medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-7-122-128medsovet-5663Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYПероральные бисфосфонаты как терапия выбора у пациентов с умеренным риском переломовOral bisphosphonates as the therapy of choice in patients with moderate risk of fractureshttps://orcid.org/0000-0003-1886-124XМарченковаЛ. А.MarchenkovaL. A.

Марченкова Лариса Александровна, к.м.н., заведующая отделом соматической реабилитации, активного долголетия и репродуктивного здоровья

121099, Россия, Москва, ул. Новый Арбат, д. 32

Larisa A. Marchenkova, Cand. of Sci. (Med.), Head of Department of Somatic Rehabilitation, Active Longevity and Reproductive Health, Lead Researcher,

32, Novyy Arbat St., Moscow, 121099, Russia

MarchenkovaLA@nmicrk.ruhttps://orcid.org/0000-0003-3767-8475МакароваЕ. В.MakarovaE. V.

Макарова Екатерина Владимировна, научный сотрудник отдела соматической реабилитации, активного долголетия и репродуктивного здоровья

121099, Россия, Москва, ул. Новый Арбат, д. 32

Ekaterina V. Makarova, Researcher, Department of Somatic Rehabilitation, Active Longevity and Reproductive Health

32, Novyy Arbat St., Moscow, 121099, Russia

rue-royal@inbox.ruНациональный медицинский исследовательский центр реабилитации и курортологииРоссияNational Medical Research Center of Rehabilitation and BalneologyRussian Federation20202805202007122128Copyright © Марченкова Л.А., Макарова Е.В., 20202020Марченкова Л.А., Макарова Е.В.Marchenkova L.A., Makarova E.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5663

У специалиста, занимающегося остеопорозом (ОП), сегодня есть доступ к качественным диагностическим алгоритмам, позволяющим определить риск переломов и необходимость назначения лечения, а также возможность выбрать современную лекарственную терапию, которая будет наиболее подходящей, максимально комфортной и безопасной. Такой современный алгоритм выбора терапии ОП основан на оценке степени риска перелома пациента, который определяется наличием и тяжестью перенесенных низкоэнергетических переломов, уровнем минеральной плотности кости (МПК), а также 10-летней вероятностью переломов по калькулятору FRAX. Пациенты с умеренным риском остеопорозных переломов – наиболее спорная категория больных в отношении выбора и оценки прогноза лечения, поскольку они либо не имеют переломов в анамнезе, либо перенесли всего один низкоэнергетический перелом на фоне остеопении или нормальной МПК. В таких случаях в качестве стартовой терапии ОП рекомендуются пероральные бисфос- фонаты (БФ) с планируемой длительностью лечения 5 лет. Алендровая кислота – наиболее известный и назначаемый пероральный БФ, отличающийся финансовой доступностью и благоприятным профилем клинической эффективности при лечении ОП. Эффективность лечения пероральными БФ во многом определяется переносимостью препарата и приверженностью пациентов лечению. Нежелательные эффекты, особенно со стороны верхних отделов желудочно-кишечного тракта (ЖКТ) и отсутствие мотивации пациентов были признаны в качестве основных причин низкой приверженности терапии ОП. Благодаря низкой частоте развития нежелательных явлений и удобной для приема фармакологической форме, способствующим повышению комлаентности лечения, буферный раствор алендроната в растворимых шипучих таблетках может иметь предпочтения у больных с уме- ренным риском переломов. Солюбизированый в буферном растворе алендронат в значительно меньшей степени контактирует со слизистой пищевода и желудка, минимизируя контакт между частицами препарата и слизистой оболочкой верхних отделов ЖКТ и уменьшая в итоге местный раздражающий эффект и вероятность возникновения гастро-эзофагеального рефлюкса.

Nowadays clinicians have access to high-quality diagnostic algorithms to determine the risk of fractures and the need for treatment, as well as the ability to choose the most advanced drug therapy that will be the most suitable, comfortable and safe for the patient with osteoporosis. This algorithm for the selection of therapy is based on an assessment of the fracture risk, which is determined by the presence and severity of low-energy fractures, the level of bone mineral density (BMD), and the 10-year probability of fractures. Patients with a moderate risk of osteoporotic fractures are the most controversial category of patients regarding the choice and assessment of the prognosis of treatment, since they either have no history of fractures or have suffered only one low-energy fracture due to osteopenia or normal BMD. In such cases, oral bisphosphonates with a planned treatment duration of 5 years were recommended as starting therapy for osteoporosis. Alendronic acid is the most well-known and widely prescribed oral bisphosphonate, characterized by financial availability and a favorable profile of clinical efficacy in the treatment of osteoporosis. The effectiveness of treatment with oral bisphosphonates is largely determined by the tolerability of the drug and patient adherence to treatment. Gastrointestinal side effects and the lack of patient motivation are the main reasons for the low adherence to anti-osteoporotic therapy. Due to the low incidence of adverse events and the convenient pharmacological form for enhancing treatment compliance, alendronate buffer solution in soluble effervescent tablets may be preferred in patients with a moderate risk of fractures. Solubilized in a buffer solution alendronate less contacts the mucous membrane of the esophagus and stomach, minimizing contact between the particles of the drug and the mucous membrane of the upper gastrointestinal tract, and ultimately reducing the local irritating effect and the likelihood of gastroesophageal reflux.

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