Women after menopause have an increased risk of cardiovascular disease associated with atherosclerosis (CVD-AS), and osteoporosis. Low body weight is an independent risk factor for osteoporosis and related fractures. At the same time, osteoporosis occurs in people with overweight and is associated with a high risk of death from cardiovascular disease. As the link of overweight with CVD-AS was proved long ago, the impact of obesity on bone status is not sufficiently investigated. Purpose: To study the relationship between bone, fat, lean mass and adipokines in postmenopausal women with low and high risk of cardiovascular disease. Materials and Methods: The cross-sectional study included 100 women aged 45-65 years. Assessment of cardiovascular risk was carried out using an electronic version of the scale of SCORE. Measurement of bone mineral density (BMD), the amount of bone, fat and lean mass was performed using dual energy x-ray absorptiometry. We investigated the concentration of leptin and adiponectin in serum. Results: The increased cardiovascular risk, and low BMD was associated with duration of menopause. Women with an increased risk of CVD-AS more common had obesity and osteoporosis. Osteopenia and osteoporosis were found in 63% of patients, among whom 49% were overweight and 27% obese. To assess the distribution of fat and lean body mass in the ratio have been introduced «fat mass in the trunk (kg)/fat mass in the limbs (kg)» (TF/LF) and «lean mass in the trunk (kg) / lean mass in the limbs (kg) «(TL/LL). The ratio TF/LF, was associated with the presence or absence of abdominal obesity, directly correlated with an increased cardiovascular risk, and BMD at the proximal femur, and TL/LL directly correlated with BMD of the proximal femur and spine. In a linear regression analysis confirmed the connection of the BMD only with the lean mass. Leptin was directly correlated with % fat in the body, spine and BMD of the proximal femur, in the regression analysis the relationship of leptin and BMD remained highly significant. The inverse correlation of BMD in the proximal femoral neck and adiponectin after regression analysis was not confirmed. Conclusions: Low bone mass is associated with increased cardiovascular risk. Fat mass does not have neither protective, nor deleterious effect on BMD. Lean body mass and leptin may claim to be independent prognostic factors for bone mass.

Many patients with prolactin secreting pituitary tumors have a decreased bone mineral density. The bone loss is associated with an increase in bone resorption and is secondary to prolactin-induced hypogonadism. Normalization of prolactin increases the BMD but is not associated with its normalization. Despite low BMD hyperprolactinemic subjects do not demonstrate increase in fractures compared with the general population.

We investigated the awareness of physicians of different specialties in the field of osteoporosis. With the help of a poll, consisting of 34 basic questions on the diagnosis, prevention and treatment of osteoporosis, we tested 503 physicians of 13 different medical specialties from Moscow and Moscow region. According to test results, the median of correct answers in the test was 6 (3, 9), i.e. 18% of the maximum possible score. 50% of respondents answered correctly to questions 5 and less, i.e., <15% of the total number of questions, and in only 19.4% of respondents the number of correct responses exceeded 10, i.e. > 30% of the maximum possible score. We found a negative correlation between age and level of knowledge in physicians № 1/2012 Остеопороз и остеопатии (r=-0, 25; p <0, 001). The highest awareness on the issue of osteoporosis showed endocrinologists — the median of correct answers in the test was 12 (7, 14), rheumatologists — 10 (6.5, 14), neurologists — 10 (3, 13), and cardiologists — 6 (5, 8). and the lowest — obstetricians — 3 (1, 4). The number of correct answers from doctors working in Moscow was significantly higher than that of the doctors working in the Moscow region (median 5 (3, 9). and 9 (5, 12). points, respectively, p <0, 001 — Mann-Whitney U-test). Thus, physicians in the Moscow region revealed a distinct lack of knowledge in the field of osteoporosis.

In a review of the literature reflects the modern understanding of the cellular-molecular mechanism development of osteoporosis. Reflects the importance of cytokine RANKL-RANK-OPG sistem and Wnt/β-catenin signaling pathway in the development process of osteoblasto- and osteoclastogenesis. Noting the key role in the process of bone formation a number of molecules of cell signaling pathway and their antagonists are of interest as a target molecule to search for new drugs treatment for osteoporosis.

New tool to assess fracture probability — the 10-year absolute fracture risk (calculator FRAX), released by WHO in 2008 - is discussed in this review. Dual-energyX-rays absorptiometry (DXA) is considered as a gold standard of diagnosis of osteoporosis. The goal of FRAX was to improve the prognostic performance of densitometry in assessing fracture risk through adding the information on different clinical risk factors independent of bone mineral density. The methodology used in searching for the risk factors included in FRAX is reviewed. Disadvantages and limitations of FRAX as well as ways of it implementation in clinical practice are discussed.