medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-21-200-209medsovet-5985Research ArticleГИНЕКОЛОГИЯGYNECOLOGYОстеопороз у женщин в менопаузе/постменопаузе: что делать?Osteoporosis in women in menopause/postmenopause: what to do?https://orcid.org/0000-0001-8062-7775КульчавеняЕ. В.KulchavenyaE. V.

д.м.н., профессор, главный научный сотрудник, 630040, Новосибирск, Охотская улица, д. 81а;

профессор кафедры туберкулеза, 630099, Новосибирск, Красный проспект, д. 52;

630099, Новосибирск, проспект Дмитрова, д. 7

Dr. of Sci. (Med.), Professor, Leading Researcher, 81а, Okhotskaya St., Novosibirsk, 630040;

Professor of the Department of Tuberculosis, 52, Krasny Ave., Novosibirsk, 630099;

7, Dmitrov Ave., Novosibirsk, 630099

urotub@yandex.ruhttps://orcid.org/0000-0002-5435-2955ТрейвишЛ. С.TreyvishL. S.

к.м.н., заведующая поликлиническим акушерско-гинекологическим отделением, врач акушер-гинеколог высшей квалификационной категории, 

630099, Новосибирск, проспект Дмитрова, д. 7

Cand. of Sci. (Med.), Head of the Policlinic Obstetrics and Gynecology Department, obstetrician-gynecologist of the highest qualification category,

7, Dmitrov Ave., Novosibirsk, 630099

ms.lubov_tr@mail.ruhttps://orcid.org/0000-0001-7210-8764ПрокудинаВ. В.ProkudinaV. V.

акушер-гинеколог,

630099, Новосибирск, проспект Дмитрова, д. 7

Obstetrician-Gynecologist,

7, Dmitrov Ave., Novosibirsk, 630099

pvasilina_83@mail.ruНовосибирский научно-исследовательский институт туберкулеза; Новосибирский государственный медицинский университет; Медицинский центр «Авиценна»РоссияNovosibirsk Research Institute of Tuberculosis; Novosibirsk State Medical University; “Avicenna” Medical CenterRussian FederationМедицинский центр «Авиценна»Россия“Avicenna” Medical CenterRussian Federation202015012021021200209Copyright © Кульчавеня Е.В., Трейвиш Л.С., Прокудина В.В., 20212021Кульчавеня Е.В., Трейвиш Л.С., Прокудина В.В.Kulchavenya E.V., Treyvish L.S., Prokudina V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5985

Проведен аналитический обзор отечественной и зарубежной литературы по проблеме остеопороза, описаны принципы подхода к диагностике и лечению этого заболевания.

Вероятность перелома позвонка должна предполагаться, если в анамнезе имеется потеря роста на 4 см и более, появившийся кифоз у пациентов, получавших длительную терапию глюкокортикоидами, при минеральной плотности костной ткани (МПК) менее 2,5 балла.

В лечении больных остеопорозом на начальном этапе стараются ограничиться немедикаментозными мерами, советуя изменить образ жизни и диету, повысить поступление с пищей витамина D и кальция, оптимизировать физические нагрузки. Однако основное место в профилактике и лечении остеопороза у женщин в постменопаузе занимает медикаментозная терапия, с помощью которой риск переломов может быть снижен на 70%: бисфосфонаты, препараты, полученные из паратироидного гормона, деносумаб и селективные модуляторы рецептора эстрогена. Начинать терапию в большинстве случаев целесообразно с пероральных бисфосфонатов. Они являются мощными ингибиторами резорбции костей и действуют путем уменьшения активности остеокластов и увеличения их апоптоза. В 2020 г. закончился срок патентной защиты основных оригинальных бисфосфонатов и появились дженерики российского производства: Резовива (ибандроновая кислота 3 мг для внутривенного введения 1 раз в 3 мес.) и Остеостатикс (золедроновая кислота 5 мг 100 мл раствора для внутривенного капельного введения 1 раз в год). После 3–5 лет лечения бисфосфонатом лечение следует пересмотреть. Риск повторного перелома необходимо повторно оценить после возникновения травмы. Риск новых переломов увеличивается у пациентов, прекращающих лечение. Результаты исследований позволили рекомендовать ибандронат как препарат первой линии у женщин с постменопаузальным остеопорозом. Исследования по сравнению периодического внутривенного введения ибандроната с ежедневным пероральным лечением у женщин с постменопаузальным остеопорозом позволили рекомендовать внутривенное введение ибандроната в дозе 3 мг каждые 3 мес. как предпочтительную терапию. 

An analytical review of domestic and foreign literature on the problem of osteoporosis was performed, and the principles of the approach to diagnosis and treatment of this disease are described.

The probability of vertebral fracture should be assumed if there is a history of growth loss of 4 cm or more, the appearance of kyphosis in patients who received long-term therapy with glucocorticoids, with bone mineral density (BMD) less than 2.5 points In the treatment of patients with osteoporosis at the initial stage there is a tendency to limit oneself to non-drug measures, advising to change lifestyle and diet, to increase intake of vitamin D and calcium with food, to optimize physical activity. However, the main place in the prevention and treatment of osteoporosis in postmenopausal women is occupied by medication therapy, which can reduce the risk of fractures by 70%: bisphosphonates, drugs derived from parathyroid hormone, denosumab and selective estrogen receptor modulators. It is advisable to start therapy with oral bisphosphonates in most cases. They are powerful inhibitors of bone resorption and act by reducing the activity of osteoclasts and increasing their apoptosis. In 2020, the patent protection period of the main original bisphosphonates expired and generics of Russian production appeared: Rezoviva (ibandronic acid 3 mg for intravenous injection once every 3 months) and Osteostatix (zoledronic acid 5 mg 100 ml solution for intravenous drip once a year). After 3–5 years of bisphosphonate treatment, treatment should be reconsidered. The risk of recurrent fractures should be reassessed after the injury occurs. The risk of new fractures increases in patients who stop treatment. Study results have recommended ibandronate as a first-line drug in women with postmenopausal osteoporosis. Studies comparing intermittent intravenous ibandronate administration with daily oral treatment in women with postmenopausal osteoporosis allowed to recommend intravenous ibandronate at a dose of 3 mg every 3 months as the preferred therapy. 

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