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The growing interest in the tandem of osteoporosis and sarcopenia is dictated by a higher level of low-traumatic fractures, disability, and mortality than against the background of individual diseases. Osteoporosis and sarcopenia are associated with aging and are characterized by a simultaneous decrease in bone and muscle mass. Osteoporosis and sarcopenia share common risk factors (genetic, endocrine, dietary and lifestyle conditions) and etiopathogenetic pathways that combine diseases into a single syndrome known as osteosarcopenia. Among the hormonal factors that play a leading role in the development and maintenance of the functional state of bone and muscle tissue, it is necessary to single out estrogens. Currently available research results confirm the protective effect of hormone replacement therapy in relation to osteoporosis. Data on sarcopenia and hormone replacement therapy require further research. Correct understanding and application of therapeutic strategies is essential in order to stop the growing wave of low-traumatic fractures.

Woman’s nature is unique. Taking into account some historical milestones, it can be noted that the role of women in society has undergone large-scale changes. The woman took a confident position in society. Its main function remains unchanged and it consists in procreation and procreation. A woman’s activity is consistent with the work of her reproductive system (RS). The gradual decrease, and then the cessation of the work of the ovaries, contributes to the life order and health of the fair sex. Menopause is a natural stage in a woman’s life, which corresponds to the peak of social self-realization. However, in some cases, hormonal changes characteristic of this period can serve as a favorable background for the formation of a number of pathological changes. The growing estrogen deficiency is becoming a pathogenetic impetus for the development of a wide range of climacteric disorders. Vasomotor symptoms and hyperhidrosis are the most frequent companions of women during the perimenopausal transition and early postmenopause. Maintaining optimal activity and the full quality of life of patients should be the goal of correcting the negative manifestations of estrogen deficiency and the complications associated with it. Compensating for estrogen deficiency with menopausal hormone therapy (HRT) is the benchmark for menopausal problems. However, there are a number of patients who have contraindications to prescribing HRT or who refuse to receive it for some reason. For this category of patients, alternative methods of diet correction. Combinations of plant extracts with vitamins and minerals have been successfully used in clinical practice for a long time. The article will provide information on the most studied phytoestrogens contained in soy.

Over the past several decades, there has been a global aging of the population around the world. The demographic situation in the Russian Federation is no exception, being a natural result of an increase in the life expectancy of the population. In clinical practice, geriatric diseases have been identified and are widely studied, which deserve priority attention due to a sharp decline in the quality of life of elderly patients. Osteoporosis is called a “silent epidemic” among elderly and senile patients. This disease is associated with a high risk of low-traumatic fractures of various localization. The imperfect rehabilitation program after complex fractures and its insufficient funding are forcing clinicians to focus on more cost-effective solutions to this problem – the prevention and treatment of osteoporosis. Osteomodifying agents are widely used by physicians of various specialties. Bisphosphonates effectively reduce the risk of low-traumatic fractures against the background of an increase in bone mineral density. The level of effectiveness of bisphosphonates depends on the patient’s adherence to antiresorptive therapy and the degree of compensation for vitamin D and serum calcium. Low adherence to osteoporosis therapy is based on the need for long-term use of bisphosphonates and a different spectrum of adverse events. In the article, using alendronate as an example, the problem of low adherence to antiresorptive therapy will be considered and ways to solve it are presented.

The history of the discovery of vitamin D (VD) has crossed 100 years. Initially, VD deficiency was limitedly associated with the development of rickets in children. Later, on the basis of a number of studies, it was found that VD deficiency is a risk factor for osteoporosis in men and women. However, the traditional concept of VD as the main regulator of calcium-phosphorus metabolism has undergone dramatic changes over the past two decades. A prerequisite for revising the role of VD and the spectrum of its biological properties was the identification of the distribution of its specific receptors in the body. VD receptors are expressed in the intestine, thyroid and parathyroid glands, kidneys, ovaries, uterus, placenta, hypothalamus, pituitary gland and play a vital function not only in calcium homeostasis. Accordingly, the list of target organs for VD action has been modified. VD deficiency, calculated on a pandemic scale, is a factor that increases the risk of developing not only osteoporosis, but also a number of other diseases. Observational and epidemiological studies have shown that reproductive system disorders are very often combined with VD insufficiency / deficiency. Subsequent scientific research aimed at establishing the role of VD in the formation of a particular pathology of the reproductive system has shown very ambiguous results. VD is recognized as an essential component of maintaining a woman’s reproductive health. Of course, the presence of an established association is not evidence of a causal relationship. There is a need for additional testing. This review focuses on the effect of VD on ovarian function and the formation of various dysfunctional conditions.

