Переломы различной локализации, возникшие при падении с высоты не выше собственного роста или спон-танно, у людей в возрасте 50 лет и старше в большом про-центе случаев ассоциированы с остеопорозом (ОП) -за-болеванием, характеризующимся снижением плотности и ухудшением качества кости. Современная стратегия терапии остеопороза основывается на постулате, что для получения более значимого результата от проводимого лечения необходимо его назначать тем пациентам, у кого ранее уже был перелом, особенно, если это перелом бедра ТЕЧЕНИЕ ОСТЕОПОРОЗА: СТРАТИФИКАЦИЯ РИСКА ПЕРЕЛОМОВ © О.А. Никитинская, Н.В. Торопцова ФГБНУ Научно-исследовательский институт ревматологии имени В.А. Насоновой, Москва, Россия Обоснование: Для выделения кандидатов для лечения остеопороза применяются два подхода: выявление лиц с низ-кой минеральной плотностью кости с помощью рентгеновской денситометрии аксиальных отделов скелета и опре-деление 10-летнего абсолютного риска переломов по алгоритму FRAX®. Цель: оценить диагностические возможности использования различных значений 10-летнего абсолютного риска ос-новных остеопоротических переломов по алгоритму FRAX® в качестве порогов терапевтического вмешательства для российской популяции. Методы: включены 224 женщины в постменопаузе, наблюдавшиеся в течение 10 лет, у которых ретроспективно был рассчитан риск переломов по FRAX® на момент первой консультации и проспективно собрана информация о произо-шедших малотравматичных переломах. Оценивались диагностические возможности российского и «европейского» возраст-зависимого порогов, фиксированного порога в 20%; среднего показателя FRAX® пациенток, у которых про-изошел малотравматичный перелом за время наблюдения (16%); значения FRAX®, соответствующего «оптимальной точке разделения» (12,5%). Результаты: Российская модель FRAX® показала среднюю клиническую значимость метода, площадь под ROC-кри-вой составила AUC=0,665±0,036 (95% ДИ 0,595; 0,736). «Европейский» порог терапевтического вмешательства проде-монстрировал 72% чувствительность и 38% специфичность; 20% порог -27% и 87%; российский порог -41% и 77%, 12,5% порог -68% и 58%; 16% порог -57% и 73%, соответственно. Диагностическая точность перечисленных порогов была 54%, 58%, 60%, 63% и 65%, соответственно. Заключение: на сегодняшний день российский возраст-зависимый порог остается оптимальным способом для при-нятия решения о инициировании противоостеопоротической терапии на основании оценки 10-летнего абсолютного риска перелома по FRAX®.КЛЮЧЕВЫЕ СЛОВА: Риск перелома; остеопороз; порог терапевтического вмешательства; FRAX PROGRESS OF OSTEOPOROSIS: STRATIFICATION OF FRACTURE RISK© Oksana A. Nikitinskaya, Natalya V. ToroptsovaResearch Institute of Rheumatogy named after V.A. Nasonova, Moscow, Russia Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX®. Aims: to assess the diagnosti...

Aim – to identify the frequency of isolated and combined pathological phenotypes of body composition in women with rheumatic diseases and to determine the factors associated with the sarcopenic phenotype.Materials and methods. 255 women (median age 60 [54; 64] years) were included in the study: 114 patients with rheumatoid arthritis (RA), 46 – with systemic sclerosis (SSc), 56 – with osteoarthritis (OA), and 39 persons without rheumatic diseases (control). Questionnaires, anthropometric measurements, double-energy X-ray absorptiometry of the whole body, lumbar spine and proximal femur were performed. The assessment of the factors associated with the sarcopenic phenotype was carried out using a univariate regression analysis.Results. The frequency of isolated and combined pathological phenotypes in women with SSc was 34.8% and 52.2%, with RA – 51.8% and 38.6%, with OA – 71.4% and 10.7%, respectively. The sarcopenic phenotype was more often determined in patients with SSc (43.5%) and RA (29.8%) compared with women with OA (1.8%) (p<0.001). The factors associated with the sarcopenic phenotype were BMI><25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p><0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001). The factors associated with the sarcopenic phenotype were BMI<25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96];>˂ 25 kg/m2 (OR=7.89 [95% CI: 3.90–15.96]; p<0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p><0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004). Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI><25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 0.001), glucocorticoids (GC) intake (OR=2.50 [95% CI: 1.32–4.73]; p=0.005) and cumulative GC dose (OR=1.04 [95% CI: 1.01–1.07]; p=0.008), presence of osteoporosis (OP) (OR=4.31 [95% CI: 2.33–7.97]; p<0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).>˂ 0.001), leukocytosis more than 9.0×109 /l (OR=4.08 [95% CI: 1.38–12.10]; p=0.011), total protein less than 65 g/l (OR=1.11 [95% CI: 1.02–1.19]; p=0.019) and calcium intake less than 500 mg/day (OR=2.78 [95% CI: 1.39–5.53]; p=0.004).Conclusion. The study demonstrated a significant frequency of pathological phenotypes of body composition in women with rheumatic diseases, while combined phenotypes were more common in patients with SSc and RA compared with patients with OA. The probability of sarcopenic phenotype increased with BMI<25 kg/m2 , GC using, the presence of OP and insufficiency of calcium intake. Key words: rheumatic diseases, body composition phenotypes, sarcopenia, osteoporosis, osteosarcopenia, overfat, rheumatoid arthritis, systemic scleroderma, osteoarthritis, risk factors>˂ 25 kg/m2, GC using, the presence of OP and insufficiency of calcium intake.

ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия Проведен одномоментный скрининг случайных выборок мужчин в возрасте 50 лет и старше, проживавших в пяти городах (Архангельск, Мурманск, Тюмень, Красноярск, Челябинск) 3-х федеральных округов РФ, с целью оценки частоты встреча-емости отдельных факторов риска (ФР) остеопоротических переломов. В результате обследования 1330 мужчин установ-лено, что наиболее распространенными были следующие факторы: курение, низкоэнергетические переломы в анамнезе, вторичные причины ОП, недостаточное потребление кальция с продуктами питания. Мужчины в СФО и СЗФО курили чаще, чем лица из УФО (p=0,0011 и p=0,047, соответственно), распространенность других ФР по регионам не различалась. Осте-опороз по данным периферической рентгеновской денситометрии выявлялся чаще у жителей УФО (26%), чем у мужчин в СЗФО (17%) и СФО (19%). Более 50% мужчин в каждом регионе имели 2 и более ФР, при этом лиц с 3-мя и более ФР было достоверно больше в УФО, а в возрасте 50-59 лет -в СЗФО. 85 % мужчин в этих регионах не получали с продуктами пита-ния адекватного количества кальция.КЛЮЧЕВЫЕ СЛОВА: Остеопороз; факторы риска переломов; потребление кальция с пищей; периферическая рентгенов-ская денситометрия; Cross-sectional screening of random samples of men aged 50 years and older living in five cities (Arkhangelsk, Murmansk, Tyumen, Krasnoyarsk, and Chelyabinsk) from three Federal Districts (FD) of the Russian Federation was conducted to evaluate the frequency of individual risk factors (RF) of osteoporotic fractures among them. Total 1330 men were included in the study. We found that the most common were the following RF: smoking, prior fragility fractures after age 40, secondary causes of OP, insufficient calcium intake. Significantly more smokers were among males in Siberian (S) FD and North -Western (NW)FD compared with those from Ural (U) FD (p=0,0011 and p=0,047, respectively), the frequency of other RF did not differ depending on region. The рprevalence of osteoporosis according to peripheral x-ray densitometry of the proximal forearm was higher among residents of the UFD (26%) than among men in the NWFD (17%) and SFO (19%). More than 50% of men in each region had 2 or more RF, while those with 3 or more RF were significantly more in the UFD at any age, and at the age of 50-59 years -in the NWFD. Calcium intake was inadequate in 85% of the respondents in these regions. OSTEOPOROSIS AND OSTEOPOROTIC FRACTURES RISK FACTORS IN MEN AGED 50 YEARS AND OLDER©

Aim. To evaluate the frequency of different body composition phenotypes, physical performance (PP) and their relationship with quality of life in women with rheumatoid arthritis (RA). Materials and methods. The study included 157 women (average age 58.68.8 years) with RA. Clinical and laboratory examination, dual-energy X-ray absorptiometry, quality of life assessment according to the questionnaires EQ-5D (European Quality of Life Questionnaire), HADS (Hospital Anxiety and Depression Scale) and RAID (Rheumatoid Arthritis Impact of Disease), determination of muscle strength and the PP of skeletal muscles were carried out. Results. Osteoporotic, sarcopenic and osteosarcopenic phenotypes of body composition were identified in 27 (17%), 16 (10%) and 16 (10%) patients, respectively; 139 (88.5%) people had low muscle strength, and 96 (61.1%) had reduced PP. Quality of life according to the EQ-5D index and RAID, the severity of depression according to HADS in women with different phenotypes of body composition did not differ. Women with osteosarcopenic phenotype had worse indicators for EQ-5D-VAS (VAS visual analog scale), and patients with sarcopenic phenotype had more severe anxiety according to the HADS questionnaire compared to those with normal phenotype (p=0.014 and p=0.027, respectively). The quality of life according to all questionnaires was significantly worse in patients with reduced PP. Conclusion. Pathological phenotypes of body composition were found in 37% of RA patients. A decrease in muscle strength was revealed in 88.5%, and a low PP in 61.1% of patients. The relationship between quality of life and body composition has not been established, at the same time quality of life associated with the PP of skeletal muscles.

Aim – to evaluate the nutritional status and its relationship with the sarcopenic phenotype of body composition in women with rheumatoid arthritis (RA).Material and methods. The study included 91 women aged 40 to 75 years with RA according to ACR/EULAR criteria (2010) and a disease duration of at least 1 year. A questionnaire, laboratory and densitometric examination were conducted. Nutritional status was assessed using a MNA (Mini Nutricial Assessment) questionnaire.Results. Malnutrition and at risk of malnutrition according to the MNA were detected in 44.0% of patients with RA. These patients differed from those with normal nutritional status with a higher risk of osteoporotic hip fractures according to FRAX (p=0.035), lower appendicular muscle mass (AMM) (p=0.048) and lower self-assessment of health status (p=0.012). Patients significantly differed in nutritional status according to MNA, daily intake of calcium with food, circumferences of the mid-upper arm, calf, waist and hips, depending on the presence of sarcopenic phenotype. Multivariate regression analysis showed that the sarcopenic phenotype was associated with a nutritional status according to MNA less than 24 points (odds ratio (OR) – 6.14; p=0.036), daily calcium intake less than 500 mg (OR=9.55; p=0.007) and mid-upper arm circumference less than 25 cm (OR=9.32; p=0.015).Conclusion. Malnutrition was found in almost half of the patients with RA. It was revealed that a low nutritional status according to the MNA, low calcium intake and mid-upper arm circumference less than 25 cm increased the risk of having a sarcopenic phenotype in women with RA.