endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2024-5-1-09endofocus-8Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWДиагностика и лечение остеопороза: смена парадигмыDiagnosis and treatment of osteoporosis: a paradigm shifthttps://orcid.org/0000-0002-3656-0312ЛобановаК. Г.LobanovaK. G.

Лобанова Кристина Геннадьевна   –   ассистент кафедры эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Kristina G. Lobanova –   Can. Sci. (Med.), assistant of the department of endocrinology medical faculty

Moscow

miss.sapog@mail.ruhttps://orcid.org/0000-0001-5512-6899УшановаФ. О.UshanovaF. O.

Ушанова Фатима Омариевна   –   к.  м.  н., доцент кафедры эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Fatima  O. Ushanova–  Can. Sci. (Med.), associate professor of the department of endocrinology medical faculty

Moscow

fati_2526@mail.ruРоссийский национальный исследовательский медицинский университет имени Н. И. ПироговаPirogov Russian National Research Medical University202407052024516573Copyright © Лобанова К.Г., Ушанова Ф.О., 20242024Лобанова К.Г., Ушанова Ф.О.Lobanova K.G., Ushanova F.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/8

Основным клиническим проявлением остеопороза (ОП) является низкоэнергетичный перелом. Перелом, в свою очередь, ассоциирован с высоким риском инвалидизации и летальности. В связи с этим целью лечения  ОП является снижение риска развития переломов. Именно поэтому эксперты из  Великобритании в 2019 г. разработали и внедрили в практику систему  стратификации риска переломов, на основании которой принимается решение о лечении пациентов с ОП. Так, пациентам с очень высоким риском переломов  необходимо безотлагательное назначение анаболической терапии с последующим назначением антирезорбтивных препаратов. Пациентам с высоким риском  –    назначение антирезорбтивной терапии, а при ее неэффективности  –    назначение анаболической терапии. Пациентам с низким и  промежуточным риском рекомендовано динамическое наблюдение с постоянной переоценкой риска развития переломов. Это заключение полностью изменяет существующую парадигму лечения ОП.

The main clinical manifestation of osteoporosis is a low-energy fracture.  Fracture is associated with a high risk of disability and  mortality. Therefore, the aim of osteoporosis treatment is to reduce  the risk of fractures. Therefore, experts from the UK in  2019 developed and put into practice a fracture risk stratification  system, on the basis of which a decision is made  on the treatment of patients with osteoporosis. So patients with  a very high risk of fractures need to prescribe anabolic  therapy, followed by the appointment of antiresorptive drugs. Patients at  high risk –    the appointment of antiresorptive therapy, and if  it is ineffective, the appointment of anabolic therapy. Patients with low and intermediate risk are recommended dynamic monitoring with constant reassessment of the risk of fractures. This conclusion completely changes  the existing paradigm of osteoporosis treatment.

