Национальный медицинский исследовательский центр эндокринологии, Москва, Россия В настоящей статье представлен обзор литературы, посвященный особенностям клинического течения различных форм гипофизита, а также проблемам лучевой диагностики и лечения данной патологии. Гипофизит является малоизученным и многофакторным заболеванием, сложность диагностики которого обусловлена не только разнообразными неспецифическими клиническими проявлениями, данными гормонального исследования, но и неоднозначными результатами МРТ-исследования, отсутствием четких МР-паттернов. Данный обзор посвящен современным представлениям о клиническом течении гипофизитов, представлен набор характерных диагностических признаков заболевания по данным МРТ, также освещены рекомендуемые на сегодняшний день алгоритмы лечения. В статье обобщены данные зарубежной литературы и собственные клинические наблюдения с целью выработать оптимальный протокол МРТ-исследования у пациентов с подозрением на гипофизит, рекомендации для врачей-рентгенологов и эндокринологов для правильной интерпретации полученных результатов. Уникальностью данного обзора является отсутствие на сегодняшний день в российской литературе данных о клинической картине, диагностике и лечении гипофизита.

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.Screening to identify groups with a high probability of fracture is recommended using the FRAX® Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX® (B2).It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).

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Osteosarcopenia was identified as a separate syndrome in 2009, and is defined as a combination of sarcopenia and osteopenia/osteoporosis. Osteosarcopenia develops mainly in old age, leads to a decrease in quality of life, an increased risk of falls and low-traumatic fractures. Patients with osteosarcopenia have worse indicators of physical functions, compared with people suffering from only one of the components of the syndrome. An important role in the osteosarcopenia prevention is played by the lifestyle of patients, Adherence to diet with the consumption of adequate amount of protein, physical activity and preventive prescription of calcium and vitamin D are important for osteosarcopenia prevention. The article summarizes data on the prevalence, pathogenesis and risk factors of osteosarcopenia, provides diagnostic criteria for the disease and discusses therapeutic approaches.

Osteogenesis imperfecta (OI) is a monogenic disorder characterized by increased bone fragility and several extraskeletal manifestations. In most cases, OI is caused by mutations in one of the two genes encoding alpha chains of type I collagen, COL1A1 or COL1A2. Mutations in at least 20 other genes can also lead to OI. Clinical manifestation of the disease ranges from mild to severe form with possible perinatal lethality. The disease may significantly reduce patient’s quality of life, which requires timely and optimal treatment and a multidisciplinary approach. Currently, the therapeutic treatment of osteogenesis imperfecta is symptomatic, but the search for new treatment strategies aimed at preventing the risk of new fractures and the progression of bone deformity continues. Key words: аnabolic therapy, antiresorptive therapy, сollagen, osteogenesis imperfecta, fracture