The examination of residents of St. Petersburg and Petrozavodsk revealed a high frequency of vitamin D deficiency and according to the criteria of the International Society of Endocrinology (ENDO, 2011), normal levels of vitamin D sufficiency had only 16.8% of residents of the north-western region of the Russian Federation, while vitamin D insufficiency was seen in 37.5%, and deficit — in 45.7% of patients. When reviewing the results using the criteria proposed by the U.S. Institute of Medicine (IOM, 2011), normal values of 25(OH)D in serum were detected in 49.6% insufficient levels — in 40.0% and deficit — in 10.4%. The decrease ofvitamin D levels was independent of age, but more frequent in women and people who are overweight. Given the lack of national standards for assessing the sufficiency ofvitamin D, as well as the average level of 25(OH)D in the blood serum in the study population, to assess vitamin D status in the northwestern region of Russia is preferable to use the criteria proposed by the U.S. Institute of Medicine in 2011.

Introduction. Bone health in type 2 diabetes mellitus (T2DM) is discussed for a long time as a known fact for increased risk of fractures. Purpose. To estimate the parameters of bone remodeling in pre-andpostmenopausal women with T2DM. Materials and Methods. In a cross-sectional pilot study which included 80 women: 40 with T2DM and 40 without disturbances of glucose metabolism (K), divided into subgroups of premenopausal (pre) and natural menopause (post) — 20 patients each. Results and conclusions. We found a tendency toward a decrease in bone turnover in patients T2DM, a significant negative relationship with C-peptide and ALP in T2DM, a positive correlation with tartrate — resistant acid phosphatase in the control group, although the levels of C-peptide did not differ in patients with T2DM and in the control group . Identified characteristics of decreased bone remodeling in patients with T2DM pathogenically justify the use of anabolic antiosteoporotic drugs for treatment of osteoporosis in such patients.

Introduction. There is evidence that patients with ankylosing spondylitis (AS) in the early stages of the disease have a significantly decreased bone mass. However, the prevalence of osteoporosis, and the mechanism of its development in the AS are poorly understood. The appearance of inhibitors of tumor necrosis factor alpha (TNF-α) significantly improved the prognosis and quality of life of patients with AS. The largest clinical experience has been gained in relation to infliximab (INF). Purpose. To assess the impact of IFN therapy on BMD of the femoral neck in patients with AS. Materials and Methods. We observed 65 male patients with a diagnosis of AS (according to the modified New York criteria 1984). In a deployed or late stage of the disease, with a high degree of activity — BASDAI > 4.0. All patients were divided into 2 groups: group 1 (n=25) — patients receiving combination therapy NSAIDs and IFN, group 2 (n=40) — patients with monotherapy at standard doses of NSAIDs (diclofenac 150 mg/ day, 200 mg of nimesulide/day meloxicam, 15 mg/day). IFN was administered a dose of 5 mg/kg of patient body weight: 1st day after 2 weeks and 6 weeks after the first injection, and after every 8 weeks. Follow-up for BMD was performed at 0 and 24 months. Results. We saw the BMD reduction at femoral neck in all patients with AS. During therapy with IFN BMD parameters showed a trend toward stabilization, which is probably due to a decrease in activity of the disease.

Infusions of aminobisphosphonates are now established therapies ofpostmenopausal osteoporosis. Their use is associated with fever and musculoskeletal pain in some subjects, referred to as the acute phase response (APR). The purpose of the study was to explore tolerability of zoledronic acid in the treatment of postmenopausal osteoporosis. In a 36-month open label, prospective study patients with postmenopausal osteoporosis iv received zoledronic acid at a dose of 5 mg every 12 months. We then analyzed the tolerability of the treatment at the hospital and via telephone interviews during the next 14 days and every 3 months after the infusion. Prevention of APR was carried out with paracetamol 500 mg x 3 times a day on the day of first infusion and the next 2 days. Symptoms of APR were recorded in 39% (n=43) of patients with prevention therapy. APR developed in the first 12-24 hours after infusion of zoledronic acid. Among women without prevention APR developed in 65% (n=75) of cases. (OR=0.34 CI (0.2-0.59)). After the 2 nd infusion symptoms of APR were noted in 27.9% (n=26) (р<0.05) of 93 patients, after the 3 rdin 6.6% (n=2) of 30 patients. Thus, in >90% of cases the symptoms were of mild or moderate severity, with resolution within 3 days after infusion of zoledronic acid. The most frequent symptoms were bone and muscular manifestations and a flu-like syndrome (p<0.05). APR developed during the first 12-24 hours after infusion of zoledronic acid. ARR developed 2.5 times more often in the cases when zoledronic acid was used for the first time. If paracetamol treatment was administered, APR cases were documented 1.7 times less often with lesser degree and length of manifestations. Frequency of APR dropped after repeated zoledronic acid infusions.

One of the main problems in patients with chronic kidney disease (CKD) is a disturbance of calcium-phosphorus metabolism, especially in chronic hemodialysis. Besides classical endocrine axis parathyroid-kidney, in recent years was established the existence of a new endocrine axis the bone-kidney, which gives a better explanation of the calcium and phosphorus metabolism abnormalities, pathophysiology of secondary hyperparathyroidism in CKD. FGF23 is a circulating factor synthesized in osteocytes. It inhibits renal phosphate reabsorption and activity of 1-alphahydroxylase. Anti-aging Klotho protein is a potent co-factor of FGF23. This review presents the mechanisms of the interaction of these elements of the newly discovered axis in normal settings and secondary hyperparathyroidism.

Analyzed literature data demonstrates the influence of fracture in individuals of different age on the risk of post-traumatic osteopenia and osteoporosis, as well as increase in the risk of the recurrent fractures. It is proved that the fracture leads to a decrease in bone mineral density (BMD) not only in the injured limb, but also other parts of the skeleton. In majority of prospective studies and metaanalysis it was shown that there is no full recovery of BMD after sustained fracture. Posttraumatic osteopenia and osteoporosis increase the risk of re-fracture in the future.

This review summarizes the main statements of the new clinical guidelines for the diagnosis, prevention and treatment of glucocorticoid-induced osteoporosis in adult patients, published in 2013 under the auspices of the Russian Association on Osteoporosis (RAOP), the Russian Respiratory Society and the Russian Association of Rheumatologists.

On October 4—7, 2013 Baltimore (USA) hosted the Annual Congress of the American Society for Bone and Mineral Research (ASMBR), during which many publications were devoted to denosumab, a human monoclonal antibody to the main pathogenic link of osteoporosis — RANK-ligand, which results in a dramatic suppression of bone resorption, creating favorable conditions for the restoration of bone and a marked reduction in fracture risk. Some of the papers presented at the Congress deserve special attention and are discussed in this publication. These studies add new colors to the overall picture of denosumab action, showing efficacy of long-term treatment to suppress bone resorption, increase BMD, reduce fracture risk, improvement in the quality of the cortical bone tissue, ultrastructuralpreservation of normal bone parameters.