Purpose. The elucidation of the frequency and general determinants of postmenopausal women osteoporosis at the date >12 months following kidney allotransplantation (KA) and orthotopic liver transplantation (OLT). Materials and methods: There were fulfilled estimations of bone biochemical markers, estradiol, parathyroid hormone (PTH) in blood serum so as bone mineral density of lumbar vertebras (BMD) in 24 women following KA (32 estimations) and in 17 — after OLT (43 estimations). Results: Osteoporosis was revealed in 45% and 35%, hyperparathyroidism — in 90% and 37°% women after KA and OLT accordingly. BMD was positively correlated with free estradiol index in women after KA and OLT and inversely with PTH in women after KA so as with bone biochemical markers, disease duration before operation, level ofhyperbilirubinaemia in women after OLT and was more lower in women with cholestatic diseases. Conclusions: General determinants of osteoporosis in postmenopausal women following KA — estradiol deficit and hyperparathyroidism; after OLT — cholestatic liver diseases, transplant dysfunction and estradiol deficit. Osteoporosis in women with immunosupression without glucocorticoids and normobilirubinaemia so as type 1 postmenopausal osteoporosis associated with increased bone turnover and in women with transplant dysfunction — with increased bone resorption.

The pain is the main clinical symptom of osteoarthritis (OA) and it has significant influence on the daily activity. It has been shown that joint pain and synovitis are principal risk factors for the disease progression. But the data of some studies are not support this statement. The objective of our study was investigation of association between synovitis, pain intensity and progression of OA. Materials and Methods: a 5-year prospective study included 110 Women (age 42 to 80 years) with knee OA (ACR criteria). We used special questionnaire, visual analog scale for the pain assessment and x-ray and ultrasound examination of the knee joints. Results: At the end of the study 70 patients (group 1) had not radiographic changes and 40 patients (group 2) had radiographic progression. All patients were adjusted for the age and duration of the disease. However the patients from the second group had more often synovitis which was confirmed clinically and instrumentally (accordingly 65,0% and 34,3 %, p=0,004 , 50,0 % and 18,6 %, p=0,001), more severe pain in the knee joints (accordingly 57, 8±16,6 and 48,7±13,3 mm, p=0,002), and higher BMI value (33,2±6,0 and 30,5±5,6 kg/m 2, p=0,021). The patients with radiographic progression had more severe pain at the all visits. At the end of the study increasing of the pain was 56,3±14,7 mm in the nonprogression group and 67,5±21,7 mm in the group with radiographic progression (p=0,002). Conclusion: synovitis, intensity of the pain and higher BMI are risk factors for the progression of OA.

The authors review the current literature data on the influence of the genetically engineered biological drugs on the bone mineral density, bone exchange and remodeling of bone are submitted. Due to high efficiency these drugs received the deserved popularity in spite of the fact that are applied in rheumatology rather recently. The leading role in pathogenesis of local and generalized bone resorption and destruction in rheumatoid arthritis is realized by mediators of immune and inflammatory processes (pro-inflammatory cytokinins): tumor necrosis factor a, interleukin 1, 2, 12, 17, interferon γ, and also prostaglandins, proteolytic enzymes (a collagenase, other proteases), etc. There are described RANKL — dependent and RANKL — independent mechanisms of activation the osteoclastogenesis. In recent years it is established that the inhibition of pro-inflammatory cytokinins not only reduces inflammatory changes of joints, but also constrains destruction development, interferes with development of bone erosions and generalized bone loss. In the present review results of these works are discussed and questions for future researches are brought up.

In this critical review, we have summarized the specific evidence on ibandronic acid (Bonviva) efficacy, tolerability, feasibility and safety acquired from randomized controlled clinical trials, meta-analyses, bridging trials, long-term extension studies, observational studies and clinical experience. We have paid special attention to reviewing the surrogate endpoints, which are routinely used in clinical practice to estimate the treatment efficacy as well as those high technology methods that are currently used in research centers to predict anti-fracture efficacy. Although the only registered indication for Bonviva in Russia is for postmenopausal osteoporosis, we have reviewed the available clinical trials on the efficacy of ibandronic acid to prevent postmenopausal osteoporosis, to treat low bone mass in males, to treat and prevent glucocorticoid induced osteoporosis and other types of secondary osteoporosis and, in particular, in patients after organ transplantation. In addition to this, we have extensively discussed the currently available data on the safety of pharmacologic treatment for osteoporosis.

This review of the literature has been dedicated to experimental and clinical studies of mechanism of action and efficacy of 1—34 amino acid fragment of parathyroid hormone — teriparatide as well as others contries experience of its prescribtion. Teriparatide is an osteoanabolic agent which stimulates bone formation by affecting bone modeling and by stimulating bone remodeling. The effects on modeling lead to increased bone formation whereas the effects on bone remodeling lead to increased bone turnover. Thus, in its mode of action teriparatide differs from all others medicines currently available to treat osteoporosis. Daily subcutaneous injections of teriparatide are proved to be effective to prevent low-traumatic vertebral and non-vertebral fractures in postmenopausal women with the history of vertebral fractures. Teriparatide is effective to treat osteoporosis in male and even more effective than alendronate to treat glucocorticoid-induced osteoporosis. Due to high cost and some restriction related to the duration of therapy (up to 18 months in Russia and 24 months in others countries) teriparatide should be recommended to treat severe osteoporosis in patients with a history >1 moderate clinical vertebral fracture or two or more vertebral fragility fractures or in case the previous treatment was not effective. Teriparatide should be prescribed after bisphosphonates or other antiosteoporotic treatment, but not in the combination with bisphosphonates. The prescribtion of bisphosphonates after teriparatide is effective to maintaine and further improve the effect. Thus, teriparatide is effective to treat severe osteoporosis and osteoporosis resistant to other therapy.