Introduction. Hip fracture (HF) are the most serious complication of osteoporosis and a serious public health problem, causing significant economic damage. They are characterized by a high level of mortality as an inpatient and outpatient stages. Rate of severe outcome depends on the organization of medical care of these patients. Goal. To evaluate the frequency of lethality in patients undergoing HF. Subjects and methods. A longitudinal observational cohort study among residents of the city of Yaroslavl at the age of 50 years and older who received HF for the period from 01.09.2010 to 31.08.2011 years, with follow-up of 24 months (up visits 3, 6, 12 and 24 month after the date of fracture). The analysis of lethality was performed by using of life tables and the analysis of the «censored» cases. Results. Overall lethality in hospital was 9.66%, in 3 months - 21,75%, after 6 months - 26,46%, 12 months -29,82%, 24 months - 34,53%. The next characteristics of the lethality were analyzed at every stage of observation: a density of probability, function of the intensity and immediate risk of the death, the expected median of lifetime. Conclusion. The analysis allowed to obtain the most accurate and complete data on the lethality in patients with HF and to evaluate several additional features of this indicator.

Bone fractures of the skeleton with a minor injury is a clinical manifestation of osteoporosis and its population-based marker. The incidence of hip fracture varies in different geographic areas and ethnic groups. The aim was to study incidence of hip fractures in patients older than 40 years in the Republic of Sakha (Yakutia, Russian federation) in 2011-2013 and to compare the data with the previous study at the same region performed in 1997-2003. Material and methods. The study is a part of a multi-center international project «Epidemiological study of osteoporotic fractures in Eurasia (EVA).» It was a retrospective study followed by a prospective one. In the retrospective part the information on hip fracture cases registered in the official documents of the orthopedic service in 2011-2012 was collected. The prospective part was conducted in 2013, it was aimed at the identification of the patients with a hip fracture, applied not only in orthopedic department but also to other medical professionals, such as general practitioners. Results. Overall, in three years 426 hip fractures were reported in the city of Yakutsk. The total number of fractures in women was 286 (67.1%), in men - 140 (32.9%). We observed the increase in hip fracture incidence in 2013 (192 cases per 100,000 population in men and 283 per 100,000 in women 50 years old and older) which was 12% higher than in 2011 and 2012. We owe it to improved registration of hip fractures in the group of women 85 years old and older. The hip fracture incidence in this study significantly exceed the data of previous study 15 years ago. Conclusion. In recent years, there is an increase in incidence rates of hip fracture in Yakutsk due to improved hospitalization rates in orthopedic service.

Objective: to examine the relationship between bone mineral density (BMD), the parameters of vascular stiffness and biomarkers of cellular aging in postmenopausal women. Materials and Methods: In a cross-sectional study107 patients were included: women at the age range of 45 to 82 years who were observed outpatient and signed a written informed consent. Assessment of BMD was performed using DXA (Delphi W, Hologic, USA). The intima-media thickness (IMT), the presence and quantity of atherosclerotic plaques (AP), and the degree of carotid stenosis were examined by duplex scanning. The pulse wave velocity (PWV), augmentation index (Aix) were measured by applanation tonometry (SphygmoCor).To determine telomere length (DT) in leukocytes the method of real-time PCR was used. This was done by measuring the relative telomere length in the genomic DNA. Determination of telomerase activity (Aix) was carried out on pure monocyte fraction of isolated blood cells on the basis of telomerase polymerase reaction.Statistical analysis was performed using the software application Statistical Analysis System (USA). Results: With the increase in duration of menopause a gradual increase in the stiffness rate (PWV, AI), IMT and decrease of BMD was noticed in all examined parts of the skeleton. The maximal values of vascular stiffness, minimal values of BMD and the shortest telomeres were found in patients with 10+ years of menopause. The risk of bone mass loss and osteoporosis increased by 3 times in patients with high values of PWV ≥10 m/sec[OP-3,1, 95%CI, 1,13-9,89 (p<0,05)], by more than 4 times in patients with AI≥ 20% [OP-4,35, 95%CI, 1,02-11,0 (p<0,05)]and the IMT >0,9 mm by 2,45 times in patients with presence of AP in the carotid arteries and with the shortest telomeres [OP-2,45, 95%CI, 1,05-6,08 (p<0,05)]. During multivariate regression analysis after adjusting for age and menopause duration the negative relationship between IA, IMT and BMD remained highly significant, while in relation to PWV, AP presence and telomere length, such a correlation was not confirmed. Conclusion: In postmenopausal women low BMD is associated with high rates of Aix and the thickness of the IMT. The independent relationship of BMD with Aix, rather than with PWV, apparently could be explained by the involvement of small vessels -arterioles. Short telomeres are 2.45 times more frequent in patients with low bone mass, but the relationship has not been confirmed in the regression analysis, which excludes the independent nature of this aging marker with BMD.

