Background: uric acid (UA) is the end product of purine metabolism in humans. UA is considered as an antioxidant that prevents the negative effects of oxidative stress associated with aging and metabolic diseases. Some studies have shown both positive and negative associations between UA and bone mineral density (BMD) and its relationship with the trabecular bone score (TBS) is not fully understood.

Aim: to determine the relationship of BMD and TBS with UA level in postmenopausal women with rheumatoid arthritis (RA).

Materials and methods: the cross-sectional study included 140 postmenopausal women (median age 65.0 [59.5; 70.0] years) with a reliable diagnosis of RA. A unified questionnaire survey was conducted, a laboratory examination and dual-energy X-ray absorptiometry of femur and lumbar spine (L1-L4) with determination of TBS were performed.

Results: in the examined group, degraded microarchitecture was detected in 40.7% of patients, and the mean UA level was 273.9±73.7 mmol/L. Correlation analysis revealed a positive association between UA level and BMD of L1-L4 (r=0.025, p=0.003), total hip (TH) (r=0.23, p=0.007) and femoral neck (FN) (r=0,15, p=0,045) and a negative association with TBS (r=-0.18, p=0.035). Multiple linear regression revealed a significant positive association between BMD L1-L4 and TH with UA and body mass index (BMI), a negative association of BMD TH and TBS with age and UA level with TBS, while BMD FN was negatively associated with age and positively associated with BMI and calcium intake, but no relationship has been identified with UA.

Conclusion: our study showed an independent multidirectional relationship of UA level with BMD and TBS in postmenopausal women with RA: positive — with BMD L1-L4 and TH, negative — with TBS.

Primary hyperparathyroidism (PHPT) is a common endocrine disease with excessive secretion of parathyroid hormone and impaired mineral metabolism, resulting in decreased bone mineral density (BMD) and increased fracture risk. Radiography, dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), high-resolution peripheral QCT (HRPQCT) and radiofrequency echographic multispectrometry (REMS) have traditionally been used to assess bone density. However, these methods have certain limitations, therefore the search for new diagnostic approaches is necessary. In recent years, 3D femoral bone modelling (3D-DXA) has been actively developed, which allows three-dimensional analysis of bone density and structure based on DXA data. This method demonstrates high accuracy and correlation with CT, providing a more detailed assessment of changes in the cortical and trabecular components. The use of 3D-DXA opens new perspectives in the diagnosis and monitoring of bone complications in PHPT, which may contribute to more effective fracture risk prediction and personalised choice of therapeutic tactics.

The differential diagnosis of osteoporosis in children and young adults is a challenge. In young people, the most common cause of primary osteoporosis is osteogenesis imperfecta (OI). In 2013, 5 families with X-linked osteoporosis and osteoporotic fractures manifesting in childhood were described for the first time in men who had pathogenic variants in the PLS3 gene. The PLS3 gene is located on the X chromosome (Xq23) and encodes the protein plastin 3, the main function of which is to bind and group F-actin molecules, the main component of the cytoskeleton. Currently, about 50 men with this disease have been described in the literature.

In this article, two brothers with X-linked osteoporosis/OI are described, in whom hemizygous mutations in the PLS3 gene ((NM_005032.7) c.836_837dup (p.His280Phefs*43) were detected. In both brothers, fractures have occurred since childhood (forearm bones, and in the elder brother also a fracture of the humerus and a fracture of the greater trochanter), and later multiple compression fractures of the vertebrae were detected. No disorders of mineral metabolism were detected in both brothers, but bone mineral density (BMD) measured by DEXA was decreased. The elder brother is treated with teriparatide, the younger brother is treated with zoledronic acid, and new fractures were not detected during a short follow-up.

Both brothers received this PLS3 variant from their mother, in whom it was heterozygous. She was diagnosed with primary hyperparathyroidism with multiple parathyroid adenomas and severe osteoporosis with two thoracic vertebral compression fractures and decrease in spinal BMD. In Russia, cases of X-linked osteoporosis/OI due to mutations in the PLS3 gene have not been previously described. Cases of primary hyperparathyroidism in patients with PLS3 mutations have not been described in the literature.

The press release informs about the new provisions that were introduced into the latest version (2023) of the clinical recommendations of the International Society for Clinical Densitometry. The provisions relate to equipment whose use is scientifically justified from the point of view of evidence-based medicine. The use of dual-energy X-ray absorptiometry (DRA) and other technologies for bone tissue assessment is regulated by these recommendations. Changes and additions to the 2023 recommendations relate to the monitoring of measurements and the formation of standard conclusions on DХA; additional DХA programs for assessing the condition of the trabecular bone – the trabecular bone index (TBS) and hip imaging for the prognosis of atypical fractures. Changes and new provisions have been added to this document due to their increasing relevance and importance of use at the present time.

This consensus was prepared by a group of experts from various specialties in the interests of improving the quality of specialized medical care for elderly and senile patients with hip fractures, which are almost always the result of osteoporosis and an increased risk of falls. Difficulties in the treatment of this category of patients are due to both the severity of the injury itself and comorbidity, which is accompanied by high mortality and extremely low quality of life for survivors. Effective management of such patients is possible only with the joint involvement of doctors and nurses of surgical and internal medicine and geriatric profiles within the framework of the so-called orthogeriatric approach. Experts in the field of traumatology and orthopedics, anesthesiology and intensive care, geriatrics, rehabilitation, clinical pharmacology, therapy, rheumatology and endocrinology based on the available clinical recommendations and orders of the Ministry of Health Care of the Russian Federation, literature data and general discussion formulated the basic principles of interdisciplinary management of elderly and senile people with hip fracture. The aim of the consensus is to help establishing effective interaction between professionals of different specialties based on their better mutual understanding, which will contribute to improving specialized medical care, saving lives and reducing disability of elderly patients with hip fracture.