Fractures of the proximal femur (FPF) significantly affect the increase of mortality and disability in men. According to the data of the epidemiological studies in Russian Federation the incidence FPF at the age of 65 years is higher in men than in women, which is different from those obtained in most other countries. Objective: To assess the risk factors for fracture and to estimate the risk of fracture using the FRAX in order to calculate the absolute risk of fracture in men with occurred FPF. Materials and Methods: We performed a cross-sectional continuous epidemiological study. The study group included 128 men 40-69 years old with FPF, the comparison group consisted of 108 patients with FPF 70 years of age or older. The patients filled out questionnaires to assess the risk factors for fracture. Alcohol consumption was estimated based on the results of tests «CAGE» and «Audit». In order to identify vertebral fractures we performed radiography of thoracic and lumbar spine with morphometric studies. We measured the levels of testosterone and 17-estradiol electrochemiluminescence immunoassay «ECLIA» (Elecsys 2010). FRAX (www.shef.ac.uk\FRAX) was applied to estimate the absolute risk of fracture; the results were interpreted according to the schedule thresholds depending on the patient’s age (www.osteoporoz.ru). Statistical analysis was performed using STATISTICA v.10.0 software. Results: The patients in the study group had more prior fractures (p<0,05), more of them were smokers (p <0,002), systematically drank alcohol (p <0,05). Secondary osteoporosis was detected in 53 (41.40%) of men in this study group, including hypogonadism in 49 (41.88%) patients. Only 6 (4.69%) patients had no risk factors, a single risk factor noted in 20 (15.63%), two in 47 (36.72%), three or more in 55 (42.97%) patients. High risk of fractures by FRAX was observed in 17 (16.66%) in the treatment group and in 2 (1.85%) of men in the comparison group. Conclusion: The high incidence of FPF in men up to 69 years of age in Russia can be explained by their having a large number of major risk factors for osteoporotic fractures, especially of previous fractures, smoking, systematic use / abuse of alcohol and hypogonadism. A small number of individuals with FRAX values above the threshold level indicate the need for further epidemiological studies with a large number of observations that would lead to increase in the sensitivity of FRAX and would specify the threshold values of this index.

The objective of this study was to investigate the prevalence of low traumatic fractures, the factors influencing fractures in endogenous Cushing’s syndrome (CS) of various etiologies and their contributions into functional abilities and quality of life in patients with CS. Materials and methods: the retrospective data of patients, who had received treatment due to endogenous CS, (2001-2011), was evaluated. All enrolled patients underwent standard spinal radiographs in lateral positions of the vertebrae Th4-L4. Recent low traumatic non-vertebral fractures were recorded in the medical cards. Bone mineral density (BMD) was measured by DXA GE Lunar Prodigy. Serum samples on octeocalcin (OC), carboxyterminal cross-linked telopeptide of type I collagen (CTx), latenight cortisol in serum were assayed by electrochemiluminescence (ECLIA). 24h urinary free cortisol (24hUFC) was measured by an immunochemiluminescence assay (extraction with diethyl ether). Functional assessment was performed using «chair rising», «up and go» and «tandem» tests. Universal pain assessment tool (verbal descriptor scale, Wong-Baker facial grimace scale, activity tolerance scale), EQ-5D and ECOS-16 questionnaires were given to patients and they self-reported their conditions. Results: Among 215 patients, 178 were females and 37 males, median age 35 (Q25-Q75 27-48); 88patients (40,9%) had low traumatic fractures, including vertebral fractures in 76 cases (in 60 cases multiple vertebral fractures) and non-vertebral fractures in 27 cases (17 patients had rib fractures, 3 -fractures of metatarsal bones, 2 fractures of radius, 2 fractures of tibia and fibula, 1 humerus, 1 breastbone; 1 hip fracture). Patients with fractures had higher 24hUFC, late-night cortisol in serum, lower OC, Total Hip BMD, but did not differ in age, BMI, CTx or etiology of CS. After applying the logistic regression analysis (adjusted for sex, age, BMI, BMD, OC), the main predictor of fractures was late-night serum cortisol level (p=0,001). Patients with late-night serum cortisol higher than 597 nmol/l were more likely to have low traumatic fractures (Odds ratio 2,86 (95%CI 1,55-5,28) p=0,001). Patients with fractures suffered from more pain and reported worse functional abilities. They had slightly worse results in «tandem» test, but did not differ in other functional tests, which assessed mainly muscle power. Conclusions: Patients with CS have very high risk of low traumatic fractures. The severity of hypercortisolemia is the best predictor of low traumatic fractures in patients with CS. Patients with fractures sufferedfrom more severe pain and because of this they restricted their daily activity even more than patients with CS without fractures. Consequently, patients with higher levels of late-night serum cortisol need earlier preventive treatment for osteoporosis.

