Aim. To identify gene polymorphisms (OPG, RANKL, VDR, SOST) and evaluate their relationship with bone mineral density (BMD) and fractures for further optimization of diagnosis and treatment of postmenopausal osteoporosis (PMO). Materials and methods. The study included 236 postmenopausal women living in Moscow and the Moscow region. The main group (I) consisted of 174 patients, aged 50 to 83 years, with BMD < - 2.5 SD for the T-score. The comparison group (II) consisted of 62 postmenopausal women with BMD within the normal range and the lack of previous fractures, aged 50 to 77 years. Molecular genetic analysis of polymorphisms of VDR (rs10735810, rs1544410), RANKL (rs9594738, rs9594759) and OPG (rs3102735, rs3102735 and rs4355801), SOST (rs1230399) was performed by polymerase chain reaction in all subjects with PMO and in the control group. Results. In the presence of the T allele of the gene RANKL (rs9594759 and rs9594738) risk of reduced BMD at L1-L4 was increased by 2 times. Women with genotype C/C gene polymorphism of OPG (rs3102735) the risk of fractures of the distal radius (PR) was increased by 17 times, regardless of BMD. Genotype G/G rs1544410 polymorphism of VDR gene in patients with PMO is associated with an increased risk of fractures of the distal radius by three times. In patients with PMO genotype C/C in gene SOST (rs1230399) only cause differences in body mass index. According to an autosomal recessive pattern, homozygous genotype C/C was significantly associated with obesity in the PMO. Conclusions. Polymorphisms of genes RANKL (rs9594759 and rs9594738), OPG (rs3102735) and VDR (rs1544410) are associated with the risk of fractures and PMO. Gene SOST (rs1230399) had no statistically significant effect on BMD and fracture risk.

Aim. To study the vitamin D levels in the period of maximal sun exposure in individuals older than 50 years residing in the Republic of Bashkortostan, to compare them with the levels during the period of the minimum insolation. Materials and methods. In the period of high insolation in 175 people aged over 50 years residing in the city (Ufa) and rural areas of the Republic of Bashkortostan, we investigated the levels of 25 (OH) D and parathyroid hormone (PTH) by the indirect ELISA. Results. We show that the senior age groups of the population of the Republic of Bashkortostan even in the period of the maximum insolation are characterized by the high frequency of hypovitaminosis and deficiency of vitamin D. The level of vitamin D is higher in the period of the maximum insolation, and in rural areas, this increase is more prominent. Levels of vitamin D and PTH in the period of the maximum insolation do not depend on male or female sex, and do not differ in rural and urban population. Conclusions. In general, our results show that the problem of deficiency of vitamin D for senior citizens remains of high relevance even in the period of the maximum insolation.

Aim of this study was to estimate the markers of mineral turnover and BMD in young women with the central hypogonadism, to compare them with healthy young women and healthy postmenopausal women of middle/advanced age. Materials and methods. One hundred seventy women were included in the study: 73 patients with the central hypogonadism (isolated hypogonadism n=35, hypopituitarism n=38), age of 25 [21.2; 30.5] y.o., amenorrhea duration 5 [2.3; 10.1] years; 47 healthy women with regular menstrual cycles, age 24 [23.1; 28.0] y.o., and 50 healthy women with natural menopause, age 56 [53; 58] y.o., menopause duration 6.0 [2.1; 10.0] years. Groups did not differ by age. Results. In patients with central female hypogonadism concentrations of calcium and alkaline phosphatase were significantly higher than in healthy women of similar age, however did not differ from the parameters in postmenopausal women. T-scores <-2.5 SD in lumbar spine were noted in 55% and 28% patients with central hypogonadism and in menopause respectively (р<0.001), and in a hip - 27% and 7%, respectively (r=0.002). The factors promoting lower values of BMD in young women with central hypogonadism were the amenorrhea duration, low level of total testosterone, primary amenorrhea. Distinctions of mineral turnover and BMD in isolated hypogonadism and a hypopituitarism were not revealed. Conclusions. Central hypogonadism in women at young age is a higher prognostic factor of low BMD than natural menopause, and might be considered as a marker of premature aging.

The results of a comparative study (study group included 35 patients after hip arthroplasty, control group - 36 patients) of mineral monitoring in different skeletal segments showed that a deficit in bone mineral density is formed in operated limb and is reflected at the system level leading to various forms of suppression of bone homeostasis, which subsequently impairs the quality of life. The efficiency of the use of calcium salts in combination with alfacalcidol, and in conjunction with an active functional rehabilitation after hip arthroplasty based on clinical and radiological monitoring. Such a scheme has a positive effect on treatment outcomes when using this medical technology.

