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The global diversion of health resources during the COVID-19 pandemic from the provision of routine medical care, and the more frequent and severe course of this infection in older patients justify the need to study the impact of the pandemic on the management of patients with osteoporosis.Aim – to assess the impact of the COVID-19 pandemic on the management of patients with osteoporosis, as well as the impact of anti-osteoporotic drugs on the incidence of COVID-19.Material and methods. A cross-sectional study was conducted, including a telephone survey and analysis of outpatient records of 304 patients with osteoporosis, who were recommended therapy with anti-osteoporotic medications. The average age was 70.8±8.8 years. The vast majority of patients took bisphosphonates in oral or parenteral forms.Results. Problems with the timely conduct of laboratory tests were noted by 91 (30.4%) subjects, DXA testing – 98 (32.8%). 65 (22.1%) were unable to receive the drug in a timely manner. Problems were more common when taking parenteral drugs (p=0.002). The cumulative incidence of COVID-19 was 12.2%, which is twice as high as in the population. There was a tendency to a lower incidence of confirmed SARS-CoV-2 infection when treated with denosumab or zoledronic acid. COVID-19 cases were not associated with either a vitamin D dose or a 25(OH)D level.Conclusions. During the COVID-19 pandemic, there is a significant decline in the quality of medical care for patients with osteoporosis, which cannot but lead to a new epidemic in the future – an epidemic of low-energy fractures. Our data confirmed the predisposition of older age groups to a higher incidence of COVID-19. However, there is no clear association of osteoporosis therapy with the risk of developing clinical manifestations of COVID-19.

Knee osteoarthritis (OA) and varicose disease of the lower extremities (VD) are two diseases common in middle– aged and older women. Questions about whether their combination is accidental or natural and whether VD affects the course and severity of OA, remain unresolved.The aim of the study was to look for the possible association between knee OA and lower limb vein pathology on the basis of clinical and modern instrumental investigation sand to study the effect of the VD on the clinical manifestations and severity of knee OA.Materials and methods. A case-control study was conducted in 85 women 40–60 years old with knee OA diagnosed in accordance with the criteria of ACR (1986) and 50 women of the same age without signs of knee OA. Women of both groups were evaluated for complaints and objective examination with an emphasis on diseases of the joints and veins of the lower extremities, radiography of the knee joints, ultrasound duplex scanning of the veins of the lower extremities. The severity of OA was assessed by the Lequenne indices. The clinical assessment of venous pathology was carried out according to the CEAP classification.Results. Patients with knee OA more often than their peers without joint pathology have VD (43% vs 22%; p=0.015), signs of chronic venous insufficiency (28% vs 12%; p=0.03), as well as valve failure of several lower limb veins simultaneously (53% vs 20%; p=0.0004). After correction by body mass index, the association of knee OA with detected vascular pathology remained clinically and statistically significant. The presence of VD with moderate manifestations of chronic venous insufficiency, as well as ultrasound signs of venous pathology, was not associated with the clinical signs and course of knee OA.Conclusions. Knee OA in middle-aged and older women, regardless of body mass index, is associated with VD and ultrasound signs of simultaneous valves failure of several veins. Manifestations of chronic venous insufficiency did not affect the clinical picture and severity of knee OA.

Objective: to analyze the clinical and organizational feasibility of using different intervention thresholds for the Russian population. Subjects and methods . The probability of fractures using the Russian FRAX model was calculated on a sample of 3,866 postmenopausal female residents from 6 cities of the Russian Federation. Different intervention thresholds, including fixed (20% for major fractures and 3% for hip fractures), age-dependent (European and Russian) ones, as well as alternative models, were analyzed. The proportion of women to be treated was estimated using different intervention thresholds. Results and discussion. The analysis of the effectiveness of the thresholds showed that the European threshold was the least appropriate one for the formed sample, since more than half (53.6%) of the women to be treated using the threshold, while the vast majority (90%) of the patients were in the younger age groups (50—54 years). There were very similar results of the effectiveness analysis of the fixed threshold (according to the USA National Osteoporosis Foundation — NOF) recommendations and that of the age-dependent threshold for Russia (in the context of the national clinical recommendations). Using the NOF approach in our sample could identify 47.8% of the postmenopausal women to be treated for osteoporosis. Their proportion rose from 29.6% of the patients aged 50—54 years to 80.6% of those aged 85 years and older. The alternative analyses of age-dependent thresholds showed great effectiveness when the fracture was considered not as a risk factor for future fractures, but as a clinical disease manifestation that was sufficient to recommend that the patient should be treated without FRAX counting. However, with their use, the proportion of older people to be treated remains not high enough. In this connection, there remains a need to search for the more adequate application of the existing intervention threshold or to develop a new, for example, hybrid variant of the age-dependent threshold.