In the age of broad medical options, women’s health has received sufficient attention. The different periods of a woman’s life are characterised by specific physiological changes, based on the age-related characteristics of the reproductive system. The onset of menopause can have a negative impact on health in varying degrees. Clinicians have a clear understanding of the effects of estrogen deficiency and the therapeutic options for managing it with menopausal hormone therapy (MHT) and alternative methods of treatment. However, to date, methods for optimising and individualising the correction of menopausal disorders continue to improve. The individualization of MHT is aimed at increasing the efficacy of menopausal management and minimizing possible adverse events. Individualization is based on the selection of a hormone drug taking into account age, menopausal status, somatic health of the woman and her main complaints against the background of estrogen deficiency. The next stage of transformation of MHT concerned the composition of the drugs and the doses of their components. The evolution of the estrogenic component began with the use of conjugated estrogens, whose metabolism is not fully clarified, and stopped at the production of bioidentical estrogens (17p-estradiol and estradiol valerate), which in their structure are as close as possible to ovarian estradiol. The type, dose and combination of estrogens and progestogens determine the severity and specificity of the effect of the hormone. This article will present a clinical case study of the low- and ultra-low-dose combination of 17p-estradiol and dydrogesterone (E/DG).

In accordance with the data of the Federal Clinical Recommendations for the Diagnosis, Treatment and Prevention of Osteoporosis, with the latter, antiresorptive drugs (denosumab, bisphosphonates) are used, which mainly suppress bone resorption, and anabolic compounds (teriparatide), which enhance bone formation. The vector of their pharmacological effect helps to prevent BMD loss and significantly reduces the risk of low-energy vertebral fractures and fractures of other localizations. The experience of clinical trials makes it possible to successfully carry out antiresorptive therapy with some drugs (denosumab) for up to 10 years, demonstrating good adherence and tolerance. Bisphosphonates remain in the bone matrix for a long time and are characterized by a period of a certain aftereffect. Denosumab and teriparatide show their effect only during the period of direct use. According to some data, when denosumab therapy is canceled in a situation where the targeted goal is achieved, the incidence of vertebral fractures increases, especially in patients with a history of low-traumatic fractures. The article will present the main provisions of the European Calcified Tissues Society, the European Medical Agency, the Russian Association for Osteoporosis regarding the timing of treatment and an analysis of clinical situations requiring the appointment of alternative antiresorptive therapy. According to the resolution of the Council of Experts of the Russian Association on Osteoporosis, bisphosphonates are recommended for all patients to prevent an increased risk of vertebral fractures 6 months after patients had their last subcutaneous injection of denosumab. Oral bisphosphonates should be taken immediately, and zoledronic acid injection should be delayed for another 65 days following a missed denosumab injection.

In the civilized world, there is a dilemma on how to relate to aging - to perceive it as a natural process characteristic of any living organism or to elevate it to the rank of a disease in order to try to develop methods of “treatment”. Age-related changes in a woman begin at about 40 years old and are associated with various hormonal changes. Often this stage in the life of the fair sex does not go unnoticed, it makes unpleasant corrections to the lifestyle with the need to change established habits and rules. Interestingly, in the era of information technology, women are not always sufficiently informed about the main age-related changes in their own body. The primary task of clinicians is to timely reveal the secrets of women’s health and help them adapt to the upcoming changes. Fluctuations in hormonal status are observed throughout a woman’s life. Contrary to the common misconception among women, it is completely incorrect to identify menopause with old age, because the hormonal function in women begins to fade long before the true aging. Climax is a multistage period of life, during which all systems of the female body adapt to the new conditions of estrogen deficiency.In the treatment of climacteric disorders hormonal therapy with synthetic analogues of female sex hormones is used. Only preparations of bioidentical hormones have a real protective effect on metabolic disorders, osteoporosis, cardiovascular complications, cognitive disorders. According to clinical recommendations, approaches to the treatment of menopausal disorders should be clearly customized to the identified risks and expected benefits. Choosing the optimal composition and regime of MHT allows to increase efficiency and minimize possible risks. Clinicians should not forget about situations where there are restrictions or contraindications to the use of MHT. The presence of absolute and relative contraindications to MHT, as well as widespread hormoneophobia in our country in women have led to the development of alternative methods of treatment of menopausal disorders.

