Переломы различной локализации, возникшие при падении с высоты не выше собственного роста или спон-танно, у людей в возрасте 50 лет и старше в большом про-центе случаев ассоциированы с остеопорозом (ОП) -за-болеванием, характеризующимся снижением плотности и ухудшением качества кости. Современная стратегия терапии остеопороза основывается на постулате, что для получения более значимого результата от проводимого лечения необходимо его назначать тем пациентам, у кого ранее уже был перелом, особенно, если это перелом бедра ТЕЧЕНИЕ ОСТЕОПОРОЗА: СТРАТИФИКАЦИЯ РИСКА ПЕРЕЛОМОВ © О.А. Никитинская, Н.В. Торопцова ФГБНУ Научно-исследовательский институт ревматологии имени В.А. Насоновой, Москва, Россия Обоснование: Для выделения кандидатов для лечения остеопороза применяются два подхода: выявление лиц с низ-кой минеральной плотностью кости с помощью рентгеновской денситометрии аксиальных отделов скелета и опре-деление 10-летнего абсолютного риска переломов по алгоритму FRAX®. Цель: оценить диагностические возможности использования различных значений 10-летнего абсолютного риска ос-новных остеопоротических переломов по алгоритму FRAX® в качестве порогов терапевтического вмешательства для российской популяции. Методы: включены 224 женщины в постменопаузе, наблюдавшиеся в течение 10 лет, у которых ретроспективно был рассчитан риск переломов по FRAX® на момент первой консультации и проспективно собрана информация о произо-шедших малотравматичных переломах. Оценивались диагностические возможности российского и «европейского» возраст-зависимого порогов, фиксированного порога в 20%; среднего показателя FRAX® пациенток, у которых про-изошел малотравматичный перелом за время наблюдения (16%); значения FRAX®, соответствующего «оптимальной точке разделения» (12,5%). Результаты: Российская модель FRAX® показала среднюю клиническую значимость метода, площадь под ROC-кри-вой составила AUC=0,665±0,036 (95% ДИ 0,595; 0,736). «Европейский» порог терапевтического вмешательства проде-монстрировал 72% чувствительность и 38% специфичность; 20% порог -27% и 87%; российский порог -41% и 77%, 12,5% порог -68% и 58%; 16% порог -57% и 73%, соответственно. Диагностическая точность перечисленных порогов была 54%, 58%, 60%, 63% и 65%, соответственно. Заключение: на сегодняшний день российский возраст-зависимый порог остается оптимальным способом для при-нятия решения о инициировании противоостеопоротической терапии на основании оценки 10-летнего абсолютного риска перелома по FRAX®.КЛЮЧЕВЫЕ СЛОВА: Риск перелома; остеопороз; порог терапевтического вмешательства; FRAX PROGRESS OF OSTEOPOROSIS: STRATIFICATION OF FRACTURE RISK© Oksana A. Nikitinskaya, Natalya V. ToroptsovaResearch Institute of Rheumatogy named after V.A. Nasonova, Moscow, Russia Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX®. Aims: to assess the diagnosti...
Aim. To evaluate the frequency of different body composition phenotypes, physical performance (PP) and their relationship with quality of life in women with rheumatoid arthritis (RA). Materials and methods. The study included 157 women (average age 58.68.8 years) with RA. Clinical and laboratory examination, dual-energy X-ray absorptiometry, quality of life assessment according to the questionnaires EQ-5D (European Quality of Life Questionnaire), HADS (Hospital Anxiety and Depression Scale) and RAID (Rheumatoid Arthritis Impact of Disease), determination of muscle strength and the PP of skeletal muscles were carried out. Results. Osteoporotic, sarcopenic and osteosarcopenic phenotypes of body composition were identified in 27 (17%), 16 (10%) and 16 (10%) patients, respectively; 139 (88.5%) people had low muscle strength, and 96 (61.1%) had reduced PP. Quality of life according to the EQ-5D index and RAID, the severity of depression according to HADS in women with different phenotypes of body composition did not differ. Women with osteosarcopenic phenotype had worse indicators for EQ-5D-VAS (VAS visual analog scale), and patients with sarcopenic phenotype had more severe anxiety according to the HADS questionnaire compared to those with normal phenotype (p=0.014 and p=0.027, respectively). The quality of life according to all questionnaires was significantly worse in patients with reduced PP. Conclusion. Pathological phenotypes of body composition were found in 37% of RA patients. A decrease in muscle strength was revealed in 88.5%, and a low PP in 61.1% of patients. The relationship between quality of life and body composition has not been established, at the same time quality of life associated with the PP of skeletal muscles.