The aim is to carry out language adaptation and validation on the Russian sample of a special SarQoL questionnaire, designed to assess the quality of life of elderly people with sarcopenia. Material and methods. 100 patients over 65 years, mean age 74.0±6.5 years, observed on an outpatient basis were included. 50 from them had sarcopenia and 50 participants were without it. The diagnosis of sarcopenia was based on criteria developed by the European working group on sarcopenia (EWGSOP, 2010). The validation procedure was carried out in accordance with the Protocol. Results and discussion. There was a significant decrease in the overall quality of life according to SarQoL questionnaire in patients with sarcopenia compared with the control group without sarcopenia (50.65±14.23 and 75.10±14.46, respectively; pConclusion. The Russian version of the SarQoL questionnaire is valid, consistent and reliable and can be used to assess the quality of life in older patients with sarcopenia.

The authors performed an analysis of published stadies devoted to osteoporosis situation in Russian Federation including epidemiological, social, medical and economical aspects of this pathology. The analysis demonstrated that osteoporosis is reported in every third woman and every forth man of 50 years old and older. Seven vertebra fractures happen every minute and one fracture of proximal femur — every 5 minutes in Russia. An overall number of all key osteoporotic fractures will increase from 590 thousand up to 730 thousand cases by the year 2035. Osteoporosis is financially demanding for healthcare due to high treatment cost of fractures that are accompanied by life quality deterioration, high mortality and invalidization of patients. Epidemiological studies demonstrated that due to high fracture risk the osteoporosis therapy should be assigned to 31% of female and 4% of male patients over 50 years old. Such factors of osteoporosis risks are widespread in the society: smoking, low food calcium consumption, vitamin D deficit, low physical activity. The authors analyzed the problems in organization of medical care to patients with osteoporosis and osteoporotic fractures and possible solutions to existing issues. The organization of healthcare should be addressed at identification of high risk patient groups, early diagnosis and assignment of corresponding treatment aimed at decreasing potential fracture risk as well as at pathology prophylaxis.

Objective : to analyze the dynamics of quality of life (QOL) in patients with prior osteoporotic vertebral compression fracture during an 18-month follow-up study. Subjects and methods . The investigation enrolled 219 patients (mean age, 67.6 years) with vertebral fracture from seven centers of the Russian Federation. QOL was assessed four times using the EQ-5D (EuroQoL-5D) and TTO (Time Trade-Off) questionnaires during an 18-month prospective follow-up study. The work was done within the framework of the International Multicenter Study ICUROS (The International Costs and Utilities Related to Osteoporotic Fractures Study) organized by the International Osteoporosis Foundation (www.icuros.org). Results and discussion . The patients with vertebral compression fracture showed a statistically significant decrease in QOL throughout the follow-up period. Immediately after the fracture, there was a dramatic decrease in the total EQ-5D score, followed by its gradual increase. However, the emerging trend in QOL recovery proved to be unstable, and by the end of the 18th month, it was significantly lower than that before the fracture. On the contrary, the TTO questionnaire showed that QOL drastically decreased immediately after fracture, but at month 4 it reached the level that was before the fracture, and remained stable until the end of the follow-up period. Conclusion . The performed investigation enabled us to obtain data on QOL using the EQ-5D (QOL assessment from the social point of view) and TTO (individual QOL assessment) in the population of residents of the Russian Federation, in men and women aged 50 years and older with osteoporotic vertebral compression fracture.

