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According to the European guidelines for osteoporosis, the same FRAX intervention threshold is suggested for men as for women. At the same time, in the Russian Federation, according to research data, an extremely low proportion of identified men who are subject to the initiation of osteoporosis therapy. The female intervention threshold identifies only 1.1 to 4% of men for treatment. Aim – to develop and evaluate various options for the intervention threshold using the FRAX calculator for men in the Russian Federation and adopt the most acceptable intervention threshold by consensus. Material and methods. Delphi voting was conducted among 18 Russian experts who have publications and personal reports about their experience with the FRAX calculator. For discussion, 5 intervention threshold options with the corresponding rationale based on the literature reference were presented, as well as the proportion of men of different ages to be initiated in each of the options (based on several Russian population-based studies). Anonymous voting was carried out using the Delphi method with questionnaire placed in the Google form. It was proposed to evaluate all options for intervention thresholds on a 9-point Likert scale. Consensus was considered reached if the intervention threshold reached a Likert score of 7 or more points in 80% or more of the experts. The rating of each intervention threshold option was expressed as mean and standard deviations. Results. In the first round of voting, the maximum rating and percentage of agreement is reached for the 9% fixed interference threshold option based on the FRAX calculation. The rating was 7.72±1.6 points, the percentage of experts’ agreement was 88.9%. A fixed threshold of 9% determined 13–19.5% of men aged 50 years and older to be treated for osteoporosis, while their proportion increased to 26–38% at the age of 85 years and older. Conclusion. The consensus of experts of the Russian association on osteoporosis suggests initiating treatment of osteoporosis in Russian men with a 10-year probability of major osteoporotic fractures according to FRAX of 9% or higher.

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 demonstrate the possibility of having a spondyloarthritic mask of osteomalacia in patients of both sexes.Materials and methods. Two clinical cases of osteomalacia occurring under the mask of spondyloarthritis in patients treated at the Clinical Rheumatology Hospital of Saint-Petersburg, Russia, as well as similar cases described in the literature, were analyzed.Results. In the cases described, patients were diagnosed with a disease from the group of spondyloarthritis based on a number of individual symptoms, such as pain in the lower back and stiffness, as well as instrumental examination data. At the same time, with in-depth evaluation, the pain in the lower back did not did not met to the inflammatory pain ASAS criteria, and there were also no signs of general laboratory activity of the disease. The conventional therapy for spondyloarthritis was ineffective. With the re-evaluation of clinical, laboratory and instrumental data, the diagnosis was changed to osteomalacia. Appointment of adequate therapy with vitamin D after a review of the diagnosis resulted in both a regression of clinical symptoms and an improvement in laboratory parameters.Conclusions. If the patient has pain in the lower back, especially without clear signs of inflammatory, no signs of general laboratory activity, further examination is necessary to clarify possible osteomalacia. Spondyloarthritis should be only diagnosed in cases with the secondary nature of symptoms excluded.

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; p

Objective: to identify irreversible organ damages and factors influencing their development and to compare existing musculoskeletal injuries with the activity of systemic lupus erythematosus (SLE).Patients and methods. The investigation enrolled 197 peri- and postmenopausal female outpatients (mean age, 50.94±9.1 years) with SLE, who were followed up at Clinical Rheumatology Hospital Twenty-Five, Saint Petersburg. The mean disease duration was 9.7±7.5 years. Cytostatic and glucocorticoid (GC) treatment regimens and dosages in the examinees were analyzed on the basis of their primary medical records. The investigators assessed the current disease activity by the SLE Disease Activity Index (SLEDAI-2K) and the Lupus Low Disease Activity State (LLDAS) and irreversible organ damages by the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (DI).Results and discussion. 93.4% of the patients continued to receive GS therapy at the time of inclusion in the study. The median GS maintenance dose was 12.5 mg/day. Almost half of the patients (n=86/43.7%) were in menopause (its mean duration was 12.8±7.1 years). Half of the examinees were noted to have remission (n=36/18.3%) or low SLE activity (n=92/46.7%) according to the SLEDAI-2K. Fifty-seven (28.9%) patients met all 5 LLDAS criteria; at the same time other 96 (48.7%) patients met 4 out of the 5 criteria, the 5th criterion being a high GC maintenance dose. High DI scores of ≥4 were found in two thirds (n=131/66.5%) of the examinees. Musculoskeletal system injuries ranked first among other disorders: osteoporosis (OP) and muscle weakness were detected in 76 (38.6%) and 69 (35.0%) patients, respectively. Regression analysis involving all statistically significant factors showed that the degree of damage was influenced by age (p=0.013215), total GS dose (p=0.000047), and previous therapy with cyclophosphamide (p=0.041505).Conclusion. The contribution of GS therapy to irreversible damage accrual is obvious in peri- and postmenopausal women with SLE. Timely dose adjustment or complete withdrawal of GS during remission in SLE is one of the key factors that substantially reduce the risk of progression of irreversible organ damages due to the prevention of OP and osteoporotic fractures in these patients.

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.

