Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis [Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза]

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). Copyright © 2017 by the MediaSphere

Authors
Belaya Z.E.1 , Mel'nichenko G.A.1 , Rozhinskaya L.Ya.1 , Toroptsova N.V.2 , Alekseeva L.I.2 , Biryukova E.V.3 , Grebennikova T.A.1 , Dzeranova L.K.1 , Dreval A.V.4 , Zagorodniy N.V. 5, 6 , Il'yin A.V.1 , Kryukova I.V.4 , Lesnyak O.M.7 , Mamedova E.O.1 , Nikitinskaya O.A.2 , Pigarova E.A.1 , Rodionova S.S.5 , Skripnikova I.A.8 , Tarbaeva N.V.1 , Farba L.Ya.9 , Tsoriev T.T.1 , Chernova T.O.1 , Yureneva S.V.10 , Yakushevskaya O.V.10 , Dedov I.I.1
Number of issue
6
Language
Russian
Pages
392-426
Status
Published
Volume
63
Year
2018
Organizations
  • 1 Endocrinology Research Center, Moscow, Russian Federation
  • 2 Research Institute of Rheumatology n.a. V.A. Nasonova, Moscow, Russian Federation
  • 3 Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov, Moscow, Russian Federation
  • 4 Moscows Regional Research Clinical Institute n.a. M.F. Vladimirskiy, Moscow, Russian Federation
  • 5 Central Research Institute of Traumatology and Orthopedics n.a. N.N. Priorov, Moscow, Russian Federation
  • 6 Peoples' Friendship University of Russia, Moscow, Russian Federation
  • 7 North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russian Federation
  • 8 National Research Center for Preventive Medicine, Moscow, Russian Federation
  • 9 Municipal Clinical Hospital No 13, Moscow, Russian Federation
  • 10 Research Center for Obstetrics, Gynecology, and Perinatology, Moscow, Russian Federation
Keywords
Fragility fracture; Minimal trauma; Osteoporosis; Severe osteoporosis
Date of creation
06.07.2022
Date of change
06.07.2022
Short link
https://repository.rudn.ru/en/records/article/record/83498/
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