Objective. Estimation of microbiocenosis of lower and upper genital tract in different morphological forms of chronic endometritis and endometrial polyps. Material and methods. Histological examination of endometrial aspirates and microview of the lower and upper genital tract in 164 women of reproductive age with different character of menstrual and reproductive history. Results. The risk of endometrial colonization in disturbance microecology of the vagina is 3.5 times higher than that in patients with normosenosis (р

A woman’s life can be theoretically divided into certain periods: children’s, adolescent, reproductive and ageing. The latter is also called menopause. Everything related to ageing is usually associated with negative expectations and a pessimistic disposition. But if it is remembered, the word «climax» comes from the Greek language, meaning «staircase». Thus, menopause presents a culmination of a «female career». Each period is marked by its physiological characteristics, and menopause is no exception. The completion of the reproductive system functioning is often accompanied by the formation of a number of estrogen-deficient conditions. The latest modern insights, ranging from hormonal substances to alternative compounds, can effectively solve the problems of menopause.

Many women equate the word menopause primarily with decline of life. On the one hand, the aesthetic component of the delicate age makes negative contributions to the dissatisfaction with this state; on the other hand, the growing pool of somatic health problems does not improve the quality of life in the best way. The woman’s path of life is unique and consists of chapters of beginnings and endings, losses and gains. A person, who develops harmoniously and consistently, reaches their creative climax by the age of 50. This is the age, when a person is able to plunge into their inner world more deeply, and the perception of what is happening in the outer world weakens. Mental maturity, accumulated experience, well established social connections allow a person to feel confidently in everyday reality. However, the physiological changes associated with menopause and the reproductive function failure affect the personal history of each of the fair sex in one way or another. Not a simple, but at the same time a very significant period begins after 50 years, when it is necessary to conquer new peaks and overcome new distances. Only a thoughtful and successful start of menopause can provide a sense of satisfaction and a cloudless horizon in physical well-being.

The article presents the basic definitions related to the treatment of postmenopausal osteoporosis, and certain sections from the guidelines of the Russian Association on Osteoporosis (2016) dedicated to the prescription of active vitamin D metabolites (alfacalcidol).

The paper presents a review of accumulated data relating to major definitions in diagnostics and therapy of the premenstrual syndrome and own experience represented by case histories. Various therapeutic approaches from the point of view of evidencebased medicine are highlighted.

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.

Цель: Изучить эффективность золедроновой кислоты в терапии постменопаузального остеопороза (ПМО) с учетом полиморфизма гена фарнезилдифосфат-синтетазы (FDPS). Методы исследования: клинический, определение биохимических маркеров костного метаболизма (БМКР) - электрохемилюминесцентным методом («Хоффманн-Ла Рош ЛТД», Швейцария). Измерение МПК проводили с помощью двухэнергетической рентгеновской абсорбциометрии позвонков поясничной области (L1-L4) и шейки бедренной кости (Neck left, Neck total left). Молекулярно-генетический (определение однонуклеотидного полиморфизма гена FDPS (rs2297480) - методом «примыкающих проб» с анализом кривых плавления (ЗАО «НПФ ДНК-Технология, Россия)). Результаты. Обследовано 225 женщин с постменопаузальным остеопорозом. Средний возраст составил 59 (5466) лет. Средняя продолжительность периода постменопаузы 7 (2-13) лет. ИМТ=27,2(23,6-29,05) кг/м2. Распределение аллелей (АА:АС:СС) составило 55,1(n=144):39,5(n=103):5, 4(n=14). Базальные уровни биохимических маркеров костного ремоделирования (БМКР) соответствовали периоду постменопаузы и статистически значимо не различались в зависимости от генотипа FDPS. Средние показатели МПК в поясничном отделе позвоночника и/или шейке бедра соответствовали остеопорозу. Всем пациенткам проводили терапию золедроновой кислотой (zol) в дозе 5 мг в виде внутривенной инфузии 1 раз в 12 месяцев в течение 2 лет. Дополнительно все пациенты получали кальций 1000 мг/сут и витамин Д3 800МЕ/сут. Реакция БМКР на инфузию zol различалась в зависимости от генотипа FDPS. Через 6 месяцев после 1-ой инфузии достоверно более выраженное снижение B-Crosslaps 92 (91-93)% отмечено у пациентов с С/С генотипом (p=0,056), по сравнению с 82% у носителей аллеля А (p=0.07). Через 9 месяцев после инфузии B-Crosslaps у носителей аллеля А повышались до 75%, остеокальцина - 44,4% от исходного. Тогда как у носителей генотипа C/C как B-Crosslaps - (87%), так и osteocalcine -(53,6%) оставались по-прежнему низкими (р=0,056). К 12 месяцу после инфузии уровни B-Crosslaps и osteocalcin у носителей аллеля A повышались и соответствовали премено-паузальным значениям, тогда как у носителей С/С генотипа оставались в пределах ниже нижней границы нормы для пременопаузы. У пациентов с СС генотипом на фоне выраженного снижения БМКР после 2ой инфузии золедроновой кислоты произошло снижение МПК на 5,6%. Выводы. Различная реакция на терапию золедроновой кислотой у пациенток с ПМО связана с полиморфизмом гена FDPS (rs2297480). Для пациентов с генотипом С/С характерно «гиперторможение» костного обмена в ответ на терапию золедроновой кислотой, что возможно, было причиной отрицательной динамики МПК в поясничном отделе позвоночника на втором году терапии золедроновой кислотой.