The main goal of treatment for rheumatoid arthritis (RA) is to suppress inflammation using basic and symptomatic therapies. At the same time, the above strategy does not significantly stop joint destruction that leads to disability in patients. The review analyzes publications dealing with a search for intercellular interaction regulators among the main effector cells in the pannus – fibroblast- like synoviocytes (FLSs). It assesses the influence of FLS aggression factors on invasive pannus behavior, the possibility of their targeted deactivation during biological therapy, and the preliminary results of similar treatment by the examples of animal models. It is shown that the most promising targets for biological therapy may be FLS adhesion molecules, such as transmembrane receptor cadherin 11, integrins α5/β1, and VCAM1, ICAM1, which actively participate in the attachment of FLSs to the cartilage surface and activate their production of cytokines, growth factors and aggression factors.

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.

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.

The article summarizes the data of two randomized controlled trials (RCTs) Phase III MEASURE 1 and MEASURE 2 investigating the efficacy and safety of secukinumab (SEC) in treating ankylosing spondylitis (AS) and compares the data with the results obtained from Russian patients with active AS, who were enrolled in these RCTs.Subjects and methods. Among 590 patients included in the MEASURE 1 and MEASURE 2 trials, the Russian group totaled 107 patients: 44 and 29 patients took SEC in the MEASURE 1 and MEASURE 2 trials, respectively; 34 patients had placebo in the two trials.Results and discussion. A retrospective analysis of the results for the Russian patient group showed that the efficacy of SEC in treating AS was fully similar to that demonstrated in the entire MEASURE 1 and MEASURE 2 group cohort. At 1 to 16 weeks of SEC therapy, the MEASURE 1 trial Russian patients displayed a rapid clinical improvement in 52.6% (p = 0.043); and in the SEC 150- and 75-mg groups, ASAS20 improvement was achieved by 64% (p = 0.0015), respectively. The SEC 150-mg group in the MEASURE 2 trial exhibited an ASAS20 response in 66.7% of cases (p = 0.0063). The clinical response at 16 weeks in the patients randomized at baseline into SEC treatment groups was sustained for 52 weeks. The proportion of patients achieving ASAS20 response at 52 weeks was 63.2 and 68% in the MEASURE 1 trial (in the SEC 150- and 75-mg groups, respectively) and 73.3% in the MEASURE 2 trial (the SEC 150-mg group). At 52 weeks, ASAS40 reponse was achieved by 52.6% of the patients in the MEASURE 1 trial and by 60% of those in the MEASURE 2 trial (the SEC 150-mg group). In the MEASURE 1 trial, ASAS 5/6 response rates at 16 weeks were 42.1 and 52.0% in the SEC 150- and 75-mg groups (p = 0.0249 and p = 0.0013, respectively). In the MEASURE 2 trial, the proportion of the SEC 150-mg group patients achieving ASAS 5/6 response was 53.3% (p=0.0135). After 52 weeks, these rates were 57.9, 52, and 73.3%, respectively. The adverse reactions observed in both the placebo-controlled and later follow-up periods and in the Russian patient cohort suggest that SEC has an acceptable safety profile and good tolerability in patients with AC.

Objective: to estimate the cost of treatment in patients with complicated osteoporosis (OP) in the first year after fracture under the conditions of the Moscow municipal healthcare system.Patients and methods. The investigation enrolled 196 women (mean age, 65.8±9.1 years) who had sustained fractures at five major osteoporotic sites (proximal hip (PH), distal forearm (DF), surgical humeral neck, vertebral column, and medial and/or lateral ankle). A unified questionnaire that included data on inpatient and outpatient treatment, patients' personal costs, and social benefits, as well as tariffs on services of the Moscow City Fund of Obligatory Health Insurance was used to estimate the cost of treatment for complicated OP during one year after fracture.Results. The direct cost of treatment for PH fracture amounted to 101,243 rubles and was significantly higher (p < 0.01) than that for fractures at other sites: DF (22,080 rubles); humeral neck (39,855 rubles), vertebral column (51,167 rubles), and ankle (43,345 rubles). The average cost of treatment in terms of indirect costs of treatment for complicated OP during a year was as high as 61,151 rubles. In the overall cost structure for the disease, hospital costs accounted for 44%; social benefits were 12% and the cost of antiosteoporotic drugs was only 7%, which was associated with the fact that the latter were rarely prescribed by primary healthcare physicians.Conclusion. Costs of treatment in patients with complicated OP in Moscow were estimated in relation to the site of low-energy fracture. The disease was shown to cause considerable economic losses regardless of the site of osteoporotic fracture; however, the cost of antiosteoporotic drugs has an insignificant share in the overall cost structure for treatment. At the same time, secondary prevention of OP requires that combination antiosteoporotic therapy should be performed in all patients who have sustained low-energy fracture.