Aim – to evaluate the nutritional status and its relationship with the sarcopenic phenotype of body composition in women with rheumatoid arthritis (RA).Material and methods. The study included 91 women aged 40 to 75 years with RA according to ACR/EULAR criteria (2010) and a disease duration of at least 1 year. A questionnaire, laboratory and densitometric examination were conducted. Nutritional status was assessed using a MNA (Mini Nutricial Assessment) questionnaire.Results. Malnutrition and at risk of malnutrition according to the MNA were detected in 44.0% of patients with RA. These patients differed from those with normal nutritional status with a higher risk of osteoporotic hip fractures according to FRAX (p=0.035), lower appendicular muscle mass (AMM) (p=0.048) and lower self-assessment of health status (p=0.012). Patients significantly differed in nutritional status according to MNA, daily intake of calcium with food, circumferences of the mid-upper arm, calf, waist and hips, depending on the presence of sarcopenic phenotype. Multivariate regression analysis showed that the sarcopenic phenotype was associated with a nutritional status according to MNA less than 24 points (odds ratio (OR) – 6.14; p=0.036), daily calcium intake less than 500 mg (OR=9.55; p=0.007) and mid-upper arm circumference less than 25 cm (OR=9.32; p=0.015).Conclusion. Malnutrition was found in almost half of the patients with RA. It was revealed that a low nutritional status according to the MNA, low calcium intake and mid-upper arm circumference less than 25 cm increased the risk of having a sarcopenic phenotype in women with RA.
Objective: to evaluate physical activity (PA) and its relationship with body composition in patients with rheumatoid arthritis (RA).Patients and methods. The study included 93 women with RA. A standardized questionnaire survey, anthropometric measurements, laboratory work up, and dual-energy x-ray absorptiometry were conducted to assess body composition and bone mineral density. The level of PA was determined using the International Physical Activity Questionnaire (IPAQ).Results and discussion. The IPAQ survey showed that 46 (49.5%), 41 (44.1%) and 6 (6.4%) patients had high, moderate and low levels of PA, respectively. The patients did not differ in clinical and anamnestic, laboratory and instrumental data depending on the level of PA. Correlations were found between total energy expenditure by IPAQ and daily food calcium intake (r=0.26, p=0.012), shoulder circumference (r=0.22, p=0.042) and postmenopausal duration (r=-0.27, p=0.016). The relationship between the sarcopenic phenotype (SP) and the time of vigorous physical activity less than 15 minutes per day was revealed (odds ratio, OR 6.31; 95% confidence interval, CI 1.75–22.71; p=0.004), between the frequency of moderate physical exercise and walking less than 4 times a week (OR 4.09; 95% CI 1.16–14.47; p=0.027 and OR 4.73; 95% CI 1.24–18.07; p=0.021, respectively), the presence of osteoporosis – OD (OR 9.41; 95% CI 2.73–32.47; p <0.001). The risk of obesity increased with vigorous exercise less than 15 minutes per day (OR 3.03; 95% CI 1.11–8.29; p=0.029). The osteoporotic phenotype (OPP) was associated with patient age (OR 1.12; 95% CI 1.05–1.19; p=0.001) and the presence of SP (OR 8.97; 95% CI 2.39– 33.60; p=0.001).Conclusion. Half of the patients had moderate and low level of PA, independent of age, RA duration and activity. SP was associated with insufficient PA and the presence of OPP. Obesity is also associated with lack of PA, while OPP is associated with age and the presence of SP.
