In order to reduce the incidence of recurrent fractures in patients that had already experienced low-energy (osteoporotic) fracture, the International Osteoporosis Foundation initiated the program «Capture the fracture». Established Best Practice Framework represents 13 standards to evaluate the effectiveness of the centers for the prevention of recurrent fractures, organized in different countries. In 2012 the Russian Association on Osteoporosis started the project PROMETHEUS [Creation the system to prevent recurrence of fractures in patients with osteoporosis]. In order to implement this program in the city of Yaroslavl we conducted a pilot project to establish a center for the prevention of recurrent fractures in patients who have received osteoporotic fracture. In this article we assess the effectiveness of the work of this center with the use of international standards, identify key problems and propose solutions.

To assess the influence of informing patients with postmenopausal osteoporosis about the their probability of 10-year absolute fracture risk calculated by FRAX tool on the patient ’s decision to start treatment and their adherence to therapy during 3 years of follow-up. Materials and Methods. Multicenter open randomized trial included 417 women (mean age 65.9 years). Patients of the 1 group (n=191) were informed about the value of their absolute risk of fracture by FRAX. Patients of the 2 group (the control; n=196) got usual advice and recommendations without calculating FRAX. All patients were recommended to take alendronate in a standard dose (70 mg a week) and calcium/vitamin D supplements. Results. During the first three months after initial visit 96.4% of patients started their treatment. The adherence to treatment at sixth month was 7% higher in the group 1; the compliance in the group 1 was 8% higher, than in the control group. 6.4% of patients developed adverse drug reactions, which led to cancellation of therapy in only 2.9% of patients.

The aim of this study was to assess the role of simple clinical and laboratorial markers for prediction of low bone mineral density (LBMD < -2 SD) in children with juvenile idiopathic arthritis (JIA). Low weight and linear growth (<10% and 25%), BMI < 16.6, MD VAS > 5.0, DAS > 2.9, DAS28 > 4.2, JADAS 10 > 15.6, JADAS 27 > 15.1, CDAI > 18.1, Steinbrocker's functional class > 2, systemic arthritis, corticosteroid treatment, arthritis duration > 4.5 years, number of active joints > 5, number of painful joints > 9, morning stiffness > 90 minutes, parental overall JIA activity (VAS) > 5.8, ESR > 16 mm/h, CRP > 22.6 mg/l were associated with increased risk of LBMD in JIA children. Among metabolic markers Ca total < 2.42 mmol/l and Pi > 1.59 mmol/l also increased the possibility of LBMD. Our data can help to identify the JIA patients at risk for LBMD and to suggest the indications for densitometry evaluation of JIA children.

Objectives. To study the comparative efficacy and safety of intra-articular treatment of knee osteoarthritis (OA) with hyaluronic acid (HA) of different molecular weights (MW). Material and methods. Randomized double-blind controlled study included 50 patients with osteoarthritis of the knee stage II-III, weight-bearing pain more 40 mm on VAS and Lequesne index score > 4 and < 12. 25 patients received HA with MW 3500 kDa (Rusvisk group) and 25 patients were treated with HA with MW 1200-1400 kDa (Ostenil group) injected at 3-weekly intervals. During the 22-week observation period we assessed dynamics of pain on VAS (weightbearing pain, pain at rest), index WOMAC, and recorded the overall assessment of the effectiveness of therapy by patient and physician, OMERACT-OARSI criteria and the need for NSAIDs. Results. One week after the last injection, a significant decrease in weight-bearing pain (in the group Rusvisk by 69% in the group Ostenil 55%) and the total index WOMAC (group Rusvisk by 63% in the group Ostenil 60%), continuing until the end of observation. A significant decrease in pain at rest observed in the group Rusvisk at all visits and in the group Ostenil only at 6 and 10 weeks of therapy. The overall evaluation of effectiveness of therapy by patient and physician yielded the benefits observed in high molecular HA group. A high percentage of responses to therapy using OMERACT-OARSI criteria and reduced need for NSAIDs were observed in both groups. Tolerability was satisfactory and did not differ significantly between the groups. Most common adverse reactions were mild pain at the injection site. Conclusion. Intra-articular therapy with HA of different molecular weight Rusvisk and Ostenil resulted in pain reduction and improved joint function in patients with knee OA with satisfactory tolerability.

Introduction. Experienced osteoporotic fractures are a significant predictor of repeated, more severe fractures, entailing reduced quality of life and its expectancy. Objectives. To study the clinical and instrumental data of patients with single and repeated osteoporotic fractures of the forearm, proximal femur and spine, as well as the frequency of their occurrence in women of Gomel region of Belorussia. Materials and methods. The study included 2356 women aged over 50 years. Protocol included questionnaire with the assessment of detailed fracture data, medical history and Charlson comorbidity index calculation, quantitative assessment of bone mineral density (BMD) by dual-energy X-ray absorptiometry (LUNAR Prodigy, GE, USA). Results. Osteoporotic fractures of the forearm, spine and proximal femur were found in 523 (22%) of women. More than one fracture was revealed in 106 patients of the total number of patients with fractures (20%). The average age of first fracture in patients with multiple fractures was 59.9 years, for second fracture - 63.3 years and for the third fracture - 66.6 years. Most repeated fractures (67%) occurred within the first three years from the time of initial fracture and were not associated with the densitometry data. Despite the presence of multiple osteoporotic fractures, adequate specific therapy of severe osteoporosis was recommended to only every third patient in need of treatment. Conclusions. Every fifth woman over the age of 50 years had experienced an osteoporotic fracture, with the highest risk of re-fracture occurring during the first three years. Mandatory antiosteoporotic therapy is the only effective method of secondary prevention of complications of osteoporosis.

Congenital adrenal hyperplasia (CAH) is a disease leading to decreased adrenal cortisol secretion which requires lifelong treatment with glucocorticoids (GC). However the question whether these patients need regular DXA screening for osteoporosis is still widely discussed in literature. The aim of this study was to evaluate bone mineral density (BMD) in adult patients with classical forms of CAH in Russian population. We have shown that 22% of patients had low BMD which had no correlation with compensation and GC doses. There were no significant deviations in biochemical markers of bone turnover levels. The serum Vitamin D deficiency was found in 89% of patients with CAH which needed early correction in patients with low BMD.

The article presents a literature review summarizing the contemporary data on the effects of drug therapy on various parameters of renal osteodystrophy: phosphate binders, vitamin D preparations, bisphosphonates, denosumab, and calcimimetics. We discuss the results of pilot study of the efficacy of teriparatide and denosumab on parameters of bone metabolism in patients with chronic kidney disease.

The present review of literature is focusing on the role of the trace element silicon in the process of remodeling of bone tissue and exploring the possibility of using the silicon-containing supplements in the complex prevention of osteoporosis. The experimental studies had proved the involvement of silicon in the development of connective tissue, formation and mineralization of bone tissue. A few clinical trials showed a positive effect of silicon supplements on the bone mass and markers of a bone metabolism. Because the potential biological role of silicon in osteogenesis was not completely studied the growing attention of the scientific medical community to this important nutrient will improve the understanding of its role and place in the formation of healthy bone tissue, and its use to prevent the development of osteoporosis.