To establish a possible association between knee osteoarthritis (OA) and lower extremity venous diseases ((LEVDs) on the basis of thorough clinical and instrumental studies.A case-control study recruiting 40-60-year-old women was conducted. A study group included 85 women with knee OA; a control group consisted of 50 women without this condition. The patients of both groups underwent assessment of complaints and goal-directed objective examination to identify joint diseases and chronic LEVDs, knee X-ray study, and duplex scanning of the lower extremity veins.The patients with knee OA were more frequently diagnosed with lower extremity varicose vein disease (VVD) (43% vs 22%; p=0.015) and had signs of chronic venous insufficiency (28% vs 12%; p=0.03). Duplex scanning of the lower extremities showed that knee OA was characterized by generalized LEVD (bilateral valve lesions of the great and small saphenous veins and severe valvular incompetence in the veins) that was detected in 53% of the patients in this group versus 20% of the women in the control group (p = 0.0004). After adjustment for body mass index, the differences in the incidence of VVD between the groups remained clinically and statistically significant (odds ratio (OR), 2.7; 95% confidence interval, 1.1-6.7; p=0.036).The 40-60-year-old patients with knee OA more commonly develop symptoms of chronic venous insufficiency than their healthy peers. Although obesity is a risk factor for both diseases, there is an independent association between knee OA and lower extremity VVD.Цель исследования. На основе тщательного клинико-инструментального исследования установить возможную ассоциацию между остеоартрозом (ОА) коленных суставов (КС) и патологией вен нижних конечностей (ВНК). Материалы и методы. Проведено исследование случай-контроль с включением женщин 40-60 лет. В основную группу включили 85 женщин с ОА КС, в контрольную - 50 женщин без ОА КС. У пациенток обеих групп проведены оценка жалоб и целенаправленный объективный осмотр в целях выявления заболеваний суставов и хронических заболеваний ВНК, рентгенография КС, дуплексное сканирование ВНК. Результаты. У пациенток с ОА КС чаще, чем в контрольной группе, диагностировали варикозную болезнь (ВБ) нижних конечностей (НК) (43% против 22%; р=0,015) и признаки хронической венозной недостаточности (28% против 12%; р=0,03). Дуплексное сканирование НК показало, что для ОА КС характерно генерализованное поражение ВНК (двустороннее поражение клапанов большой подкожной вены и малой, тяжелая степень клапанной недостаточности вен), которое выявлено у 53% пациенток этой группы против 20% женщин контрольной группы (р=0,0004). После коррекции по индексу массы тела различия по частоте развития ВБ между группами оставалась клинически и статистически значимыми (отношение шансов 2,7 при 95% доверительном интервале от 1,1 до 6,7; p=0,036). Заключение. У пациенток с ОА КС в возрасте 40-60 лет ВБ НК, признаки хронической венозной недостаточности развиваются чаще, чем у их здоровых сверстниц. Хотя ожирение является фактором риска развития обоих заболеваний, между ОА КС и ВБ НК существует самостоятельная ассоциация.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that most commonly occurs in women. Improved treatments for SLE have led to a substantial increase in the life expectancy of patients, so the problems of complications of both the disease itself and its therapy have come to be top priority. The most common complications of SLE among the musculoskeletal system lesions are osteoporosis and related vertebral compression fractures (VCFs). However, only one third of these fractures has clinical manifestations and causes the patient to seek medical advice. More VCFs remain undetected because they have no or scarce symptoms. The question of the influence of various factors (gender, age, menopause, etc.) on the incidence of VCFs in patients with SLE remains open. It should be expected that in postmenopausal women with SLE, the incidence of VCFs may be considerably higher than that in the population.Objective: to determine the frequency of and to evaluate the role of various factors in the development of asymptomatic vertebral fractures in postmenopausal women with SLE (a retrospective study).Subjects and methods. A total of 86 postmenopausal women (mean age, 59±7.9 years) with a diagnosis of SLE, which met the 2012 Systemic Lupus Collaborating Clinics (SLICC) criteria, were examined. The mean duration of the disease and menopause was 15±8.3 and 12.8±7 years, respectively. All the patients with SLE were treated with glucocorticoids (GC) at a dose of 15±5 mg/day calculated with reference to prednisolone for more than 12 months (mean, 159.7±90.9 months) and had a low disease activity (the mean SLEDAI-2K score was 5.1±3.9). The ACR damage index for SLE averaged 5.5±2.6. All the patients underwent vertebral fracture assessment (VFA) using a Hologic Explorer bone densitometer to identify VCFs in the thoracic and lumbar spine. The anterior, middle, and posterior heights of ТhIV–LV, and the height of each vertebra as well as the underlying vertebra were calculated and compared. If the differences in the anterior, middle, or posterior vertebral heights were >20–25%, this deformation was regarded as VCFs. Bone mineral density (BMD) in the hip and spine was measured with an X-ray bone densitometer. Results. VFA revealed VCFs in 40 (46.5%) patients with SLE; these were detected for the first time in 22 (55%) patients since they had no significant clinical manifestations. VCFs happened most commonly in the mid-thoracic spine (ThVI–IX). All the patients with asymptomatic VCFs had a fracture of only one vertebra. The patients with VCFs had a longer duration of SLE and menopause, more frequently received cytostatic therapy, and had a higher cumulative dose and a longer duration of GC therapy. They also had a higher damage index and lower BMD values in LI–IV than patients without VCFs (p < 0.05). Neither SLE activity nor hip BMD was associated with VCFs (p > 0.05).Conclusion. The detection rate for VCFs is nearly 50% in postmenopausal women with SLE, and about every two VCFs remain undetected. The long duration of SLE, menopause, and GC treatment, a high cumulative dose, a high damage index and low BMD values in LI–IV were associated with VCFs. VFA is an effective screening method to detect asymptomatic VCFs.

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.

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.

Aim. To estimate the burden of fractures in patients with rheumatic inflammatory diseases. Materials and Methods. A specially designed questionnaire was introduced to patients of rheumatic department of Sverdlovsk regional hospital № 1. The study included 242 patients aged 50 to 79 years (mean age 58.4± 6.5 years, 194 women and 48 men). Results. High incidence of osteoporosis (35.5%) was observed in patients with rheumatic inflammatory diseases. Intervention threshold (FRAX) was identified in 46.8% of patients. Low-energy fractures of the skeleton were identified in 33.9% of patient. Oral glucocorticoid therapy increased the risk (odds ratio (95% confidence interval (95% CI)) of osteoporotic fractures by 2.68-fold (95% CI 1.55 - 4.63, p=0.004). Conclusion. High incidence of osteoporosis and osteoporotic fractures was observed in patients with rheumatic inflammatory diseases.