Objectives. To assess the frequency and preferences when assigning intraarticular therapy with hyaluronic acid (HA) in knee оsteoarthritis (ОА) in clinical practice. Material and methods. The analysis of 200 patient records with knee OA treated at the regional center of rheumatology to assess the frequency and spectrum assignment of НА, profile of patients, who were prescribed HA, and its effectiveness. To assess the opinions of rheumatologists on intraarticular therapy with НА we conducted an anonymous questionnaire of 20 rheumatologists of Ekaterinburg. Results. The analysis showed that intraarticular НА therapy was recommended by rheumatologists to 46% of patients with knee ОА, of which the treatment was performed in only 35%. Patients who received treatment were older and more often took NSAIDs and symptomatic slow-acting drugs. Intra-articular НА therapy was effective in 69% of patients. НА with higher molecular weight were more effective, although rheumatologists prefer НА with low molecular weight. Conclusion. In clinical practice, НА is used widely in the treatment of knee ОА, a positive effect from the treatment noted in more than a half of patients.

Aim. To assess the patients compliance to treatment of osteoporosis (OP). Materials and methods. Poll study of random sample of 1565 patients (86% women and 14% men) with OP aged 50 years and older (mean age 64 ± 7 years) from 10 cities of five federal districts of the Russian Federation with the duration of the disease a year or more. Results. Over the previous year before the survey, preparations for the treatment of OP took 96% of patients but were adherent to it only 40% of patients. Age, education, and the presence of any previous fractures had no effect on adherence, while the duration of the disease and the total duration of therapy contributed to its reduction (p <0.05). All patients who received zoledronic acid and denosumab had a 100% compliance. Among taking oral bisphosphonates (BP) and strontium ranelate (SR) adherence was higher compared to those who used only calcium supplements and vitamin D (p <0.005), there were no differences in treatment adherence to BF and SR, and compliance of women was not dependent on the dosing regimen of oral BF (p> 0.05). Less committed to oral drugs were women who took more other medications. The high cost, lack of necessary medicines in the pharmacy, the duration of therapy were the most common causes of omission or substitution treatment of OP. Conclusion. In our country, patients with OP have poor adherence to medical treatment. Reduced compliance to OP therapy is due to prolonged duration of the disease, total duration of the treatment, cost of drugs or their absence in the pharmacy, and in women was dependent on the number of drugs taken.

This review discusses the recent evidence showing that the skeleton itself produces at least two hormones: fibroblast growth factor 23 (FGF23) and osteocalcin. FGF23 is secreted by osteocytes in bone and acts on the kidney to inhibit 1-alpha-hydroxilation ofvitamin D and promote phosphorous excretion. The affinity of FGF23 to FGF receptor is low, but FGF23 binds to FGF receptor-Klotho complex with more affinity. Therefore, Klotho determines the kidney-specific action of FGF23. Increase in FGF23 or Klotho levels due to genetic defects or ectopic production results in low serum phosphorous levels in humans. Contrary to this, low FGF23 or Klotho levels lead to hypophosphatemia and ectopic calcification. Mouse genetics studies revealed that osteoblast product, osteocalcin, in its undercarboxylated stage acts on the pancreatic beta-cells to enhance insulin production and on peripheral tissues to increase glucose utilization as a result of increased insulin sensitivity and to reduce visceral fat. In addition to this, undercarboxylated osteocalcin may also have another hormonal role, this time as a mediator of testosterone secretion. Osteocalcin was shown to induce testosterone production in Leydig cells of the testes both in ex vivo and in vivo studies. In both localizations, at the pancreas and at the testes osteocalcin acts through the GPCR6A receptor, this activates the cAMP response element-binding protein signaling pathway. Thus, this review reports the recent studies indicating bone ’s role as an endocrine organ.

The meeting of the Russian Council of Experts for improvement the approaches to the treatment of osteoporosis (OP) was held in Moscow on December 4, 2014. Leading Russian and Switzerland specialists in orthopedics, traumatology and rheumatology attended the meeting as well as members of Russian unit of clinical department AOTrauma of the international public (non-government) organization AOFoundation and members of the Russian Osteoporosis Association. The participants of the Russian Council of Experts have discussed the system of care for patients with OP in the Russian Federation. They discussed the need for the development of measures to optimize interdisciplinary interaction between orthopedic surgeons and internal medicine specialists in the treatment of patients with OP to reduce the number of postsurgical complications and prevention of further vertebral and nonvertebral fractures. Experts have noted the need to raise the level of knowledge about OP in orthopedic surgeons, clinical characteristics of fractures in patients with OP and measures to control it; to raise awareness of OP among patients by billboards in clinics and outpatient emergency rooms; to develop and implement into clinical practice of orthopedic surgeons standard of care for elderly patients with fragility fractures; to develop algorithm of secondary fractures prevention through the prescription of pathogenic OP therapy at the level of the trauma unit; to form an interdisciplinary system of the medical care for patient with fragility fractures, as well as contribute to the organization of the service Secondary Fractures Prevention (Fracture Liaison Service) in the Russian health care system.