Introduction: fracture of distal part of forearm at a low level of a trauma with women in the age of 50 and elder is the index to osteoporosis and serves as reason to get tested for the diagnosis of OP. However, osteoporosis isn’t often diagnosed and treated with patients with such localization of fracture. The purpose: to estimate of detection and treatment of osteoporosis at the patients of senior age group with fracture of distal part of forearm and influence of traumatologist’s information on their changes. Materials and methods: The study was conducted in two stages. At the first stage a retrospective analysis of a sample of 104 patients aged 50 years and older who underwent fracture of distal part of forearm with a low level of injury was conducted. At the second stage a controlled trial with the inclusion of 121 women aged 50 years and older with fracture of distal part of forearm obtained with a low level of injury was carried out. The patients of intervention group (56 patients, the median age was 61.3 ± 8.6) received information about osteoporosis, assignment to densitometry and recommendation of treatment from traumatologist. The patients of control group (65 patients, the median age was 63.5 ± 8,1) were conducted as it was established in practice of the department of traumatology. There was a questioning of all patients who had been included in investigation after 6 months since fracture. Osteoporosis investigation and treatment were estimated at both stages. Results: osteoporosis was identified in 18 (17.3%) patients, densitometry was performed in 6 (5.8%) patients, calcium and D3 were taken 13 (12.5%) patients, medications of pathogenic action - 2 (1.9%) patients in a retrospective study. By the results of the second phase of the study densitometry was performed in 26 (46.4%) patients of intervention group and 2 (3.1%) patients of control group, р<0.0001. 31 (55.4%) patients of intervention group and 23 (35.4%) patients of control group began to take calcium and D3, p=0,0276. 7 (12.5%) patients of intervention group and 2 (3.1%) patients of control group began the treatment with pathogenetic medications, p=0.051, in 6 months pathogenetic medications took 12.5 % persons of intervention group and 1.5 % patients of control group, p=0.018. Conclusion: the patients with fracture of distal part of forearm at a low level of a trauma concern to group of the high risk of osteoporosis, but most of them remain without corresponding examination and treatment. Information about osteoporosis, assignment to densitometry and recommendation by treatment from traumatologist is an effective way to motivate patients to perform densitometry and start treatment.

Background: educational programs may be beneficial in a variety of important factors for the prevention, treatment and management of osteoporosis. Objectives: to evaluate the influence of the three different educational interventions on knowledge, dietary calcium, physical activities and adherence to treatment of osteoporosis. Methods: 117 patients (middle age 63.3 ± 8.1 years old, 95.7% are women) with osteoporosis have been included in this study. All patients were randomized to three groups. The patients of intervention group (n=39) had an osteoporosis school program (4 lessons with using interactive methods in groups of 5-8 patients). The patients of the control group (n=38) received brochures with general information about osteoporosis. The patients of the comparison group(n=40) received lecture (1 x 1.5 h) about osteoporosis. Average changes from baseline in knowledge, dietary calcium, physical activities and time of physical exercises was evaluated in 3, 6 and 12 months. Adherence to treatment was evaluated in 12 months. Results: After educational programs level of knowledge was increased in patients of the intervention group in 3, 6 and 12 months by 23,8%, 22,9%, 21,1%, in the group of brochures - by 0.5%, 1.8%, 4.7%, correspondingly, p<0.01. In the group, who received lecture level of knowledge was increased by 18.0%, 15.8%, 14.6% (р<0.05 when compared with the brochure at visits 3 and 6 months). The using of dietary calcium was increased in 3, 6 and 12 months in the intervention group by 188.5 mg, 211.8 mg and 238.1 mg. In group,whoreceivedbrochuresby 146.8 mg, 106.4 mg, 84.4 mg, in group,whoreceived lecture by 66.0 mg, 80.4 mg and 68.3 mg (p<0.05when compared intervention group with the group,who received lecture at visits 3 months).Physical activity was increased in 3, 6 and 12 months in intervention group by 1.7, 1.9, 0.9 scores and was significantly higher, than in group,whoreceived lecture(0.2, 0.2, 0.1 scores) and in control group,whoreceived brochures(0.1, 0.2, 0 scores). Time of physical exercises was increased by 45.1, 54.2 и 49.9 min in week in the intervention group and was significantly more than in the groups,whoreceived lecture or brochures. Adherence to pathogenetic osteoporosis treatment was higher in the intervention group: 56.4% of intervention group, and 30.0% of the group,whoreceived lecture, and 13.2% of group,whoreceived brochures took pathogenetic medication regularly during the year (p<0.01when compared the intervention group with the control group). Conclusions: educational program with using interactive methods in small groups increases knowledge about of osteoporosis, dietary calcium,physicalactivities and increases adherence to treatment of pathogenetic medication more than brochure and lecture.

This article is dedicated to the problem of creating off fracture liaison services (FLS) for patients with osteoporosis including overview of the problem and some recommendations on it. The article presents there levance of the problem discussed, gives recommendations of the IOF working group,shows an international and Russian experience of FLS creation, its medical-economic effectiveness and discus the key moments that provide effectiveness of fracture liaison services for patients with osteoporosis. The recommendations part includes goals, main working directions and principles of FLS creation in the Russian Federation. They are based on the "Prometheus" program that was introduced by the Russian Osteoporosis Association and became the first national experience of organizing fracture liaison service. According to author’s point of view the information from this article can be help full in organizing FLS invarious medical institutionsin our country and can be used to reduce the negative effects of repeated osteoporosis fractures.

Clinical symptoms of vitamin D deficiency may be quite misleading and masked as rare hereditary syndromes. We describe a family, sister and brother presented with the pain in lower extremities at the age of 14 and 16years accordingly, with severe vitamin D deficiency that was misdiagnosed in the course of the disease with pseudohypoparathyroidism and 1-alpha-hydroxylase deficiency. They benefited from treatment with alfacalcidol and ossein-hydroxyapatite complex supplement which were further discontinued due to socioeconomic factors. At presentation after 2 years without treatment extremely low 25(OH)D levels were revealed. The patients' family history was remarkable for the same clinical features in mother and her Indian ancestry. Thus we describe an uncommon manifestation of severe vitamin D deficiency in a familial setting which emphasizes the necessity of vitamin D testing in calcium or parathyroid disorders.