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

The paper presents data on the role of vitamin D and calcium in the function of many human organs and tissues. Lifestyle, dietary preferences, and insufficient physical activity contribute to the high prevalence of vitamin D and calcium deficiencies in the adult population of Russia, causing different diseases and abnormalities. The authors have worked out recommendations for the preventive use of vitamin D and calcium in healthy population, give consumption rates for these substances, and describe the clinical and laboratory signs of vitamin D deficiency and indications for screening. They also propose treatment regimens for vitamin D deficiency and depict the signs of intoxication in overdose. Particular emphasis is laid on the place of vitamin D and calcium in the therapy of osteoporosis.

Objective: to study the actual intake of vitamins and calcium and their provision in rheumatoid arthritis (RA) in the Middle Urals. Subjects and methods. The case-control method was used to form 150 pairs of RA patients aged 55.31±11.3 years. Their actual nutrition was studied from the frequency of food intake for a month, by applying a questionnaire. Based on the obtained food consumption data, the authors calculated the daily intake of vitamins A, B 2 , C, E, β -carotene, and calcium. The plasma levels of these factors were measured in 40% of the random patient sample and in 68 (45%) control persons. A complete clinical examination included the evaluation of patients' general health and articular status, inflammatory activity assessment with DAS28, laboratory tests (general blood and urine analyses, estimation of the levels of transaminases, creatinine, electrolytes, C-reactive protein, and rheumatoid factor), and instrumental examination, involving electrocardiography and joint X-ray. Results and discussion. The study demonstrated that actual nutrition was depleted of vitamins A, C, and B 2 in the patients with RA as compared to the controls. Inadequate provision of vitamin C, β -carotene, riboflavin, and calcium was found in RA. The inconsistency between the consumption of vitamins C, B 2 , and β -carotene and their plasma levels could suggest increased demands for these nutrients in RA. The findings should undergo detailed studies; first of all, this concerns the comparison of intake of the nutrients and their provision with the most important clinical characteristics of RA, such as duration, progression, activity, X-ray stage, and the presence of rheumatoid factor. The knowledge of these matters could, in our opinion, improve the results of therapy and prognosis in RA.

Introduction. The incidence of fractures of the proximal femur (FPF), fractures of the forearm and humerus was studied in two cities of the Russian Federation. This index was used to create the Russian model FRAX and to assess the present and future burden of fractures. Objective. So far, little is known about the epidemiology of fractures in Russia. The aim of the study was to determine the incidence of major fractures to create a Russian model of FRAX and evaluate the present and future burden of fractures. Materials and methods. In well-defined populations of two Russian cities, we had determined a number FPF and forearm fractures of the humerus for 2-2-year period. Data were combined and the resulting incidence used to calculate FRAX model for the Russian Federation and to calculate the projected number of fractures in the Russian Federation in 2010 and 2025. Results. A total of 6012 fractures were identified. Among all FPF, 27% of Pervouralsk and 1.8% in Yaroslavl were not registered on the official data of medical institutions. The incidence of fractures increased with age and was higher in women than in men. The probability of experiencing a FPF in later life at the age of 50 years was 4% of men and 7% of women. Total number FPF in 2010 was 112 thousand cases and it is expected to rise by 2025 to 159 thousand a year. The estimated number of major osteoporotic fractures will increase from 590 thousand to 730 thousand cases for the same period. Conclusions. Osteoporotic fractures are a serious health problem for Russia. It is necessary to take urgent measures to improve emergency care at FPF and long-term care for this and other osteoporotic fractures.

Objectives. To study the comparative efficacy and safety of intra-articular treatment of knee osteoarthritis (OA) with hyaluronic acid (HA) of different molecular weights (MW). Material and methods. Randomized double-blind controlled study included 50 patients with osteoarthritis of the knee stage II-III, weight-bearing pain more 40 mm on VAS and Lequesne index score > 4 and < 12. 25 patients received HA with MW 3500 kDa (Rusvisk group) and 25 patients were treated with HA with MW 1200-1400 kDa (Ostenil group) injected at 3-weekly intervals. During the 22-week observation period we assessed dynamics of pain on VAS (weightbearing pain, pain at rest), index WOMAC, and recorded the overall assessment of the effectiveness of therapy by patient and physician, OMERACT-OARSI criteria and the need for NSAIDs. Results. One week after the last injection, a significant decrease in weight-bearing pain (in the group Rusvisk by 69% in the group Ostenil 55%) and the total index WOMAC (group Rusvisk by 63% in the group Ostenil 60%), continuing until the end of observation. A significant decrease in pain at rest observed in the group Rusvisk at all visits and in the group Ostenil only at 6 and 10 weeks of therapy. The overall evaluation of effectiveness of therapy by patient and physician yielded the benefits observed in high molecular HA group. A high percentage of responses to therapy using OMERACT-OARSI criteria and reduced need for NSAIDs were observed in both groups. Tolerability was satisfactory and did not differ significantly between the groups. Most common adverse reactions were mild pain at the injection site. Conclusion. Intra-articular therapy with HA of different molecular weight Rusvisk and Ostenil resulted in pain reduction and improved joint function in patients with knee OA with satisfactory tolerability.

