Objective: To investigate the effect of treatment with betablockers (β-AB), inhibitors of angiotensin converting enzyme (ACEI) on bone mineral density (BMD) depending on the risk factors (RF) of osteoporosis. Material and methods. In a retrospective study included 1129 outpatients (1093 women) aged over 40 years, who had the first DXA examination prior to start of the treatment for osteoporosis. Baseline characteristics of pts including data on osteoporosis risk factors (RF) and medication were obtained at the initial visit which had taken place between 2001 and 2011. BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH) were measured by DXA (Hologic Delphi W). 384 pts have been taking β-AB, ACEI and their combination not less than 6 months before the DXA examination ("users group”), 745 pts. have not been receiving any therapy ("non-users group”). Results. In the "users group” risk of reduction of BMD was lower than in the non-users [RR=1,6 (95 % CI 1.25-2,022) p<0.001], osteoporosis was diagnosed 1,3 times less frequently, and the BMD in LS, FN and TH were significantly higher than these parameters in "non-users group”. The highest BMD were noted in pts on combined therapy. The risk of BMD reduction not depends in both groups on RF such as age, postmenopause duration, presense of early or surgical menopause, low body weight, physical inactivity, previous fractures, fractures in relatives, rheumatoid arthritis, glucocorticoid use or alcohol abuse. In multivariate regression analysis after adjustment with these RF, BMD at all measured locations in users group maintained significantly higher than in non-users. There was no correlation between BMD and duration of β-AB and ACEI therapy. Conclusion Prolonged use of β-AB, ACEI in combination as well as monotherapy could has a protective effect on bone mass regardless of osteoporosis risk factors.

Despite high prevalence and severity of complications, osteoporosis (OP) in Russia is still not recognized as a socially significant disease and there are no common standards for prevention of OP and associated fractures. The aim of the study was to investigate the adherence of healthy females to prevention measures of OP and the affecting it factors to develop the principles governing the preventive strategy of OP. Methods. The study is performed in Moscow Region (MR) in a form of a questionnaire survey in the population of adult healthy women aged >20 years. The data are obtained using "Questionnaires on osteoporosis prevention" and "The test of knowledge in the field of osteoporosis" developed in Clinical Research Institution of Moscow Region named after M.F. Vladimirsky. Study comprised 1712 female aged from 20 till 87 years (median 55,0 years [45,0; 44,0]) living in 16 districts and 11 cities of MR. Taking into account the quality of the filling of questionnaires, data provided by 1631 women were included in the statistical analysis. Results. It is established that 31% of female inhabitants of MR are engaged in OP prevention, using for this purpose mainly calcium-containing drugs (64,3%) and increased consumption of calcium in food (59,8%). 93% of these women get preventive therapy at their own expense, spending on them on the average 200 rub a month, and preventive medication has appeared more saving than non-pharmacological preventive measures. Socially active working women at the age of 50-69 years are motivated on prevention of OP better than others. Level of the OP awareness and undertaking densitometry screening also directly influence adherence to OP prevention.

This study estimates the recovery of bone mineral density (BMD), markers of bone remodeling and quality of life in patients with endogenous Cushing’s syndrome (CS) after 12 months of achieving remission. Materials and methods: 21 patients with CS were prospectively evaluated at active stage of the disease and after being in a full remission (substitutional therapy with hydrocortisone or normal 24 hours urinary free cortisol (24h UFC) and late-night cortisol) during 12 months.A thoracic and lumbar X-ray was performed to reveal vertebral fractures. Bone mineral density (BMD) was measured by DXA ((Prodigy, Lunar, GE, USA). The level of 24h UFC was measured on a VitrosECi. Late-night serum cortisol and markers of bone remodeling were assayed by ECLIA Cobas e601 Roche. Patients fulfilled EQ-5D, ECOS-16 questionnaires and performed "up-and-go ”, "tandem ” and "chair-rising ” tests. Results: Among enrolled patients 17 (80%) were females and 4 (20%) - males; median of age (Q25-Q75) - 41 (33-49) years old; in 10 cases (48%) low traumatic fractures were diagnosed: 7 patients suffered from vertebral fractures; in 3 cases - ribs fractures. After the achieving remission no new fractures were registered and significant improvement in Z-score was reviled at all regions: L1-L4 -1,8 [-2,6; -0.5] at active stage vs -1,2 [-2,2; -0.5] after 12 months of remission (p=0.05); Neck Z-score -0,9 [-1,7; - 0,8] vs -0,7 [-1,6; -0,3], (p=0,003). The level of both bone metabolism markers increased: osteocalcin from 8,2 (6,912,0) to 22,7 (12,1-36,5) ng/ml (p=0,01) and CTx from 0,35 (0,22-0,63) to 0,7(0,28-1,05) ng/ml (p=0,01); whereas 24hUFC decreased from 1449 (926,4-2371) nmol/24h to 66,4(54,2-76,4) nmol/24h (p=0,01). The quality of life significantly improved at all dimensions if measured by ECOS-16. According to the EQ-5D patients suffered less from pain 1,35 (0,49) vs 1,12 (0,34), (p=0,04) and reported the improvement in their health (visual analogue scale) from 49 (18,9) to 68 (10,9), (p=0,004), but did not differ in others dimensions. Although 100% of patients admitted the improvement in their functional ability, the difference in functional tests did not reach statistical significance. Conclusions: Achieving the remission of CS improves BMD and quality of life in patients with CS. However, longer time is needed for full recovery, including the functional performance.

Alfacalcidol or colecalciferol in combination with ibandronic aciWhen a comparative study of the ibandronic acid (Bonviva) using with two forms of vitamin D (colecalciferol and alfacalcidol) was conducted, it has been showed that in some patients with initially a slight increase in the level of resorption markers colecalciferol, in contradistinction to alfacalcidol, not always it is possible to prevent the development of hypocalcemia and secondary hyperparathyroidism. As well, the appointment of colecalciferol may lead to hypocalcemia as a hidden manifestation of excessive oppression remodeling influenced ibandronate in patients with the presence of somatic pathology with an impact on vitamin D metabolism. In the current study, the clinical confirmation of excessive oppression remodeling and failure D hormone was the smaller increase of BMD at lumbar, no significant increase in femoral neck fractures and a higher incidence in the group receiving colecalciferol compared to the group receiving alfacalcidol. Increasing of 25(OH)D concentrations in the blood of patients while taking colecalciferol doesn’t guarantees rising of D-hormone.