Vitamin D is a fat-soluble secosteroid that plays a significant role in the whole body, including the maxillofacial region. The discovery of its receptors in many cells and organs made it possible to reveal the participation of vitamin D not only in the regulation of calcium phosphate metabolism, but also in immune processes, in providing anti-inflammatory and antimicrobial effects, slowing down cell proliferation and stimulating differentiation. In this literature review, we demonstrate the association between low vitamin D levels and the development of recurrent aphthous stomatitis, the course and response to treatment of squamous cell carcinoma of the oral cavity, the severity of periodontal diseases, and the processes of osseointegration and bone remodeling during dental implantation and guided tissue regeneration. The aim of our article was to demonstate a possible connection between vitamin D level and the oral diseases that can be presented at an oral surgery appointment, which will help clinicians to reduce the risk of early dental implant failure, ensure favorable outcomes of augmentative operations, as well as decrease the destructive effects of severe periodontitis and other conditions throug knowledge and timely lab tests and endocrinologist prescriptions.

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

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Glycemic control represents an integral part of diabetes mellitus (DM) therapy. It is not surprising that diabetes technology is evolving to not only create new routes of insulin administration, but also to improve the measurement of glycemia. A significant number of new glucose monitoring systems have been launched to the market over the past 10 years. Nevertheless, only 30% of patients with type 1 diabetes and very few patients with type 2 diabetes use continuous or flash glucose monitoring. The reason for this is not only the cost and technical difficulties of continuous glucose monitoring, but also its clinical appropriateness. There is indisputable evidence that patients who receive intensified insulin therapy, especially those with type 1 diabetes, need frequent self-monitoring / continuous glucose monitoring. As for patients with type 2 diabetes receiving basal insulin and / or other antihyperglycemic therapy, the data received seem to be contradictory and uncertain. However, most of the recommendations simmer down to the need for self-monitoring of blood glucose levels in patients with type 2 diabetes. The diabetes technology section of the American Diabetes Association guidelines 2021 goes into details about the role of self-monitoring of blood glucose in diabetes management, including the need for continuous patient education on the principles and rules of self-monitoring, interpretation and practical use of the results of self-monitoring, various standards of glucometers, factors affecting the accuracy of the results.

Elderly patients with diabetes type 2 represent complex and heterogeneous group with different diabetes complications and comorbidity, polypharmacy, functional and cognitive state. Each of those factors should be taken into account to choose the best glycemic targets as well as the most tailored treatment so that it is necessary for endocrinologist to perform geriatric assessment. The most favorable antidiabetic drugs for elderly are safe in terms of hypoglycemia and cardiovascular risks, can be used irrespective of kidney function, do not affect weight or bone mineral density, and are available in fixed combinations with other drugs. Dipeptidyl pepti-dase-4 (DPP-4) inhibitors meet all these requirements with low adverse events rate. Interdisciplinary approach, close interaction with patient and his relatives and considerations for both intensification and deprescribing are keys to successful treatment in this patient subgroup. Cardiovascular events are the most common cause of death and hypoglycemia is highly unfavorable in elderly because it can lead to falls, life-threatening arrhythmias, and cognitive impairment. So deprescribing in elderly with diabetes should be primarily aimed at minimizing of cardiovascular events and severe hypoglycemia risks. For this purpose, it is considered to the reject use of sulfonylureas, glinides, insulins in favor of safer ones (metformin, GLP-1 receptor agonists, SGLT-2 inhibitors, DPP-4 inhibitors).

Hyperparathyroidism is an endocrine disease characterized by excessive secretion of parathyroid hormone (PTH) by the parathyroid glands. Primary hyperparathyroidism (PHPT) can be diagnosed biochemically with the combination of hypercalcemia and upper-normal or elevated levels of PTH. There are few descriptions of PHPT with normal intact PTH secretion in the literature. The incidence of PHPT among patients with recurrent urolithiasis is 28%. We present a clinical case of diagnosing PHPT in a 64-year-old female patient with rare variant of the disease. Before establishing the diagnosis, the main patient complaints were long-term recurrent nephrolithiasis and nephrocalcinosis. Surgical treatment made it possible to achieve rapid normalization of biochemical parameters of calcium-phosphorus metabolism, increase bone mineral density in the lumbar spine, improve the general condition of the patient. This clinical case demonstrates errors and late diagnosis of PHPT associated with poor knowledge of the manifestations of hyperparathyroidism and its masks. The authors recommend to determine the concentrations of total calcium, albumin, serum levels of PTH in patients with clinical picture of PHPT, in order to exclude the disease.

Idiopathic hypercalciuria is a heterogeneous generalized disorder caused by various defects in calcium transport and increased urinary calcium excretion. The main etiopathogenetic factors are violations of vitamin D metabolism, changes in the sensitivity of calcitriol receptors and violations of the processes of calcium reabsorption in the proximal tubules and in the ascending knee of the Henle loop. This article presents a clinical observation of patient with idiopathic hypercalciuria, initially high levels of parathyroid hormone (PTH) in the absence of hyperparathyroidism. Therapy with thiazide diuretics allowed to achieve normalization of daily urinary calcium excretion and reducing PTH. Despite the low prevalence of idiopathic hypercalciuria, differential diagnosis of this metabolic disorder should be carried out with mandatory consideration of clinical and laboratory data, as well as with diseases that may cause increased PTH production.

Primary hyperparathyroidism (PHPT) is the third most common endocrine disease after diabetes mellitus and thyroid pathology. Recent epidemiological and experimental data have shown that long-term maintenance of low vitamin D levels in the blood can lead to the development of hyperplastic processes in the cells of the parathyroid glands, followed by autonomous production of parathyroid hormone. In PHPT vitamin D insufficiency or deficiency according to various sources occurs with a frequency of 5377% of cases. The literature review indicates more severe disease in patients with concomitant vitamin D deficiency. The expediency of preoperative assessment of vitamin D levels in all patients with PHPT in order to minimize the risk of hypocalcemia after parathyroidectomy is discussed. This article presents the relationship between vitamin D deficiency and PHPT, as well as possible methods for correcting vitamin D deficiency in PHPT. Molecular and cellular mechanisms of the occurrence of pathological processes in the parathyroid glands under conditions of low vitamin D levels are presented.