Objective : to compare the efficacy and safety of intra-articular therapy with Rusvisk (hyaluronic acid product) and Ostenil in early stages of knee osteoarthritis. Subjects and methods. 50 patients with II–III stage of the knee osteoarthritis were included in the randomized double blinded controlled study. They had pain at movement of more than 40 mm by visual analogue scale (VAS) and Lequesne index of 4–12. All patients received a course of three intra-articular injections with products of hyaluronic acid at the interval of 7 days. Rusvisk (molecular weight 3500 kDa) was administered to 25 patients, whereas other 25 received Ostenil (molecular weight 1200–1400 kDa). In 1, 2, 3 weeks after the first injection following criteria were registered: changes of WOMAC index, pain at movement and at rest by VAS, general assessment of therapy efficacy by doctor and patient, assessment of efficacy according to OMERACTOARSI. Results. In three weeks after the first injection a significant decrease of pain at movement (by 69% in Rusvisk group and by 55% in Ostenil group) and of WOMAC index (by 63% in Rusvsik group and by 60% in Ostenil group) was achieved in both groups without any differences between them. Significant decrease of pain at rest was observed at all visits only in Rusvisk group. When assessing the general efficacy, patients found more advantagesin the domestic product, whereas the therapist did not see the differences between groups. Response to the therapy by OMERACT-OARSI criteria was observed in 88% of patients in Rusvisk group and in 64% in Ostenil group. Short-term pain in the site of injection was mentioned by 64% of patients from Rusvisk group and by 72% from Ostenil group. Conclusion. Intra-articular therapy with the products of hyaluronic acid «Rusvisk», «Ostenil» provides comparable decrease of pain and improvement of functional parameters in patients with knee osteoarthritis.

Vertebral fractures in osteoporosis (OP) patients are accompanied by a decrease in quality of life (QoL) and functional limitations. Physical activity is often recommended for such patients to reduce pain, improve QoL, and functional status. Objective. To assess the impact of exercises on QOL, functional performance, and balance in patients with osteoporotic vertebral fractures. Material and Methods. The study included 78 women with vertebral fractures and chronic back pain (40 patients in the study group and 38 patients in the control group). The average age of patients in the study group was 70.7 ± 8.1 years; in the control – 67.6 ± 7.0 years (p = 0.35). The studied parameters did not significantly differ for two groups at the beginning of the study. In the study group, physical exercises were conducted for 40 minutes twice a week during 12 months. Patients in the control group were recommended to follow the same physical activity as it was prior to the study. Evaluation of the studied parameters at study baseline and 12 months later was carried out using the QUALEFFO-41 questionnaire, a computer system for disequilibrium diagnostics and the «Stand up and walk» test. Results. After 12 months, a statistically significant improvement in QoL was observed among patients of the study group, both in the total score (41.2) compared with the control (57.3, p

The purpose of the study was to investigate the prevalence and severity of vitamin D insufficiency in multiple sclerosis (MS) patients in Sverdlovsk region. Was examined 61 patients with MS of 18 to 61 year old (38,0 ± 10,6). The study was performed in March-April in 2010 and 2011. The control group included 32 healthy volunteers. The groups were comparable in age and sex. All MS patients and 94 % of control group had hypovitaminosis D3. However, patients with MS had clearly lower 25 (OH) D3 concentration as compared to control group (p = 0,01). Half of the patients had vitamin D deficiency, whereas in the control group the deficit was identified only in 21.9% (р = 0,04). We did not found any correlation between concentration of serum 25-hydroxyvitamin D3 and sex, duration and type of MS, degree of disability on EDSS scale, as well as with depression. A moderate direct correlation between patients’age and concentration of 25 (OH) D3 in serum was found.

To study the relationship of osteoporosis, depression and fractures analyzed more than 200 publications, selected for analysis 124. Osteoporosis (OP) and depressive disorder (DD) have several common risk factors. Biological, psychological and psychosocial factors associated with both diseases. The pathogenesis of OP and DD are closely correlated. OP and fractures lead to the development of DD., degrades rehabilitation and reduce adherence to OP therapy. DD in turn is associated with a decrease in BMD and an increase the risk offalls and fractures. Early detection and treatment of DD in patients with OP., as well as detection and treatment of OP in patients with depression should be an integral part of general medical practice.

