The main approaches to the diagnosis and treatment of osteoporosis

Background. Osteoporosis is one of the most common diseases among the elderly, while it often remains undiagnosed, as it can occur without clinical symptoms, and fractures that occur with minor injury or spontaneous, doctors do not always correlate with its presence in the patient.

Results. The review presents epidemiological data indicating the urgency of the osteoporosis problem, as well as information on normative documents regulating the procedure for observation patients with osteoporosis. Modern approaches to the diagnosis of osteoporosis are considered, including the causes of secondary osteoporosis, which must be excluded in the case of newly diagnosed patients. Current criteria for the diagnosis of osteoporosis are given: the presence of a history of low-energy fractures after 40 years of age or on the background of a disease affecting bone, and/or a high risk of fractures calculated using the FRAX algorithm (Russian version), and/or low bone mineral density. The options for using diagnostic and therapeutic intervention thresholds based on the possibility of conducting a dual-energy X-ray absorptiometry for the patient are presented. The issues of diagnosis of osteoporosis in young people – fertile women and men under the age of 50 are considered. Indications for the use of markers of bone turnover are given, which are recommended to be used only to assess the effectiveness of treatment and adherence to therapy. The article presents modern aspects of anti-osteoporotic therapy, provides practical recommendations for the use of antiresorptive (bisphosphonates, denosumab), depending on the presence of osteoporosis and low-energy fractures, and also presents the first biosimilar of denosumab in Russia. The issues of prescribing an anabolic medication (teriparatide), as well as supplements of calcium and vitamin D (colecalciferol, alfacalcidol) were discussed. The duration of anti-osteoporotic therapy depending on the medication used and the criteria for its effectiveness, as well as the algorithm for drug replacement in case of its ineffectiveness are considered.

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