Background: Denosumab is a highly effective and safe first-line treatment for osteoporosis. Primary hyperparathyroidism is a prevalent condition found in patients with osteoporosis. However, data regarding effectiveness of denosumab treatment in patients with PHPT are scarce.

Aims: To estimate the comparative effects of denosumab to treat postmenopausal osteoporosis (PMO) and osteoporosis caused by primary hyperparathyroidism (PHPT) or glucocorticoid-induced osteoporosis (GIOP) in postmenopausal women in routine clinical practice. Materials and methods: Retrospective study based on the medical card records. Patients over 50 years of age with verified osteoporosis (based on bone mineral density (BMD) T-score ≤ -2.5 SD and/or low-trauma fracture), who had at least 3 denosumab injections were included in the study.

Results: 162 patients were included and divided into three groups according to the etiology of osteoporosis. The first group consisted of postmenopausal women with osteoporosis (PMO) [(n=85); median age 70 [64;78]]. Patients with glucocorticoid-induced osteoporosis (GIOP) were enrolled in the second group [(n=16); male to female ratio =1:15; median age 60 [57,8; 66,3]]. The third group consisted of patients with PHPT and osteoporosis [(n=61); male to female=2:59; median age 68 [63; 75]]. Among all patients, denosumab treatment significantly increased BMD and decreased serum levels of calcium and CTx compared with baseline. PMO: the median increase in BMD according to the T-score was L1-L4 0,6 (p<0,001), femoral neck 0,2 (p<0,001); serum calcium -0,04 (p=0,004). PHPT: the median increase in BMD according to the T-score was L1-L4 0,6 (p<0,001), femoral neck 0,2 (p<0,001); radius 33% 0,25 (p=0,002), serum calcium -0,04 (p<0,001). In patients with GIOP, denosumab increased BMD in the lumbar spine L1-L4 0,5 (p=0,004). There was no difference in BMD increase or in levels of bone turnover suppression between the groups. A marked decline in levels of serum calcium was noted among patients with GFR less than 60 ml / min / 1.73 m2 (median Δ Са serum=0,24 p<0,001), compared to patients without CKD (median Δ Са serum=0,08 p<0,001).

Conclusion: Denosumab treatment is similarly effective for increasing BMD and decreasing bone turnover markers in patients with PMO and PHPT among postmenopausal women. The hypocalciemic effect of denosumab is most significant in subjects with PHPT.

Osteopetrosis is a rare hereditary disease that develops as a result of genetic mutations leading to impaired development and function of osteoclasts. There are several forms of osteopetrosis that differ in the type of inheritance (autosomal recessive, autosomal dominant and intermediate) and the severity of symptoms. The main clinical manifestations of the disease are frequent pathological fractures, anemia, thrombocytopenia, infectious complications, compression of the cranial nerves and impaired function. With timely diagnosis and successful hematopoietic stem cell transplantation (HSCT), the prognosis is favorable. In the vast majority of cases, transplantation is performed in the first 10 months of life. The literature describes only 12 patients with osteopetrosis who underwent HSCT over the age of 5 years. The article presents a clinical case of osteopetrosis due to a mutation in the CA2 gene (Chr8: 86389420C> G, p.Y193X) in a 30-year-old patient who underwent THSC at the age of 27.

VII Russian Congress on Osteoporosis presents the latest advances in the field of osteoporosis, osteoarthritis and other diseases of the skeleton, new data on drugs and medical supplies.

The spectrum of pathology discussed at the congress is not limited to osteoporosis and osteoarthritis. Special sessions are devoted to the pathology of parathyroid glands, vitamin D and rare bone diseases. Quiestions of instrumental diagnostics are explored and new approaches of risk of fracture risk determination are presented.