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Комплексный подход к терапии остеопороза в постменопаузальном периоде в контексте международных клинических рекомендаций
Комплексный подход к терапии остеопороза в постменопаузальном периоде в контексте международных клинических рекомендаций
Захаров И.С., Колпинский Г.И., Шаламанова Н.В. и др. Комплексный подход к терапии остеопороза в постменопаузальном периоде в контексте международных клинических рекомендаций. Consilium Medicum. 2019; 21 (6): 86–89. DOI: 10.26442/20751753.2019.6.190530
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Аннотация
В связи с морфофункциональными изменениями в организме женщины, возникающими в период постменопаузы, увеличивается риск остеопоротических переломов. Учитывая междисциплинарность проблемы остеопороза, важную роль играет комплексный подход к ведению пациенток с данной патологией, включающий взаимодействие различных специалистов (гинеколога, ревматолога, эндокринолога). В коррекции остеопоротических изменений необходимо придерживаться индивидуального подбора медикаментозной терапии, учитывая пользу и риск используемых препаратов. В статье представлен современный взгляд на лечение остеопороза у женщин, находящихся в постменопаузальном периоде. Изложенные данные основываются на обновленных клинических рекомендациях Европейского общества эндокринологов, опубликованных в марте 2019 г., а также на метаанализах последних исследований, касающихся вопросов лечения. Уделено внимание критериям отбора для применения той или иной группы антиостеопоротических препаратов.
Ключевые слова: остеопороз, постменопаузальный период, антиостеопоротическая терапия.
Ключевые слова: остеопороз, постменопаузальный период, антиостеопоротическая терапия.
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Due to the morpho-functional changes in the woman’s body that occur during the postmenopause, the risk of osteoporotic fractures increases. Given the interdisciplinarity of the problem of osteoporosis, an important role is played by a comprehensive approach to the management of patients with this pathology, including the interaction of various specialists (gynecologist, rheumatologist, endocrinologist). In the correction of osteoporotic changes, it is necessary to adhere to the individual selection of drug therapy, taking into account the benefits and risks of the drugs used. The article presents a modern view on the treatment of osteoporosis in postmenopausal women. The data presented is based on updated clinical guidelines of the European Society of Endocrinology, published in March 2019, as well as on meta-analyzes of recent research on treatment issues. Attention is paid to the selection criteria for the use of a particular group of anti-osteoporotic drugs.
Key words: osteoporosis, postmenopausal period, antiosteoporotic therapy.
Key words: osteoporosis, postmenopausal period, antiosteoporotic therapy.
Полный текст
Список литературы
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[Lesniak O.M. Audit of osteoporosis problem in Eastern Europe and Central Asia – 2010. International Osteoporosis Foundation, 2010. Osteoporoz i osteopatii. 2011; 2 (in Russian).]
2. Колпинский Г.И., Захаров И.С. Диагностика и прогнозирование постменопаузального остеопороза. Кемерово, 2015.
[Kolpinskii G.I., Zakharov I.S. Diagnosis and prediction of postmenopausal osteoporosis. Kemerovo, 2015 (in Russian).]
3. Захаров И.С., Ушакова Г.А., Колпинский Г.И. Комплексная диагностика постменопаузального остеопороза с позиции врача акушера-гинеколога. Consilium Medicum. 2015; 17 (6): 8–10.
[Zakharov I.S., Ushakova G.A., Kolpinskiy G.I. Complex diagnosis of postmenopausal osteoporosis from a position of obstetrician-gynecologist. Consilium Medicum. 2015; 17 (6): 8–10 (in Russian).]
4. Eastell R, Rosen CJ, Black DM et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104 (5): 1595–622.
5. Kanis JA, Cooper C, Rizzoli R, Reginster JY. Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 2019; 104 (3): 235–8.
6. These are the Official Positions of the ISCD as updated in 2015. Available at: https://www.iscd.org/official-positions/2015-iscd-official-positions-adult (accessed June 18, 2015)
7. Шкарабуров А.С., Колпинский Г.И., Захаров И.С. и др. Использование лучевых методов в диагностике постменопаузального остеопороза. Фундаментальная и клиническая медицина. 2017; 2 (2): 70–6.
[Shkaraburov A.S., Kolpinskiy G.I., Zakharov I.S et al. X-ray techniques for diagnostics of postmenopausal osteoporosis. Fundamental'naia i klinicheskaia meditsina. 2017; 2 (2): 70–6 (in Russian).]
8. Marshall D, Johnell O, Wedel H. Metaanalysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 1996; 312: 1254–9.
9. Barrionuevo P, Kapoor E, Asi N et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 2019; 104 (5): 1623–30.
10. Black DM, Schwartz AV, Ensrud KE et al.; Flex Research Group. Effects of continuing or stopping alendronate after 5 years of treatment. JAMA 2006; 296 (24): 2927.
