Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Introduction: The most common form of osteoarthritis (OA) is osteoarthritis of the knee. Conservative treatment of OA is effective only in stages I and II of the disease. Meanwhile, increasing incidence of knee osteoarthritis and lowering ages of the disease onset makes high tibial osteotomy (HTO) more and more vital, allowing to extend the function of the own knee joint and to postpone or completely avoid total knee replacement (TKR). The aim of the study was to assess the effectiveness of НTO at 2-3 stages of knee osteoarthritis and to investigate the influence of age, body mass index (BMI) and correction angle on the nearest result of the operation. Materials and methods: during the period from 2003 to 2016, 35 HTOs were performed in 32 patients. The ratio of men to women was 2:1. The mean age was 59.0±13.1 years, a BMI of 29.04±3.57kg/m² and a correction angle of 12.5±2.78°. A visual analogue scale (VAS) was used to assess the pain severity. The Knee Society Score (KSS) was applied to assess the functional and objective state of the knee joint. The stage of the degenerative process was evaluated according to the X-ray classification of Kellgren-Lawrence. Results: The HTO was effective in patients with both 2nd and 3rd stages of knee osteoarthritis. One year after the operation, a significant reduction in VAS scores (from 72.27±11.79 mm to 7.72±6.62mm) and an improvement in functional and objective KSS scores (from 43.66±11.5mm and 54, 39±11.77mm to 86.51±10.86mm and 81.93±6.65mm) were observed. We obtained the following results of the HTO: excellent (36.4%), good (57.6%) and satisfactory (6%). The X-ray signs of progression of the disease were not revealed one year after the operation. The connection of BMI with the nearest result of the operation was revealed. (Spearman coefficient=-0.34 at p <0.05). Conclusion: HTO is more effective at the 2-nd stage of osteoarthritis of the knee compared with the third stage. Age and angle of correction do not affect the nearest result, while increased values of body mass index are associated with worse result and complications.

Acromegaly is a chronic endocrine disease characterized by excessive secretion of growth hormone (GH), which, in turn, leads to increased insulin-like growth factor 1 (IGF-1) secretion by the liver. GH and IGF-1 excess leads to excessive cell and tissue growth, including the osteoarticular apparatus. Joint pain in acromegaly is a frequent and early symptom. In some cases, joint manifestations can be one of the first signs of acromegaly and their intensity increases with duration of the active disease. Estimated prevalence of joint damage signs is around 70% of patients at the time of diagnosis of acromegaly. Musculoskeletal system alterations can manifest either in axial skeleton and peripheral joints. Besides arthropathy, patients with acromegaly (both active and controlled) are more prone to vertebral fractures, although it was previously thought that acromegaly has a low risk of osteoporosis. In this article, we review features of damage to the axial skeleton, peripheral joints in the setting of excessive GH and IGF-1 production, as well as the association of autoimmune rheumatic diseases and acromegaly.

Obesity consistently associated with the development of a number of chronic diseases, leading to a decrease in quality of life, disability and death. The article examines the connection between obesity and disease of the musculoskeletal system, describes the mechanisms by means of which obesity leads to the development of osteoarthritis. It is evident that reduction of body mass can slow the progression of osteoporosis. The own experience of non-pharmacological and pharmacological treatment of obesity with the use of orlistat in 50 obese patients with osteoarthritis of the knee II–III stage is presented. Treatment has resulted in a decrease in body weight, waist circumference, accompanied by a decrease in symptoms osteoarthritis among all the patients. Our results showed that the addition of orlistat to standard osteoarthritis scheme leads to significant reduction in weight and reduction of clinical manifestations of osteoarthritis. According to the above, the drugs that have impact on weight loss, should be included in the treatment regimen of patients with osteoarthritis and obesity.