Osteoporosis (OP) occupies one of the leading places in the structure of morbidity in people over 50 years of age, and its social significance is associated with the main complications – low-energy fractures of the vertebral bodies and bones of the peripheral skeleton, which lead to an increase in disability and mortality among the elderly, being a serious problem for public health. One of the doctor’s goals is the timely administration of anti-osteoporotic treatment. Bisphosphonates (BP) are first-line drugs for the treatment of OP. Since 1995, nitrogen-containing BPs have been widely used, they demonstrate their effect primarily by inhibiting the activity of osteoclasts and stimulating their apoptosis. The efficacy and safety of this class of drugs have been confirmed by numerous studies and many years of clinical practice. Since 2005, the production of generics of alendronic acid began, and later, after the patent protection of other BFs was closed, generics of risedronic, ibandronic and zoledronic acids appeared. In 2019, two domestic generics were registered – ibandronic acid 3 mg for intravenous (IV) injection once every 3 months (Rezoviva) and zoledronic acid 5 mg in 100 ml solution for IV injection once a year (Osteostatics). Since 2020 they have been introduced into clinical practice as part of import substitution, which increased the availability of these drugs and reduced the health care costs.
Patients with rheumatic diseases (RD) are at high risk of osteoporosis (OP) and osteoporotic fractures. The Trabecular bone score (TBS) is a relatively novel method of assessing bone quality, which independently predicts fracture risk regardless of bone mineral density (BMD). A lower TBS in patients with RD compared to controls is shown in most studies concerning TBS and RD. The data obtained indicate that TBS predicts fractures better in RD, especially in patients receiving glucocorticoids, than BMD or the FRAX algorithm. TBS degradation has been associated with disease activity in ankylosing spondylitis, systemic sclerosis, and rheumatoid arthritis in a few studies. However, there is little data in the literature on the effect of rheumatic disease therapy and OP treatment in patients with RD on predictive ability of TBS for incident fracture.
The aim – to determine the possibility of identifying individuals with osteoporosis using asynchronous computed quantitative tomography (CT) of the proximal femur by comparison with dual-energy X-ray absorptiometry (DХA).Materials and methods. The study included 40 postmenopausal women and 6 men over 50 years old (Me of age – 72.5 [65.3; 77.7] years) referred by the attending physician for densitometric examination. The patients signed an informed consent. The measurements were performed on a DXA with a narrow fan beam (Lunar Prodigy Advance, GE Healthcare, USA), and QCT on the Aquilion 64 (Canon Medical Systems, Japan). Correlation analysis and comparison of projected bone mineral density (BMD), bone mineral content (BMC), measurement area and T-score using the Blend – Altman method were carried out.Results. A statistically significant correlations were revealed between the indicators of DXA and asynchronous QCT: for femoral neck BMD r=0.93; for the T-score r=0.93; for the total hip – r=0.91 and r=0.91 respectively. When conducting the analysis using the Blend – Altman method, it was found that the QCT underestimated the value of the femoral neck BMC (bias –0.923 g), covered a smaller area of interest (bias 0.376 cm2 ), and therefore there was a shift in the values of BMD by –0.224 g/cm2 . The value of the T-score for the femoral neck had bias –0.29 standard deviations (SD), and for the total hip –0.72 SD, which were statistically significant.Conclusions. There was a high correlation between quantitative indicators of bone tissue of the proximal hip, assessed using QCT and DXA. The BMD and T-score values for the femoral neck and the total hip at QCT were lower compared to the values of the DXA results. Considering the conducted research, it is recommended that when introducing asynchronous QCT into clinical practice to identify people with osteoporosis, a synchronous phantom should be pre-scanned to compare the QCT and DXA results, followed by adjusting the BMD and T-score values for QCT by the average difference between them.
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.
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