Buy (150 RUB)
Generate QR code
Open Access
Subscription or Fee Access
Osteoporosis: how to diagnose and what treatment to prescribe
https://doi.org/10.33667/2078-5631-2024-29-40-45
Abstract
Osteoporosis is the fourth most common disease in the world among people over 50 years old, and its social significance is associated with low-energy vertebrae and nonvertebrae fractures, leading not only to a deterioration in the patient’s quality of life, which may not return to the pre-fracture level for many years, but also to an increase in mortality. Currently, in real clinical practice, the diagnosis of osteoporosis continues to be based on measuring bone mineral density using dual-energy X-ray absorptiometry, while this type of equipment often remains unavailable in certain regions of our country. The article discusses the clinical criteria for the diagnosis of osteoporosis, provides mandatory and, if necessary, additional laboratory tests for patients, as well as recommendations for choosing an anti-osteoporotic medication. Special attention is paid to the need for additional intake of calcium and vitamin D in combination with all medications used to treat osteoporosis.
About the Authors
N. V. Toroptsova
V. A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Natalia V. Toroptsova, DM Sci, Head of the Laboratory
Osteoporosis Laboratory
Moscow
O. V. Dobrovolskaya
V. A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
Olga V. Dobrovolskaya, PhD, researchere
Osteoporosis Laboratory
Moscow
References
1. Lesnyak O. M., Baranova I. A., Belova K. Yu. et al. Osteoporosis in Russian Federation: epidemiology, socio-medical and economical aspects (Review). Travmatologiya i ortopediya Rossii = Traumatology and Orthopedics of Russia. 2018;24(1):155–168. (In Russ.) DOI: 10.21823/2311-2905-2018-24-1-155-168
2. Dobrovolskaya O. V., Toroptsova N. V., Lesnyak O. M. Economic aspects of complicated osteoporosis: The cost of treatment in the first year after fracture. Sovrermennaya rheumatologia = Modern Rheumatology Journal. 2016; 10 (3): 29–34. (In Russ.) DOI: 10.14412/1996-7012-2016-3-29-34
3. Audit of the state of the problem of osteoporosis 2020. https://osteoporosis-russia.ru/audit-sostoyaniya-problemy-osteoporoza-2020/ The link is active on 02/11/2022.
4. Dobrovolskaya O. V., Toroptsova N. V. Postmenopausal Osteoporosis: Post-Fracture Quality of Female Patients’ Life. Effectivnaya Pharmacotherapia = Effective Pharmacotherapy. 2015; (46): 8–13. (In Russ).
5. Shubnyakov I. I., Vorontsova T. N., Bogopolskaya A. S. et al. Mortality in patients with proximalfemur fractures undergoing conservative and surgical treatment. Pirogov Russian Journal of Surgery. 2022; (4): 60–68. (In Russ.) DOI: 10.17116/hirurgia202204160
6. Belaya Zh.E., Belova K. Yu., Biryukova E. V. et al. Federal clinical guidelines for diagnosis, treatment and prevention of osteoporosis. Osteoporoz I osteopatii = Osteoporosis and bone diseases. 2021; 24 (2): 4–47. (In Russ.) DOI: 10.14341/osteo12930
7. Siminoski K., Jiang G., Adachi J. D. et al. Accuracy of height loss during prospective monitoring for detection of incident vertebral fractures. Osteoporos Int. 2005 Apr; 16 (4): 403–10. DOI: 10.1007/s00198-004-1709-z
8. Baranova I. A., Belaya Zh.E., Gasser R. V. et al. Osteoporoz: rukovodstvo dlya vrachei = Osteoporosis : a guide for physicians. Moscow: GEOTAR-Media, 2016. 464 p. (In Russ.) EDN WKNGCL.
9. Gehlbach S., Saag K. G., Adachi J. D. et al. Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res. 2012; 27 (3): 645–653. DOI: 10.1002/jbmr.1476
10. Dede A. D., Tournis S., Dontas I., Trovas G. Type 2 diabetes mellitus and fracture risk. Metabolism. 2014 Dec; 63 (12): 1480–90. DOI: 10.1016/j.metabol.2014.09.002
11. National Osteoporosis Foundation (NOF) and International Society for Clinical Densitometry (ISCD). Recommendations to DXA Manufacturers for FRAX® Implementation Guide.