The aim of the study was to evaluate foot bone mineral density (BMD) in diabetes mellitus (DM) complicated with distal neuropathy (DN). Materials and methods. 61 patients with DM (DM1-27, DM2-34) were included. 37patients had Charcot osteoarthropathy (the 1st group), the 2nd group (13 patients) with severe DN, the 3rd group (11 patients) with mild DN, and control group consisted of 15 healthy people. All patients underwent dual energy X-ray absorptiometry (DXA) Lunar Prodigy scan. BMD was measured in lumbar spine, hip and radius. Foot BMD was measured using the «Total Body» region’s analysis. Results. There was a significant difference in foot BMD between controls and the 1st (р=0,031) and the 3rd (р=0,027) groups with no significant difference between the groups of patients. Foot BMD significantly correlated with spine, hip and radiusBMD (г=0,5-0,63, р<0,00001), BMI (r=0,4, р=0,000). Negative correlation was found between foot BMD and diabetes duration (r=-0,3, p<0,005) and HbA1c (r=-0,2, р=0,045). No correlation was found between DN and foot BMD. Conclusion. No association between severity of DN and foot BMD was found.

Methods and results: bone densitometry of L2-L4 and neck of femur, the level in serum of blood some hormones (PTH, vitamin D3, estradiol, testosterone) and cytokines (OPG, IL-6, FNO-a) regulating osteoclastogenesis as well as comparative analyses of two bone resorption markers β-crosslaps and tartrate-resistant acid phosphatase type 5b (TRAP-5b) were fulfilled at different periods following orthotopic liver transplantation. At the early date after operation there were the bone density decrease of L2-L4, the lowering of vitamin D3, estradiol in women, testosterone in men and the elevation of cytokines and of resorption markers. In 1 and 2 years following liver transplantation there were revealed the rise of bone density, the level of PTH, estradiol, testosterone, which were associated with the lowering of IL-6, FNO-a and β-crosslaps while the level of vitamin D3 and TRAP-5b remained stable. Conclusion: at the early date TRAP-5b was more specific marker of bone resorption which did not depend on collagen metabolism in liver. In 1 and 2 years following liver transplantation bone resorbtion was association with level of PTH, FNO-a and OPG.

In a comparative study we investigated the influence of a combination of alendronate and alfacalcidol on the dynamics of bone mass density (BMD) at the site attached to the femoral component of endoprosthesis in total hip replacement in patients with systemic osteoporosis. Evaluation of performance of pharmacotherapy in the postoperative period on osteoporosis, systemic osteoporosis, sustained BMD deficit at Gruen regions confirmed that the essential component of osteointegration at the «implant-bone» site during the period of physiological adaptive remodeling after arthroplasty in women suffering from systemic osteoporosis is the pharmacological correction of the intensity of bone resorption in post-operative period.

This review presents the current data on the pleiotropic effects of beta-blockers in particular on the effect on bone mass and fracture development by means of increased bone fragility. In this article we discuss the mechanisms of action of beta-blockers on bone metabolism and their possible protective effect on bone tissue in the treatment of cardiovascular disease.

Advances in bone imaging have had a tremendous impact on our knowledge of skeletal anatomy, physiology, and pathophysiology while at the same time generating images of both aesthetic and scientific interest. Bone imaging for assessing bone quality very much lends itself to multidisciplinary input and collaboration across scientific disciplines, helping to drive technological and analytical advances in the assessment of bone quality. This has allowed a much deeper awareness of the changes that occur in bone quality with increasing age and disease, as well as improved fracture risk prediction and better treatment monitoring. Currently, many high-resolution imaging modalities exist to evaluate bone quality, though all have their particular merits and limitations. The ideal imaging modality, which has yet to fully emerge, would allow an accurate prediction of bone strength, discriminate at-risk individuals, identify which aspects of bone strength are faltering, and precisely monitor the effect of treatment. When this day comes, the occurrence of unheralded debilitating osteoporotic fractures in themiddle-aged and elderly will be seen as an unusual, rather than a usual, event. In the meantime, we can look forward to evenmore aesthetically pleasing images of bone structure, images that help linkform to function in the human body and as such administer a helpful dose of science to the art of medicine.