In open prospective study we determine the efficacy of zoledronic and ibandronic acids on bone metabolism markers and bone mineral density in women with postmenopausal osteoporosis. 225 women with postmenopausal osteoporosis treated with zoledronic acid in dose 5 mg, intravenously, once a year and 64 women treated ibandronic acid were followed up. The investigators assessed clinical and medical history data, evaluated the gynecological and somatic statuses, and made laboratory and instrumental studies: clinical, biochemical blood tests, general urinalysis, determination of serum bone metabolism markers (B-Crosslaps, osteocalcin), osteodensitometry and electrocardiography, therapist ’s examination if needed. Therapy with zoledronic acid 5 mg once a year and ibandronic acid 150 mg once a month was followed by a significant reduction in resorption markers (B-Crosslaps) just following one month. Formation markers decreased to a lesser degree, which was indicative of preserved positive bone remodeling balance during the therapy. Determination of biochemical markers of bone remodeling permits assessment of an individual patient response to antiresorbtive therapy just in the first month after infusion. Zoledronic acid or ibandronic acid therapy exerts a rapid and potent effect on bone metabolism, mainly by inhibiting the resorption processes.

Остеопороз - системное заболевание скелета, характеризующееся снижением костной массы и нарушением микроархитектоники костной ткани, которые приводят к повышению хрупкости костей. На сегодняшний день разработаны лекарственные средства класса бисфосфонатов с антирезорбтивным потенциалом различной степени выраженности Необходимость длительного (3-5 лет) и регулярного приема препаратов для обеспечения адекватной эффективности терапии ассоциирована с низкой приверженностью к лечению. С целью повышения приверженности терапии разработаны внутривенные формы бисфосфонатов (ибандронат, золедроновая кислота), позволяющие уменьшить кратность использования до 1 раза в 3-12 месяцев. Развитие нежелательные явлений (симптомов реакции острой фазы) после внутривенного введения антирезорбтивных препаратов способствует появлению некой настороженности со стороны пациента и нежеланию в дальнейшем использовать бисфосфонаты. Последние международные исследования расширили понимание плейотропного действия и раскрыли патогенетические механизмы развития симптомов реакции острой фазы в ответ на использование бисфосфонатов при лечении остеопороза.

Infusions of aminobisphosphonates are now established therapies ofpostmenopausal osteoporosis. Their use is associated with fever and musculoskeletal pain in some subjects, referred to as the acute phase response (APR). The purpose of the study was to explore tolerability of zoledronic acid in the treatment of postmenopausal osteoporosis. In a 36-month open label, prospective study patients with postmenopausal osteoporosis iv received zoledronic acid at a dose of 5 mg every 12 months. We then analyzed the tolerability of the treatment at the hospital and via telephone interviews during the next 14 days and every 3 months after the infusion. Prevention of APR was carried out with paracetamol 500 mg x 3 times a day on the day of first infusion and the next 2 days. Symptoms of APR were recorded in 39% (n=43) of patients with prevention therapy. APR developed in the first 12-24 hours after infusion of zoledronic acid. Among women without prevention APR developed in 65% (n=75) of cases. (OR=0.34 CI (0.2-0.59)). After the 2 nd infusion symptoms of APR were noted in 27.9% (n=26) (р90% of cases the symptoms were of mild or moderate severity, with resolution within 3 days after infusion of zoledronic acid. The most frequent symptoms were bone and muscular manifestations and a flu-like syndrome (p