12. International Society for Clinical Densitometry. 2023 SCD Positions Adult/ https://iscd.org/wp-content/uploads/2024/03/2023-ISCD-Adult-Positions.pdf The link is active on 19. 11. 2024
13. Pepe J., Body J. J., Hadji P. et al. Osteoporosis in Premenopausal Women : A Clinical Narrative Review by the ECTS and the IOF.J Clin Endocrinol Metab. 2020 Aug 1; 105 (8): dgaa306. DOI: 10.1210/clinem/dgaa306
14. Bauer D. C., Black D. M., Bouxsein M. L. et al. Foundation for the National Institutes of Health (FNIH) Bone Quality Project. Treatment-Related Changes in Bone Turnover and Fracture Risk Reduction in Clinical Trials of Anti-Resorptive Drugs: A Meta-Regression. J. Bone Miner Res. 2018 Apr; 33 (4): 634–642. DOI: 10.1002/jbmr.3355
15. Diez-Perez A., Adachi J. D., Agnusdei D. et al. IOF CSA Inadequate Responders Working Group. Treatment failure in osteoporosis. Osteoporos Int. 2012 Dec; 23 (12): 2769–74. DOI: 10.1007/s00198-012-2093-8
16. Mazurov V. I., Lesnyak O. M., Belova K. Yu. et al. Algorithm for selection of drug for osteoporosis treatment in primary care and in organization of provision with medicinal products of citizens eligible for state social assistance. Review of the literature and position of Russian Association on Osteoporosis Expert Council. Profilakticheskaya medicina = The Russian Journal of Preventive Medicine. 2019; 22 (1): 57–65. (In Russ.). DOI: 10.17116/profmed20192201157
17. Belaya Zh. E., Bilezikian J. P., Ershova O. B. et al. Long-term treatment options for postmenopausal osteoporosis: results of recent clinical studies of Denosumab. Osteoporoz I osteopatii Osteoporosis and Bone Diseases. 2018; 21 (1): 17–22. (In Russ.). DOI: 10.14341/osteo9760
18. Gallagher J, Genant H, Crans G, Vargas S, Krege J. Teriparatide Reduces the Fracture Risk Associated with Increasing Number and Severity of Osteoporotic Fractures. The Journal of Clinical Endocrinology & Metabolism. 2005; 90 (3): 1583–1587. DOI: 10.1210/jc.2004-0826, 31, 176
19. Orwoll E, Scheele W, Paul S. et al. The effect of teriparatide [Human Parathyroid Hormone (1–34)] therapy on bone density in men with Osteoporosis. J. Bone. Miner. Res. 2003; 18 (1): 9–17. DOI: 10.1359/jbmr.2003.18.1.9
20. Saag K, Shane E, Boonen S. et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl. J. Med. 2007; 357 (20): 2028–39. DOI: 10.1056/NEJMoa071408
21. European Medicines Agency: Protelos/Osseor (strontium ranelate) to remain available but with further restrictions 15 April 2014 EMA 235924/2014. J. Rheumatology. 2005; 32: 1556–1562.
22. Nikitinskaya O. A., Toroptsova N. V. The social program «Osteoscreening, Russia» is in action. Pharmateka. 2012; (6): 90–93. (In Russ.).
23. Suplotova L. A., Avdeeva V. A., Pigarova E. A. et al. The first Russian multicenter non-interventional registry study to study the incidence of vitamin D deficiency and insufficiency in Russian Federation. Terapevticheskii arkhiv. 2021; 93 (10): 1209–1216. (In Russ.). DOI: 10.26442/00403660.2021.10.201071
24. Bahtiyarova S. A., Lesnyak O. M., Kuznecova N. L. et al. The prevalence of vitamin D deficiency in the elderly in Yekaterinburg. Rheumatology Science and Practice 2004; 42 (2): 219. (In Russ.).
25. Spasich T. A., Lemeshevskaya E. P., Reshetnik L. A. et al. Hygienic value of vitamin D deficiency in irkutsk region and ways of its prevention. Acta Biomedica Scientifica. 2014; (6): 44–47. (In Russ.).
26. Nikitinskaya O. A., Toroptsova N. V., Benevolenskaya L. I. The role of calcium and vitamin D in the prevention of osteoporosis and related fractures. Meditsinskiy sovet = Medical Council. 2007; (2): 56–60. (In Russ.).
27. Safonova Yu.A., Zotkin E. G., Glazunova G. M., Strukov E. L. Analysis of security by vitamin D of the elderly people. Advances in gerontology = Uspekhi gerontologii. 2018; 31 (2): 184–190. (In Russ.).
28. Narang N., Sharma J. Sublingval mucosa as a route for systemic drug delivery. Int. J. Pharm. Pharm. Sci. 2011; 3 (Suppl 2):18–22.
Review
For citations:
Toroptsova N.V., Dobrovolskaya O.V. Osteoporosis: how to diagnose and what treatment to prescribe. Medical alphabet. 2024;(29):40-45. (In Russ.) https://doi.org/10.33667/2078-5631-2024-29-40-45
Views:
153
Email this article 