important cause of the irregular treatment and the most significant factor of poor quality medical care to patients with OP. Conclusion: OP is associated with more visits to medical facilities and long periods of disability; the quality of treatment of OP in MR needed to be improved.

medical care, osteoporosis, quality of treatment

1. Дыдыкина И.С. Эпидемиология и перспективы проблемы ОП // Вестник семейной медицины. — 2010 — №3. — С. 33.

2. Кораблева Н.Н. Состояние решения проблемы остеопороза в условиях мегаполиса // Четвертая московская ассамблея «Здоровье столицы». — 2005. — http://www.mosmedclinic.ru/conf_library/25/1/41/

3. Лесняк О.М., Беневоленская Л.И. Остеопороз в Российской Федерации: проблемы и перспективы // Научно-практическая ревматология. — 2010. — №5. — С. 14-18.

4. Лесняк О.М., Евстигнеева Л.П., Коваль А.М. и др. Приверженность российских пациентов лечению остеопороза (национальный проект «Сила в постоянстве») // Фарматека. — 2008. — № 3(157). — С. 73-9.

5. Марченкова Л.А., Древаль А.В., Крюкова И.В., Добрицына М.В. Уровень знаний врачей по проблеме остеопороза // Сборник IV конференции с международным участием «Проблема остеопороз в травматологии и ортопедии». — Москва. — 2009. — С. 48-49.

6. Марченкова Л.А., Древаль А.В., Крюкова И.В. и соавт. Оценка медицинской помощи больным остеопорозом по результатам анкетирования врачей московской области // Врач. — 2009. — № 11 — С. 95-102.

7. Миронов С.И., Кораблева Н.Н. Принципы организации амбулаторной помощи больным остеопорозом // Национальный проект «Сила в постоянстве» ЦИТО им. Н.Н. Приорова, РМАПО. — 2003. — http://bonesurgery.ru/ view/principy_organizacii_ambulatornoj_pomoschi_bolnym_s_osteoporozom/.

8. Михайлов Е.Е., Беневоленская Л.И., Мылов Н.М. Распространенность переломов позвоночника в популяционной выборке лиц 50 лет и старше // Вестник травматологии и ортопедии им Н.Н. Приорова. — 1997 — №3. — С. 20-27.

9. Cowell W., Fulford-Smith A., Poultney S. Adherence with bisphosphonate treatment for osteoporosis in UK patients // Bone. — 2005. — V. 36 (Suppl.2). — P. 409-410.

10. Cramer J., Amonkar M., Hebborn A., Altman R. Compliance and Persistence with Bisphosphonate Dosing Regimens Among Women with Postmenopausal Osteoporosis // Curr Med Res Opin. — 2005. — V. 21(9). — P. 1453-1460.

11. Goettsch W.G., Penning E., Erkens J.E. et al. Risk for osteoporotic fractures is reduced in persistent bisphosphonate users // J Bone Miner Res. — 2005 — V. 20(Suppl 44). — P. 278. — Abstract SU388.

12. Kanis J.A., Borgstrom F., Zethraeus N., et al. Intervention thresholds for osteoporosis in the UK // Bone. — 2005. — V. 36. — P. 22.)

13. Kanis J.A., Delmas P., Burckhardt P., et al. Guidelines for diagnosis and management of osteoporosis The European Foundation for Osteoporosis and Bone Disease // Osteoporosis Int. — 1997. — V. 7 — P. 390.

14. Kanis J.A., Johnell O. Requirements for DXA for the management of osteoporosis in Europe // Osteoporosis Int. — 2005. — V. 16. — P. 229-238.

15. Melton L.J., Gabriel S.E., Crowson C.S. et al. Cost-equivalence of different osteoporotic fractures // Osteoporosis Int. — 2003. — V. 14. — P. 383.

16. Nguyen T.V., Center J.R., Eisman J.A. Osteoporosis: underrated, underdiagnosed and undertreated // Med J. — 2004. — V. 180. — P. 18.

17. Sebaldt R., Shane L.G., Pham B.Z. et al. Impact of non-compliance and non-persistence with daily bisphosphonates on longer-term effectiveness outcomes in patients with osteoporosis treated in tertiary specialist care // J Bone Miner Res. — 2004. — V. 19(Suppl. 1). — Abstract M 423.

18. Siris E.S., Miller P.D., Barrett-Connor E. et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment // JAMA. — 2001. — V. 286. — P. 2815.