Цель: провести анализ переносимости терапии золедроновой кислотой у постменопаузальных женщин с остеопорозом. Материал и методы. В открытое проспективное исследование в течение 36 месяцев были включены женщины с постменопаузальным остеопорозом, получающие терапию золедроновой кислотой (n=225). Проводились оценка соматического статуса, лабораторные и инструментальные исследования (клинический анализ крови, биохимический анализ крови, общий анализ мочи, биохимические маркеры костного ремоделирования (БМКР) сыворотки крови: B-CrossLaps - маркер резорбции, остеокальцин - маркер костеобразования, остеоденситометрия (двухэнергетическая рентгеновская абсорбциометрия) определение минеральной плотности кости (МПК) в поясничном отделе позвоночника (L1-L4) и шейке бедра (Neck). Результаты. 225 женщин с диагностированным постменопаузальным остеопорозом, получали антирезорбтивную терапию золедроновой кислотой (ЗК) (5 мг, в/в, капельно, 1 раз в год). Дополнительно из этой когорты были сформированы подгруппы женщин, которым проводили в/в инфузию во второй (n=90) и в третий (n=30) раз. Медиана возраста обследованных составила 59 (54-66) лет. Наиболее частыми нежелательными являются симптомы реакции острой фазы: гриппоподобный синдром, костно-мышечные проявления, гипертермия, слабость. Причем, у всех пациентов СРОФ развились, через 12-24 часа после инфузии ЗК. В день проведения внутривенной инфузии и последующие 2 дня 48,9% (n=110) пациентам проводили профилактику реакции острой фазы (РОФ) парацетамолом по схеме: 1000 мг х 3 р/д, 3 дня. Среди тех, кому не проводили профилактику, РОФ развилась у 65,3% (n=75) и у 34,7% (n=40) пациенток нежелательных явлений отмечено не было. В общей сумме, у 48,4% (n=109) пациенток были зафиксированы симптомы реакции острой фазы различной тяжести. В структуре РОФ преобладали слабость-26%, озноб - 23,4%, боли в костях и мышцах - 28,4%, гипертермия - 20,9%. Продолжительность симптомов РОФ у пациенток без профилактики СРОФ до 3 дней отмечена у 68% (n=51), 3-7 дней у 25,3% (n=19), более 7 дней у 6,7% (n=5). У большинства пациенток без профилактики (77,3%) отмечалась легкая степень тяжести симптомов, 2-средняя степень тяжести диагностирована у 16% (n=12) пациенток и 3-тяжелая степень проявлений РОФ была отмечена у 6,7% (n=5). Симптомы РОФ (СРОФ) на фоне профилактики развивались в 1,7 раз реже и отмечались у 39% (n=43) пациенток. У пациенток, которым проводили профилактику, продолжительность СРОФ до 3 дней, наблюдалась у 67,4% (n=29) и 3-7 дней у 32,6% (n=14). После проведения профилактики нами была зарегистрирована в основном легкая 62,8% (n=27) и умеренная степень тяжести СРОФ - 34,9% (n=15). Тяжелая степень РОФ отмечена только у 1 пациентки (2,3%). В структуре РОФ преобладали слабость, озноб, боли в костях и мышцах, гипертермия (р

Conclusion. 1. There were no significant differences in the occurrence frequency of allele and genotypes of C1444 locus of CRP gene in patient with osteoporosis. 2. It was founded that T allele and TT genotype of C1846T locus of CRP gene were more common in women with osteoporosis. 3. The determination of gene CRP polymorphism gives a responsibility to realize individual prognosis and to take preventive measures. Цель исследования. Определить полиморфизмы генов OPG, RANKL, VDR, SOST и оценить их взаимосвязь с минеральной плотностью кости (МПК) и переломами для последующей оптимизации диагностики и лечения постменопаузального остеопороза. Материал и методы. В исследование вошли 236 женщин в постменопаузе, проживающих в Москве и Московской области. Основную группу составили 174 пациентки, в возрасте от 50 до 83 лет, с показателями минеральной плотности кости (МПК) < - 2,5 SD по Т-критерию. Группу сравнения составили 62 женщины в постменопаузе с показателями МПК в пределах нормальных значений и отсутствием переломов в анамнезе, в возрасте от 50 до 77 лет. В нашем исследовании всем испытуемым с постменопаузальным остеопорозом и группы контроля с помощью полимеразной цепной реакции проводили молекулярногенетическое проводили с определением полиморфизмов генов VDR(rs10735810, rs1544410), RANKL (rs9594738, rs9594759) и OPG (rs3102735, rs3102735 и rs4355801), SOST (rs1230399). Результаты. При наличии Т аллелей гена RANKL по полиморфизмам rs9594759 и rs9594738 риск снижения МПК в поясничном отделе позвоночника увеличивается в 2 раза. У женщин с гомозиготным генотипом С/С по полиморфизму rs3102735 гена OPG риск развития переломов дистального отдела лучевой кости повышается в 17 раз вне зависимости от показателей МПК. Наличие генотипа G/G по полиморфизму rs1544410 гена VDR у пациенток с постменопаузальным остеопорозом ассоциировано с повышением риска переломов дистального отдела лучевой кости в 3 раза. У пациенток с ПМО гомозиготный генотип С/С по полиморфизму rs1230399 гена SOST обуславливают только различия в индексе массы тела. Заключение. Полиморфизмы генов RANKL (rs9594759 и rs9594738), OPG (rs 3102735) и гена VDR(rs1544410) ассоциированы с риском развития постменопаузального остеопороза и переломов. Ген SOST(rs1230399) не оказывает статистически значимого влияния на МПК и риск переломов.