Introduction: Adherence to treatment in osteoporosis (OP) remains poor. Educating patients is the possible way for improving the situation. Purpose: To evaluate the effect of different forms of educational programs on treatment adherence. Materials and methods: 479 patients (mean age 66.1±7.9 years, 98.1% were women) with osteoporosis from seven centers of Russia were included in the study. The patients were randomly assigned to two groups. Treatment group (241 subjects) was trained at the School of the OP for 4 classes using interactive teaching methods with 7-10 people at a time. Patients of the control group (238 subjects) received information on the OP as a booklet. The number of patients taking calcium and vitamin D, as well as antiosteoporotic medications was not significantly different between groups at baseline. Patients had four centers interim visits at 3 and 6 months. The final visit for all patients was 12 months. Adherence was assessed at 12 months. Results: After the educational program 78.6% of study group and 80.1% of the control group took calcium with vitamin D regularly during 12 months (p>0.05). Antiosteoporotic medications were taken regularly by 55.4% of intervention and 35.1% of the control group, p

Objective: to evaluate the impact of the active introduction of clinical guidelines for the diagnosis and treatment of osteoarthrosis (OA) by primary care physicians on the efficiency of performed therapy and patient adherence to treatment. Methods. This was an open pragmatic cluster randomized controlled trial covering 16 general practitioners who completed the trial and 92 patients clinically diagnosed as having knee and/or hip OA (63 in the intervention group and 29 in the control group). The intervention involved a one-day didactic educational seminar for the physicians, printed guideline materials, and patient brochures. The control group physicians received no additional information support. WOMAC pain and stiffness scores, body mass index (BMI), adherence to treatment (nonsteroidal anti-inflammatory drugs (NSAIDs), therapeutic exercises, alternative treatments) at 6 and 12 months after the intervention were taken into account when evaluating therapeutic effectiveness. Results. In the intervention group, the mean WOMAC pain scores were 6.9 and 13.3 points lower than in the controls at 6 (p = 0.16) and 12 (p = 0.017) months, respectively. The mean WOMAC stiffness scores in the intervention group were 6.7 and 14.7 points lower than in the controls at 6 (p = 0.29) and 12 (p = 0.039) months, respectively. The proportion of the patients using an alternative treatment dramatically decreased in the intervention group by 23 and 33% at 6 (p = 0.044) and 12 (p = 0.024) months, respectively. In the intervention group, the change in other parameters was less conclusive: by the end of the year, BMI slightly decreased (-1 kg/m 2; p = 0.95); the regular usage of NSAID reduced by 3% at 6 month (p = 0.7) and then increased by 10% at 12 month (p = 0.21). Adherence to regular physical exercises in the intervention group was 13 and 9% higher than in the controls at 6 (p = 0.23) and 12 (p = 0.42) months, respectively. Conclusion. The introduction of the clinical guidelines for the diagnosis and treatment of osteoporosis by means of a didactic educational seminar in combination with the printed methodical materials and patient brochures being given to physicians may optimize treatment and improve patient outcomes, but trials involving a larger sample are needed to confirm this effect.

New tool to assess fracture probability — the 10-year absolute fracture risk (calculator FRAX), released by WHO in 2008 - is discussed in this review. Dual-energyX-rays absorptiometry (DXA) is considered as a gold standard of diagnosis of osteoporosis. The goal of FRAX was to improve the prognostic performance of densitometry in assessing fracture risk through adding the information on different clinical risk factors independent of bone mineral density. The methodology used in searching for the risk factors included in FRAX is reviewed. Disadvantages and limitations of FRAX as well as ways of it implementation in clinical practice are discussed.

The aim of this study was to analyze the medical care and determinants of outcomes in patients with hip fracture. Epidemiological data was received from official statistic for cases of hip fractures and from primary care physicians. 208 cases of hip fractures were revealed during 2008-2009 (52 men and 156 women). The part of the hospitalized patients comprised 37,0%. Other patients either didn‘t apply to a hospital (57 people), or were refused in hospitalization (74 people). Operative treatment was received by 12,5% of patients with hip fracture. The lethality after a hip fracture within 1 year was high — 41,4°%. Thus, the low level of surgical care and the serious consequences of hip fractures and low level of the surgical help dictate the need for the development of the Russian standard to help these patients.

This was first time when the epidemiology and burden of osteoporosis and fractures in the Eastern European and Central Asian region were studied. Aim: to study the incidence, prevalence and socio-economic burden of osteoporosis and fractures in Eastern Europe and Central Asia. Methods: the analysis of published data on prevalence, risk factors and consequences of osteoporosis in 21 countries, including Russia, was performed. Results: In countries where epidemiological data is available, fracture rates are high, and vary depending on the age of the population. Osteoporosis and fractures are and will continue to be a major public health burden, escalating as the proportion of people over 50 years of age increases. In the majority of the countries under Audit there is lack of modern standards of care given for patients with osteoporosis: large proportion of hip fractures patients are not hospitalized and not surgically treated, diagnostic facilities and reimbursement policies for antiosteoporotic drugs are poor. The average daily calcium intake in nearly all countries outlined in the report falls far below the FAO/WHO recommendations. In addition the majority of populations in the region suffer from severe vitamin D insufficiency. These findings should serve to focus the attention of governments and health authorities on the devastating and growing problems posed by osteoporotic fractures in the region.