остеопорозбисфосфонатыденосумабтерипаратидантирезорбтивная терапияанаболическая терапиястратификация риска переломовosteoporosisbisphosphonatesdenosumabteriparatideantiresorptive therapyanabolic therapyfracture risk stratificationReferencesМельниченко Г. А., Белая Ж. Е., Рожинская Л. Я. и соавт. Проект федеральных клинических рекомендаций по диагностике, лечению и профилактике остеопороза. от 21.04.2021 г. М., 2021 г., 82 с.Мельниченко Г. А., Белая Ж. Е., Рожинская Л. Я. и соавт. Проект федеральных клинических рекомендаций по диагностике, лечению и профилактике остеопороза. от 21.04.2021 г. М., 2021 г., 82 с.Белова К. Ю., Бублик Е. В., Гладкова Е. Н. и соавт. Первые результаты работы регистра пациентов с остеопорозом, включенных в службы профилактики повторных переломов. Российский журнал гериатрической медицины. 2021;(2):211–218. https://doi.org/10.37586/2686–8636–2–2021–201–208.Белова К. Ю., Бублик Е. В., Гладкова Е. Н. и соавт. Первые результаты работы регистра пациентов с остеопорозом, включенных в службы профилактики повторных переломов. Российский журнал гериатрической медицины. 2021;(2):211–218. https://doi.org/10.37586/2686–8636–2–2021–201–208.Kanis JA, Johansson H, Harvey NC, et al. A brief history of FRAX. Arch Osteoporos. 2018 Oct 31;13(1):118. doi: 10.1007/s11657-018-0510-0.Kanis JA, Johansson H, Harvey NC, et al. A brief history of FRAX. Arch Osteoporos. 2018 Oct 31;13(1):118. doi: 10.1007/s11657-018-0510-0.Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1059–64. doi: 10.1093/gerona/61.10.1059.Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1059–64. doi: 10.1093/gerona/61.10.1059.Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016 Sep 2;16(1):158. doi: 10.1186/s12877-016-0332-0.Dyer SM, Crotty M, Fairhall N, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016 Sep 2;16(1):158. doi: 10.1186/s12877-016-0332-0.Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, et al. Current Status of the Diagnosis and Management of Osteoporosis. Int J Mol Sci. 2022 Aug 21;23(16):9465. doi: 10.3390/ijms23169465.Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, et al. Current Status of the Diagnosis and Management of Osteoporosis. Int J Mol Sci. 2022 Aug 21;23(16):9465. doi: 10.3390/ijms23169465.Kenkre JS, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018 May;55(3):308–327. doi: 10.1177/0004563218759371.Kenkre JS, Bassett J. The bone remodelling cycle. Ann Clin Biochem. 2018 May;55(3):308–327. doi: 10.1177/0004563218759371.Fischer V, Haffner-Luntzer M. Interaction between bone and immune cells: Implications for postmenopausal osteoporosis. Semin Cell Dev Biol. 2022 Mar; 123:14–21. doi: 10.1016/j.semcdb.2021.05.014.Fischer V, Haffner-Luntzer M. Interaction between bone and immune cells: Implications for postmenopausal osteoporosis. Semin Cell Dev Biol. 2022 Mar; 123:14–21. doi: 10.1016/j.semcdb.2021.05.014.Мамедова Е.О., Гребенникова Т. А., Белая Ж. Е., Рожинская Л. Я. Антитела к склеростину как новая анаболическая терапия остеопороза. // Остеопороз и остеопатии. – 2018. – Т. 21. – No3. – С. 21–29. doi: https://doi.org/10.14341/osteo10127.Мамедова Е.О., Гребенникова Т. А., Белая Ж. Е., Рожинская Л. Я. Антитела к склеростину как новая анаболическая терапия остеопороза. // Остеопороз и остеопатии. – 2018. – Т. 21. – No3. – С. 21–29. doi: https://doi.org/10.14341/osteo10127.Langdahl B, Hofbauer LC, Ferrari S, et al. Romosozumab efficacy and safety in European patients enrolled in the FRAME trial. Osteoporos Int. 2022 Dec;33(12):2527–2536. doi: 10.1007/s00198-022-06544-2.Langdahl B, Hofbauer LC, Ferrari S, et al. Romosozumab efficacy and safety in European patients enrolled in the FRAME trial. Osteoporos Int. 2022 Dec;33(12):2527–2536. doi: 10.1007/s00198-022-06544-2.Langdahl B. L., Libanati C., Crittenden D. B., et al. Romosozumab (Sclerostin Monoclonal Antibody) versus Teriparatide in Postmenopausal Women with Osteoporosis Transitioning from Oral Bisphosphonate Therapy: a Randomised, Open-Label, Phase 3 Trial. The Lancet, 2017, p. 1585–1594. doi:10.1016/s0140-6736(17)31613-6.Langdahl B. L., Libanati C., Crittenden D. B., et al. Romosozumab (Sclerostin Monoclonal Antibody) versus Teriparatide in Postmenopausal Women with Osteoporosis Transitioning from Oral Bisphosphonate Therapy: a Randomised, Open-Label, Phase 3 Trial. The Lancet, 2017, p. 1585–1594. doi:10.1016/s0140-6736(17)31613-6.Oliveira MA, Moraes R, Castanha EB, et al. Osteoporosis Screening: Applied Methods and Technological Trends. Med Eng Phys.2022Oct;108:103887. doi: 10.1016/j.medengphy.2022.103887.Oliveira MA, Moraes R, Castanha EB, et al. Osteoporosis Screening: Applied Methods and Technological Trends. Med Eng Phys.2022Oct;108:103887. doi: 10.1016/j.medengphy.2022.103887.Kanis JA, Harvey NC, Johansson H, et al. A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res. 2020 Feb;32(2):187–196. doi: 10.1007/s40520-019-01432-y.Kanis JA, Harvey NC, Johansson H, et al. A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res. 2020 Feb;32(2):187–196. doi: 10.1007/s40520-019-01432-y.Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos.2022 Apr 5;17(1):58. doi: 10.1007/s11657-022-01061-5.Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos.2022 Apr 5;17(1):58. doi: 10.1007/s11657-022-01061-5.Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int.2011 Mar; 22(3):809–16. doi: 10.1007/s00198-010-1524-7.Kanis JA, Johansson H, Oden A, et al. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int.2011 Mar; 22(3):809–16. doi: 10.1007/s00198-010-1524-7.Leslie WD, Johansson H, McCloskey EV, et al. Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry. J Bone Miner Res. 2018 Nov;33(11):1923–1930. doi: 10.1002/jbmr.3538.Leslie WD, Johansson H, McCloskey EV, et al. Comparison of Methods for Improving Fracture Risk Assessment in Diabetes: The Manitoba BMD Registry. J Bone Miner Res. 2018 Nov;33(11):1923–1930. doi: 10.1002/jbmr.3538.Sobh MM, Abdalbary M, Elnagar S, et al. Secondary Osteoporosis and Metabolic Bone Diseases. J Clin Med. 2022 Apr 24;11(9):2382. doi: 10.3390/jcm11092382.Sobh MM, Abdalbary M, Elnagar S, et al. Secondary Osteoporosis and Metabolic Bone Diseases. J Clin Med. 2022 Apr 24;11(9):2382. doi: 10.3390/jcm11092382.LeBoff MS, Greenspan SL, Insogna KL, et all. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049–2102. doi: 10.1007/s00198-021-05900-y.LeBoff MS, Greenspan SL, Insogna KL, et all. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049–2102. doi: 10.1007/s00198-021-05900-y.Nishizawa Y, Miura M, Ichimura S, et al. Executive summary of the Japan Osteoporosis Society Guide for the Use of Bone Turnover Markers in the Diagnosis and Treatment of Osteoporosis (2018 Edition). Clin Chim Acta. 2019 Nov; 498:101–107. doi: 10.1016/j.cca.2019.08.012.Nishizawa Y, Miura M, Ichimura S, et al. Executive summary of the Japan Osteoporosis Society Guide for the Use of Bone Turnover Markers in the Diagnosis and Treatment of Osteoporosis (2018 Edition). Clin Chim Acta. 2019 Nov; 498:101–107. doi: 10.1016/j.cca.2019.08.012.Tian, A., Ma, J., Feng, K. et al. Reference markers of bone turnover for prediction of fracture: a meta-analysis. J Orthop Surg Res 14, 68 (2019). https://doi.org/10.1186/s13018–019–1100–6.Tian, A., Ma, J., Feng, K. et al. Reference markers of bone turnover for prediction of fracture: a meta-analysis. J Orthop Surg Res 14, 68 (2019). https://doi.org/10.1186/s13018–019–1100–6.Kanis JA, Harvey NC, McCloskey E, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020;31:1–12. doi: 10.1007/s00198-019-05176-3Kanis JA, Harvey NC, McCloskey E, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020;31:1–12. doi: 10.1007/s00198-019-05176-3Kendler D., Marin F., Zerbini C., et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018; 391:230–240. doi: 10.1016/S0140-6736(17)32137-2Kendler D., Marin F., Zerbini C., et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018; 391:230–240. doi: 10.1016/S0140-6736(17)32137-2Saag KG, Petersen J, Brandi ML, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377:1417–1427. doi: 10.1056/NEJMoa1708322Saag KG, Petersen J, Brandi ML, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377:1417–1427. doi: 10.1056/NEJMoa1708322Curtis EM, Reginster JY, Al-Daghri N, et al. Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clin Exp Res. 2022 Apr;34(4):695–714. doi: 10.1007/s40520-022-02100-4.Curtis EM, Reginster JY, Al-Daghri N, et al. Management of patients at very high risk of osteoporotic fractures through sequential treatments. Aging Clin Exp Res. 2022 Apr;34(4):695–714. doi: 10.1007/s40520-022-02100-4.Kanis JA, Harvey NC, McCloskey E, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020;31:1–12. doi: 10.1007/s00198-019-05176-3.Kanis JA, Harvey NC, McCloskey E, et al. Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2020;31:1–12. doi: 10.1007/s00198-019-05176-3.Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30:3–44. doi: 10.1007/s00198-018-4704-5.Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30:3–44. doi: 10.1007/s00198-018-4704-5.Kanis JA, Cooper C, Rizzoli R et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2017; 28:2023–2034. doi: 10.1007/s00198-017-4009-0Kanis JA, Cooper C, Rizzoli R et al. Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int. 2017; 28:2023–2034. doi: 10.1007/s00198-017-4009-0Мазуров В. И., Лесняк О. М., Белова К. Ю. и соавт. Алгоритмы выбора терапии остеопороза при оказании первичной медико-санитарной помощи и организации льготного лекарственного обеспечения отдельных категорий граждан, имеющих право на получение государственной социальной помощи. Системный обзор и резолюция. Профилактическая медицина. 2019; 22(1):57– 65. https://doi.org/10.17116/profmed20192201157Мазуров В. И., Лесняк О. М., Белова К. Ю. и соавт. Алгоритмы выбора терапии остеопороза при оказании первичной медико-санитарной помощи и организации льготного лекарственного обеспечения отдельных категорий граждан, имеющих право на получение государственной социальной помощи. Системный обзор и резолюция. Профилактическая медицина. 2019; 22(1):57– 65. https://doi.org/10.17116/profmed20192201157Lewiecki EM, Wright NC, Curtis JR, et al. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018 Mar;29(3):717–722. doi: 10.1007/s00198-017-4345-0.Lewiecki EM, Wright NC, Curtis JR, et al. Hip fracture trends in the United States, 2002 to 2015. Osteoporos Int. 2018 Mar;29(3):717–722. doi: 10.1007/s00198-017-4345-0.Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595–1622. doi: 10.1210/jc.2019-00221.Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595–1622. doi: 10.1210/jc.2019-00221.Barrionuevo P, Kapoor E, Asi N et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab. 2019; 104:1623–1630. doi: 10.1210/jc.2019-00192Barrionuevo P, Kapoor E, Asi N et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab. 2019; 104:1623–1630. doi: 10.1210/jc.2019-00192Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1147–55. doi: 10.1016/S0140-6736(15)61120-5.Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1147–55. doi: 10.1016/S0140-6736(15)61120-5.Cosman F, Kendler DL, Langdahl BL, et al. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int. 2022 Jun;33(6):1243–1256. doi: 10.1007/s00198-021-06174-0.Cosman F, Kendler DL, Langdahl BL, et al. Romosozumab and antiresorptive treatment: the importance of treatment sequence. Osteoporos Int. 2022 Jun;33(6):1243–1256. doi: 10.1007/s00198-021-06174-0.Finkelstein JS, Leder BZ, Burnett SM, et al. Effects of teriparatide, alendronate, or both on bone turnover in osteoporotic men. J Clin Endocrinol Metab. 2006 Aug;91(8):2882–7. doi: 10.1210/jc.2006-0190.Finkelstein JS, Leder BZ, Burnett SM, et al. Effects of teriparatide, alendronate, or both on bone turnover in osteoporotic men. J Clin Endocrinol Metab. 2006 Aug;91(8):2882–7. doi: 10.1210/jc.2006-0190.Finkelstein JS, Wyland JJ, Lee H, et al. Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2010 Apr;95(4):1838–45. doi: 10.1210/jc.2009-1703.Finkelstein JS, Wyland JJ, Lee H, et al. Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2010 Apr;95(4):1838–45. doi: 10.1210/jc.2009-1703.Wein MN, Kronenberg HM. Regulation of Bone Remodeling by Parathyroid Hormone. Cold Spring Harb Perspect Med. 2018 Aug 1;8(8): a031237. doi: 10.1101/cshperspect.a031237.Wein MN, Kronenberg HM. Regulation of Bone Remodeling by Parathyroid Hormone. Cold Spring Harb Perspect Med. 2018 Aug 1;8(8): a031237. doi: 10.1101/cshperspect.a031237.Brent MB. Abaloparatide: A review of preclinical and clinical studies. Eur J Pharmacol. 2021 Oct 15;909:174409. doi: 10.1016/j.ejphar.2021.174409.Brent MB. Abaloparatide: A review of preclinical and clinical studies. Eur J Pharmacol. 2021 Oct 15;909:174409. doi: 10.1016/j.ejphar.2021.174409.

The authors declare that there are no conflicts of interest present.