In considering the various aspects of menopause, not enough attention is paid to a significant reduction in the quality of life for women in transition and early postmenopause. Timely administration of menopausal hormone therapy is effective in reducing menopausal symptoms and improves quality of life at a given time, as well as the risk of developing diseases of aging, that can improve the quality of life related to health, and overall well-being of women in the more distant future. The choice of medication should be determined by its composition and clinical characteristics of the particular patient.

Aim. To identify gene polymorphisms (OPG, RANKL, VDR, SOST) and evaluate their relationship with bone mineral density (BMD) and fractures for further optimization of diagnosis and treatment of postmenopausal osteoporosis (PMO). Materials and methods. The study included 236 postmenopausal women living in Moscow and the Moscow region. The main group (I) consisted of 174 patients, aged 50 to 83 years, with BMD < - 2.5 SD for the T-score. The comparison group (II) consisted of 62 postmenopausal women with BMD within the normal range and the lack of previous fractures, aged 50 to 77 years. Molecular genetic analysis of polymorphisms of VDR (rs10735810, rs1544410), RANKL (rs9594738, rs9594759) and OPG (rs3102735, rs3102735 and rs4355801), SOST (rs1230399) was performed by polymerase chain reaction in all subjects with PMO and in the control group. Results. In the presence of the T allele of the gene RANKL (rs9594759 and rs9594738) risk of reduced BMD at L1-L4 was increased by 2 times. Women with genotype C/C gene polymorphism of OPG (rs3102735) the risk of fractures of the distal radius (PR) was increased by 17 times, regardless of BMD. Genotype G/G rs1544410 polymorphism of VDR gene in patients with PMO is associated with an increased risk of fractures of the distal radius by three times. In patients with PMO genotype C/C in gene SOST (rs1230399) only cause differences in body mass index. According to an autosomal recessive pattern, homozygous genotype C/C was significantly associated with obesity in the PMO. Conclusions. Polymorphisms of genes RANKL (rs9594759 and rs9594738), OPG (rs3102735) and VDR (rs1544410) are associated with the risk of fractures and PMO. Gene SOST (rs1230399) had no statistically significant effect on BMD and fracture risk.

Цель: провести анализ влияния золедроновой кислоты на минеральную плотность кости (МПК) и биохимические маркеры костного ремоделирования (БМКР) у постменопаузальных женщин с остеопорозом. Материал и методы. В открытое проспективное исследование в течение 36 месяцев были включены женщины с постменопаузальным остеопорозом, получающие терапию золедроновой кислотой (ЗК) (n=225). Проводились оценка соматического статуса, лабораторные и инструментальные исследования (клинический анализ крови, биохимический анализ крови, общий анализ мочи, биохимические маркеры костного ремоделирования (БМКР) сыворотки крови: B-CrossLaps- маркер резорбции, остеокальцинмаркер костеобразования, остеоденситометрия (двухэнергетическая рентгеновская абсорбциометрия) L1-L4 и Neck. Результаты. Медиана возраста обследованных составила 59 (54-66) лет. Естественная менопауза отмечена у 80,6%, и 19,4% женщин имели индуцированную менопаузу. Медиана возраста наступления менопаузы составила 51 год (от 47 до 53), а медиана продолжительности постменопаузы - 7 (2-13) лет. Согласно полученным данным среди всех переломов преобладали переломы дистального отдела лучевой кости (p