Compared to European countries, the incidence of hip fractures in Russia is significantly lower. The reasons for such a discrepancy have been studied insufficiently. It is known that in Russia, not all patients with hip fracture are hospitalized. The aim of the present study was to obtain the best possible precise data on epidemiology of osteoporotic fractures in older population. 208 cases of hip fractures were revealed during 2008-2009 (52 men and 156 women). 57 (27,4%) of them haven't been registered in official statistics and were consulted only by the primary care physicians. The incidence of hip fracture make up 191,9/100000 person-years (125,4 men and 233,2 women). The official statistics doesn't give the objective information on number of hip fractures, and search for patients treated only in a primary care settings is necessary in order to receive objective information.

Objective. To study willingness of pts to pay for osteoporosis (OP) treatment by themselves and analysis of factors influencing this decision. Material and methods. 342 pts (317 female, 25 male, mean age 61,4±8,9 years) required a special consultation for osteoporosis were asked to fill a questionnaire. All answered questions concerning social, demographic, medical data, assessment of pt knowledge about OP, quality of life assessment with QALY score. To assess pts willingness to pay for OP treatment they were asked to determine sum of money they were ready to pay for an appropriate drug decreasing fracture risk in two times. The pt was to consider 4 scenarios: low, small, moderate and high fracture risk during subsequent life. Results. 86% of pts were ready to pay for OP treatment. The main factors associated with absence of such willingness were older age (OR=1,06, 95% confidence interval 1,о2-1,1), invalidity (OR=3,18, 95% confidence interval 1,54-6,60), loneliness (OR=2,4(), 95% confidence interval 1,27-4,50). These pts were also worse informed about the disease. But family income did not influence the decision to pay. Number of pts ready to pay for the treatment and sum which they were ready to pay directly depended on the probability of fracture (rank test r=0,99 and r=0,28 respectively). The most powerful factor determining the sum pt was ready to pay for the treatment was family income. Next on importance were presence of the work and families consisted of 3 or more members. Personal experience of the pt in treatment with such drugs also had some significance. So pts treated with miacalcic were ready to pay significantly larger sums than other pts with equivalent incomes. Conclusion. Pts willingness to pay for OP treatment depends firstly on social factors and his knowledge about OP. The main factor determining the sum the pt is ready to pay is family income. On the whole sums the pts are ready to pay are significantly less than market price of drugs with proved efficacy. Fracture risk value determined by bone densitometry is an important factor influencing decision to pay for OP treatment.

Dynamic electroneurostimulation (DENS) is a type of percutaneous electroneurostimulation with a differentiation approach to choosing exposure areas and to optimizing electrocutaneous therapeutic action on the reflexogenic areas and acupuncture points for analgesia and for the treatment of functional disorders. Objective: to study the clinical efficiency and safety of therapy using a DiaDENS-PC apparatus in the treatment of knee osteoarthritis (OA). Subjects and methods. A multicenter randomized double-blind placebo-controlled study was conducted in 132 knee OA patients with pain value above 40 mm on visual analogue scale (VAS) and Lequesne’s index of 4–12. In a study group (n = 66), DENS was carried outwith a DiaDENS-PC apparatus using a trailing electrode applicator to the knee target in a Therapy stimulation mode at a frequency 77 Hz, a power of 15 units. In the placebo group, the similar procedure was performed with a switched-on placebo apparatus that did not differ in appearance from the working apparatus; but produced no electrical pulses. The treatment cycle consisted of 10 sessions lasting 30 min. Changes in Lequesne’s algofunctional index were primary end point. The results of the Get-Up to Go test (in seconds) and changes pain on VAS and WOMAC were used as secondary end points. Results and discussion . Both groups showed a statistically significant reduction of painand improvement of Get-Up and to Go test results by the end of the treatment course (p < 0.0001). Therewas a statistically significant difference in pain in the compared groups after a treatment session during the first (p = 0.037) and second (p = 0.010) visits. The analgesic effect of therapy was observed to persist in the DENS group 2 weeks (p = 0.006) and 1 month (p = 0.070) after treatment termination. After 10 sessions, there was a statistically significant difference between the groups in the Get-Up and Go test (p = 0.033) and Lequesne’s index (p = 0.022). Both groups exhibited a significant decrease in the total WOMAC scores. In the DENS group, positive changes in all subscales were statistically significant starting from the second visit whereas in the control group, the total WOMAC scores improved only at the expense of the pain subscale.

