Background: Osteoporosis is a global health problem, and achieving peak bone mass during adolescence is critical for preventing the disease later in life. Insufficient awareness among adolescents about osteoporosis risk factors and prevention methods requires the development of educational programs.

Aim: The aim of the study was to evaluate the effectiveness of an educational program on osteoporosis prevention among schoolchildren and to determine the level of knowledge retention in the long term.

Materials and methods: A prospective study was conducted with the participation of schoolchildren, which included three stages of questioning: before training, after completion of the educational program and one year after training. The educational program consisted of two thematic classes: «What you need to know about the human musculoskeletal system and its functions» and «Osteoporosis — a bone disease», «How to build healthy bones in childhood». To assess the assimilation of the material, a specially developed questionnaire of 10 questions was used, covering key aspects of osteoporosis prevention, including the role of nutrition, vitamins, physical activity and risk factors for the disease.

Results: The initial level of knowledge of schoolchildren was 6.3±1.5 points (63.1% correct answers). After the educational program, a statistically significant increase in the level of awareness to 9.8±0.6 points (p<0.001) was observed, while for most questions the share of correct answers exceeded 97%. A control survey a year later showed a partial decrease in residual knowledge to 9.5±1.2 points, but they remained statistically significantly higher than the initial indicators (p<0.001).

Conclusion: Educational programs for the prevention of osteoporosis demonstrate high efficiency in increasing the level of knowledge of schoolchildren about the health of the skeletal system. The obtained results confirm the feasibility of introducing such programs into the school education system as an effective mechanism for primary prevention of osteoporosis and the formation of healthy lifestyle skills in children.

In clinical practice, the cases of high bone mineral density (BMD), detected during dual-energy X-ray absorptiometry (DXA), are rather frequent. Conditions that lead to obvious structural bone changes, distorting BMD values, include degenerative spinal diseases, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, and vertebral fractures. Other causes of elevated BMD values may include external artifacts, such as calcification of the abdominal aorta, metal structures in the vertebral bodies or hip joint, kyphoplasty and vertebroplasty, ectopic calcifications in the abdominal cavity within the examination region of interest, and barium passage in the intestines.

Vitamin D is one of the most extensively studied nutrients, playing a key role in maintaining human health. The history of its research spans over 100 years, encompassing stages from the description of rickets and osteomalacia to the deciphering of molecular mechanisms of action and the recognition of its pleiotropic effects. Despite a significant body of accumulated data, debates persist to this day regarding optimal target levels of 25(OH)D, indications for prescribing vitamin D supplements, and the clinical significance of its extraskeletal effects. This review sequentially examines the main historical milestones in the discovery of vitamin D, the contributions of foreign and Russian scientists, modern concepts of its biochemistry and metabolism, and its role in regulating bone, metabolic, endocrine, immune, cardiovascular, and nervous system homeostasis. Special attention is given to the problem of the high prevalence of vitamin D deficiency in the Russian Federation, caused by geographical, climatic, and dietary factors. The article summarizes current international and Russian clinical guidelines, discusses approaches to the prevention and correction of vitamin D deficiency, and outlines promising directions for future research.

This review examines the clinical significance of osteopenia in patients undergoing pancreaticoduodenectomy (PD). It highlights that disturbances in bone mineral density (BMD) are highly prevalent among PD candidates (40-50% osteopenia, 20-30% osteoporosis) and progress dramatically after surgery, especially within the first year. Preoperative osteopenia is an independent risk factor for postoperative pancreatic fistula (POPF) – one of the most severe complications. Furthermore, the syndrome of osteosarcopenia (combined osteopenia and sarcopenia) is associated with worse overall and recurrence-free survival.

The key pathogenetic mechanism is postoperative pancreatic exocrine insufficiency (PEI), leading to malabsorption of fat-soluble vitamins (especially D and K), calcium, and other nutrients critical for bone metabolism. Chronic systemic inflammation and anatomical changes post-resection also play significant roles.

For the prevention and treatment of metabolic bone disease, lifelong pancreatic enzyme replacement therapy (PERT) is considered the cornerstone, combined with supplementation of vitamin D and calcium at individually tailored, often higher doses. Systematic BMD screening using DXA or CT data, starting from the preoperative period, is recommended. Pharmacological therapy (bisphosphonates, denosumab, anabolic agents) is indicated for diagnosed osteoporosis. Optimal management requires a multidisciplinary approach, including long-term follow-up, nutritional status correction, and lifestyle modification.

Traditionally, the assessment of fracture risk is based on measuring bone mineral density using dual-energy X-ray absorptiometry (densitometry). However, more than half of cases of low-energy fractures occur in patients with osteopenia or even normal BMD. The reason is that in addition to the bone mass, its microarchitecture is also important, which is not evaluated by standard densitometry. The trabecular bone score is a non-invasive, indirectly obtained indicator that characterizes the condition of trabecular bone tissue. It is determined by textural analysis of the image obtained during standard DXA of the lumbar spine in a direct projection. High values correspond to a well-organized, robust trabecular bone structure, while low values indicate a pronounced degradation of the microarchitecture. The trabecular bone score serves as an independent predictor of a decrease in bone strength, and combined with bone mineral density, it allows to more accurately predict fracture risk than each of these values separately. The score makes it possible to clarify the risk of both primary and secondary osteoporosis, and in clinical practice it is used as an additional parameter in assessing the risk of osteoporosis and fractures.

Based on the literature data and their own experience, the experts of the Russian Association on Osteoporosis have formulated recommendations on the use of the trabecular bone score in clinical practice to more accurately determine the individual risk of fracture within the framework of personalized medicine.