Aim: To assess the providing an organism with vitamins (А, В2, С, Е), β-carotene, and calcium in osteoporosis patients by measuring their intake and plasma concentrations. Materials and methods: 108 pairs “osteoporosis patient – healthy volunteer” aged 64.29±9.73 years were formed using a “case-control” method. Real intake of vitamins and calcium was studied defining the frequency of food taking for a month using questionnaire method. Daily intake of vitamins А, В2, С, Е, β-carotene, and calcium was calculated based on the analysis of the frequency of food taking. Among the basic group, using randomized method, 60% of osteoporosis patients were selected who underwent definition of plasma levels of vitamins А, В2, С, and Е. The same study was performed in 60 control volunteers. Results: Correlation of the intake of vitamins A, C, and β-carotene with their plasma levels wasn’t noted. It may reveal an increased need in these nutrients in osteoporosis. According to the calcium intake, every osteoporosis patient can be attributed to a population category with deep insufficiency of calcium intake (less than 500 mg a day). Conclusion: The data obtained need further investigation and, first of all, in clinical and biochemical fields (enzymatic non-provision for calcium uptake, clinical manifestations of insufficient provision with nutrients). Solution of these problems would enable regulation of food intake concerning calcium uptake in osteoporosis.

Background: Multiple sclerosis is a chronic autoimmune progressing disease of the nervous system characterized by increased fracture risk due to a series of causes including the low bone mineral density (BMD). According to the literature data, the multiple sclerosis patients of a young age can already have BMD under the age norm. Factors associated with low BMD in such patients need to be investigated. Aim: Assessment of the prevalence of the low BMD level in young multiple sclerosis patients and revealing factors enabling its decrease. Materials and methods: Age was a patient criterium for including into the study: 18 to 50 years for men and 18 to menopause – for women. Under examination there were 163 patients with multiple sclerosis, 111 women (68.1%) and 52 men (31.9%) with mean age of 36.1±7.6 years. Relapsing-remitting multiple sclerosis was diagnosed in 121 (74.2%) patients, secondary progressive multiple sclerosis – in 37 (22.7%), and primary progressive multiple sclerosis – in 5 (3.1%). Score median according to the Expanded Disability Status Scale (EDSS) was 3.5 (25% and 75% quartiles – [2,0; 5,5]). The median of the disease duration was 8.5 [5.0; 14.0] years. BMD measuring was carried out using dual-energetic roentgen absorptiometry. Investigation was performed on two skeleton points: on the lumbar spine and proximal hip. Results: Decrease of BMD to under the age norm according to Z-criterion was revealed in 30 (18.4%) patients. The results obtained has shown that the body mass index (odds ratio (OR) 0.8; 95% confidence interval (CI) 0.7-0.9, p=0.001), disease duration (OR 1,1; 95% CI 1.0-1.2, p=0.023), the number of gluco-corticosteroid therapy courses (ОR 1.3; 95% CI 1.0-1.6, р=0.03), and smoking (ОR 2.7; 95% CI 1.0-7.2, р=0.04) are independent factors causing low BMD values in the patient population of multiple sclerosis studied. Conclusion. Every forth multiple sclerosis patient has decreased BMD in young age. Disease duration, low body mass index, gluco-corticosteroid taking, and smoking are significant factors influencing BMD in the young population of multiple sclerosis studied.

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 inoverdose. Particular emphasis is laid on the place of vitamin D and calcium in the therapy of osteoporosis.

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 improvedonly at the expense of the pain subscale.

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, B2, 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 B2 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, B2, 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.

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 humerusbetween 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 increaseswith 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.

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.

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.

Aim of investigation. To study efficacy of albumin dialysis (MARS) at complications of end-stage liver diseases having various etiology.Material and methods. Overall 65 patients with chronic terminal liver diseases of Child–Pugh B and C classes have been included in original study. The first (main group) included 25 patients, that received albumin dialysis in addition to traditional drug therapy. The second group (comparison group) included 40 patients who received only traditional pharmaceutical therapy. In relation to etiology of disease all patients were divided into three groups: 1) cirrhoses of the nontoxic etiology as an outcome of viral hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis; 2) cirrhosis of toxic (alcohol-induced) etiology and 3) focal liver lesions – hepatocellular carcinoma (HCC).Results. Among patients, receiving treatment with albumin dialysis the stage of hepatic encephalopathy at patients in the subgroup with cirrhosis of toxic (alcohol-induced) etiology significantly decreased (р

Postmenopausal osteoporosis is a widespread complex disease with strong genetic predisposition. The aim of this study was to fnd association of (CA)n polymorphism of calcitonin gene (CALCA) with the risk of postmenopausal osteoporosis and serum calcitonin level in Russian women from Volga-Ural region. DNA samples of 372 women aged from 48 to 77 years old (175 with fractures and 197 without fractures) were used in the study. Femoral neck BMD was measured in 185 women, lumbal spine BMD - in 203 women. The serum calcitonin was measured in 168 women. Eight alleles of (CA)n polymorphism were revealed: each allele contained 10, 11, 12, 15, 16, 17, 18 and 19 CA repeats. CALCA*10*10 genotype is a marker of the decreased risk of osteoporosis (OR = 0,21) and osteopenia (OR = 0,21). CALCA*10*10 and CALCA*17*17 genotypes were shown to be associated with high femoral neck BMD. Statistically signifcant association of CALCA*17 allele with the increased calcitonin level have been shown.