The epidemiological characteristics of osteoporotic fractures in Russia have been inadequately studied. Objective: to estimate the incidence rate of osteoporotic fractures in the old age groups of an urban population in the Middle Urals. Subjects and methods. The survey was performed in Pervouralsk, a typical industrial town in the Middle Urals, with a total of 160,860 people, including 54,189 dwellers over 50 years of age (20,746 men and 33,443 women), which amounted to 33.7% of the general population of the town. The survey covered its residents aged 50 years and over who had fractures of the proximal hip (FPH), distal forearm (FDF), distal shin, ribs, or surgical neck of the humerus between 1 January 2008 and 31 December 2009. Statistical analysis was made applying the programs Biostatistics, Microsoft Excell 2007, and MedCalc (demo-version). The findings were processed using parametric and nonparametric statistical methods. Results . During two years, 1371 fractures, including FPH, FDF, fractures of the humerus, distal shin, and ribs, were registered in the examined sample of persons aged 50 years and over from Pervouralsk. 383 (27.9%) of these fractures occurred in men and 988 (72.1%) in women. The incidence rate of all fractures was 1265.0 per 100,000 inhabitants aged 50 years and over (1,477.1 for women and 923.1 for men). FDF were more common in women, the incidence was 787.9 cases per 100,000 population; costal fractures – in men (386.7 per 100,000). The investigation has shown that certain types of fractures are predominant in the oldest age groups. Thus, the incidence rate of FDF and fractures of the distal shin decreases while that of FPH and fractures of the humerus increases with age, which is likely to be due to several causes: an age-related decline in bone mass; an increase in the frequency of falls with age; muscle weakness and movement discoordination, which alter the mechanism of fall and increase the risk of femoral and humeral fractures.

Clinical Recommendations for diagnosis, treatment and prevention of osteoporosis were approved at the IV All-Russian Congress of general practitioners (family doctors) of the Russian Federation, November 15, 2013 in Kazan. Developed on the basis of the guidelines of the Russian Association on Osteoporosis (2009, 2012) and clinical recommendations for the glucocorticoid osteoporosis of the Russian Association of Osteoporosis, Russian Respiratory Society and the Association of Rheumatologists of Russia (2013). The text specified levels of evidence (A, B, C or D), which are provided at the respective statements in parentheses.

Osteoarthritis is an important medical and social problem. Оsteoarthritis affects 13% of the adult population in Russia. Knee and hip joints are affected most frequently. Оsteoarthritis therapy includes nonpharmacologic and pharmacologic methods. Hyaluronic acid is widely used in the treatment of osteoarthritis in recent years. Intraarticular injections of hyaluronic acid more effective than placebo, are not inferior to traditional treatments and can be used as a symptomatic treatment of OA. Local therapy with hyaluronic acid well tolerated, reduces pain and improves function. Intraarticular injections of hyaluronic acid used in patients with knee OA stages I-III, less than 65 years of age, in patients who do not respond adequately to conventional therapy or with contraindications to nonsteroidal anti-inflammatory drugs (NSAIDs). Hyaluronic acid preparations of different molecular weight are of comparable effectiveness. Repeated courses do not increase the risk of side effects.

Objective. To reveal in a population sample people with joint pain and swelling. Material and methods. A screening questionnaire for revelation arthritis and arthralgia was filled for each adult resident of 18 years or older. Screening examination was performed in country and city samples. Universal examination was performed among country residents, representative sample was formed for city residents. Results. 23438 residents were screened, mean age was 48,1 ±17,6 years. Women were prevalent - 60%. 8016 were city and 15422 - country residents. Joint pain prevalence was 45%, joint swelling - 27%. These symptoms disappeared with time in 7% and 6% respectively. In other people they became chronic. Population prevalence of joint complaints is connected with sex and depends on age. In people younger than 20 years of age prevalence of joint pain was 9% and swelling - 3%. Conclusion. Preliminary analysis of the screening part of the study showed scale of the joint pathology problem and allowed to get the first data on prevalence of arthralgia and arthritis in Russia.

Aim of studdy: To assess the frequency of practical application of different basic drugs in rheumatoid arthritis (RA). Material and methods: Tlxe study was conducted basing of questionner of pts and analysis of ycases by randomized sampling among 103 consequent pts (M:F= 13:90) with reliable RA (ARA, 1987) in rheumatologic department of Clinical Hospital Nol in Ekaterinburg. 74% of pts under study demonstrated systemic manifestations: anemia (in 47 pts), lymphadenopathy (in 34), rheumatoid nodules (in 15), Sjogren s syndrome (in 4), nephropathy (in 4), vascular disturbances including Raynaud s phenomenon, capillarites (by 1 pt). Results: In the course of disease basic therapy was prescribed to 88 out of103 (85.4%) pts and one and the same patient could take different basic drugs. Aminochinoline drugs prevailed, after them more frequent were immunodepressants and gold preparations. More rarely pts had sulfasalazin, cuprenil and wobenzym. In general, in 133 out of 184 cases of prescribing basic drugs they were canceled. The reason for cancellation were: prevalently absence of the drug in the pharmaceutical stores (in 48 cases) averagely in 8 months of taking the drug; then they insufficient efficacy (44 cases) averagely in 1.3 year. In 18 cases pts themselves stopped treatment averagely in 3.5 months of drug taking. Conclusion: In the majority of cases of basic drugs cancellation in RA the cause is their absence in sail especially on free of charge prescription. Cases ofself-cancellation of the drug demonstrate the need of explaining to pts the necessity> of long-term taking disease-modifying drugs.