Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Melnichenko G.A.; Belaia Zh.E.; Rozhinskaia L.Ia.; Toroptsova N.V.; Alekseeva L.I.; Biryukova E.V.; Grebennikova T.A.; Dzeranova L.K.; Dreval' A.V.; Zagorodniy N.V.; Il'in A.V.; Kriukova I.V.; Lesnyak O.M.; Mamedova E.O.; Nikitinskaya O.A.; Pigarova E.A.; Rodionova S.S.; Skripnikova I.A.; Tarbaeva N.V.; Farba L.Ya.; Tsoriev T.T.; Chernova T.O.; Yureneva S.V.; Yakushevskaya O.V.; Dedov I.I.

doi:https://doi.org/10.14341/probl2017636392-426

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Abstract:

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).

Keywords:

osteoporosis

fragility fracture

minimal trauma

severe osteoporosis

Authors:

Melnichenko G.A.

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia;
Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia

Belaia Zh.E.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr Minzdravsotsrazvitiia Rossiĭskoĭ Federatsii, Moskva

Rozhinskaia L.Ia.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Toroptsova N.V.

Research Institute of Rheumatology n.a. V.A. Nasonova, Moscow, Russia

Alekseeva L.I.

Research Institute of Rheumatology n.a. V.A. Nasonova, Moscow, Russia

Biryukova E.V.

Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov, Moscow, Russia

Grebennikova T.A.

Endocrinology Research Center, Moscow, Russia

Dzeranova L.K.

ndokrinologicheskiĭ nauchnyĭ tsentr Minzdrava RF, Moskva

Dreval' A.V.

Moskovskiĭ oblastnoĭ nauchno-issledovatel'skiĭ klinicheskiĭ institut im. M.F. Vladimirskogo

Zagorodniy N.V.

Central Research Institute of Traumatology and Orthopedics n.a. N.N. Priorov, Moscow, Russia;
Peoples’ Friendship University of Russia, Moscow, Russia

SPIN RSCI: 6889-8166
ORCID: 0000-0002-6736-9772

Il'in A.V.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Kriukova I.V.

Moskovskiĭ oblastnoĭ nauchno-issledovatel'skiĭ klinicheskiĭ institut im. M.F. Vladimirskogo

Lesnyak O.M.

North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburg, Russia

Mamedova E.O.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF, Moskva

Nikitinskaya O.A.

Research Institute of Rheumatology n.a. V.A. Nasonova, Moscow, Russia

Pigarova E.A.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr Minzdravsotsrazvitiia RF, Moskva

Rodionova S.S.

Central Research Institute of Traumatology and Orthopedics n.a. N.N. Priorov, Moscow, Russia

Skripnikova I.A.

National Research Center for Preventive Medicine, Moscow, Russia

Tarbaeva N.V.

Endocrinology Research Center, Moscow, Russia

Farba L.Ya.

Municipal Clinical Hospital No 13, Moscow, Russia

Tsoriev T.T.

The National Research Center for Endocrinology, Moscow, Russia

Chernova T.O.

FGBU "ndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Yureneva S.V.

Acad. V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Yakushevskaya O.V.

Research Center for Obstetrics, Gynecology, and Perinatology, Moscow, Russia

Dedov I.I.

Endocrinology Research Centre

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