11. Black DM, Reid IR, Boonen S et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27 (2): 243–54.
12. Adams AL, Adams JL, Raebel MA et al. Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res 2018; 33 (7): 1252–9.
13. Bone HG, Wagman RB, Brandi ML et al. 10 Years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5 (7): 513–23.
14. Kendler DL, McClung MR, Freemantle N et al. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 2011; 22 (6): 1725–35.
15. Brown JP, Roux C, Torring O et al. Discontinuation of denosumab and associated fracture incidence: analysis from the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial. J Bone Miner Res 2013; 28 (4): 746–52.
16. Bone HG, Bolognese MA, Yuen CK et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96 (4): 972–80.
17. Crandall CJ, Newberry SJ, Diamant A et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161 (10): 711–23.
18. Reid IR, Eastell R, Fogelman I et al. A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Arch Intern Med 2004; 164 (8): 871–9.
19. Мельниченко Г.А., Белая Ж.Е., Рожинская Л.Я. и др. Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза. Проблемы эндокринологии. 2017; 63 (6): 392–426.
[Melnichenko G.A., Belaya Zh.E., Rozhinskaya L.Ya. et al. Russian clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy endokrinologii. 2017; 63 (6): 392–426 (in Russian).]
20. Amling M. Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment. Unfallchirurg 2015; 118 (12): 995–9.
21. European Medicines Agency. Summary of product characteristics. www.ema.europa.eu/en/medicines/human/EPAR/prolia
[Lesniak O.M. Audit of osteoporosis problem in Eastern Europe and Central Asia – 2010. International Osteoporosis Foundation, 2010. Osteoporoz i osteopatii. 2011; 2 (in Russian).]
2. Колпинский Г.И., Захаров И.С. Диагностика и прогнозирование постменопаузального остеопороза. Кемерово, 2015.
[Kolpinskii G.I., Zakharov I.S. Diagnosis and prediction of postmenopausal osteoporosis. Kemerovo, 2015 (in Russian).]
3. Захаров И.С., Ушакова Г.А., Колпинский Г.И. Комплексная диагностика постменопаузального остеопороза с позиции врача акушера-гинеколога. Consilium Medicum. 2015; 17 (6): 8–10.
[Zakharov I.S., Ushakova G.A., Kolpinskiy G.I. Complex diagnosis of postmenopausal osteoporosis from a position of obstetrician-gynecologist. Consilium Medicum. 2015; 17 (6): 8–10 (in Russian).]
4. Eastell R, Rosen CJ, Black DM et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104 (5): 1595–622.
5. Kanis JA, Cooper C, Rizzoli R, Reginster JY. Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 2019; 104 (3): 235–8.
6. These are the Official Positions of the ISCD as updated in 2015. Available at: https://www.iscd.org/official-positions/2015-iscd-official-positions-adult (accessed June 18, 2015)
7. Шкарабуров А.С., Колпинский Г.И., Захаров И.С. и др. Использование лучевых методов в диагностике постменопаузального остеопороза. Фундаментальная и клиническая медицина. 2017; 2 (2): 70–6.
[Shkaraburov A.S., Kolpinskiy G.I., Zakharov I.S et al. X-ray techniques for diagnostics of postmenopausal osteoporosis. Fundamental'naia i klinicheskaia meditsina. 2017; 2 (2): 70–6 (in Russian).]
8. Marshall D, Johnell O, Wedel H. Metaanalysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 1996; 312: 1254–9.
9. Barrionuevo P, Kapoor E, Asi N et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 2019; 104 (5): 1623–30.
10. Black DM, Schwartz AV, Ensrud KE et al.; Flex Research Group. Effects of continuing or stopping alendronate after 5 years of treatment. JAMA 2006; 296 (24): 2927.
11. Black DM, Reid IR, Boonen S et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27 (2): 243–54.
12. Adams AL, Adams JL, Raebel MA et al. Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res 2018; 33 (7): 1252–9.
13. Bone HG, Wagman RB, Brandi ML et al. 10 Years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5 (7): 513–23.
14. Kendler DL, McClung MR, Freemantle N et al. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 2011; 22 (6): 1725–35.
15. Brown JP, Roux C, Torring O et al. Discontinuation of denosumab and associated fracture incidence: analysis from the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial. J Bone Miner Res 2013; 28 (4): 746–52.
16. Bone HG, Bolognese MA, Yuen CK et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96 (4): 972–80.
17. Crandall CJ, Newberry SJ, Diamant A et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161 (10): 711–23.
18. Reid IR, Eastell R, Fogelman I et al. A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Arch Intern Med 2004; 164 (8): 871–9.
19. Мельниченко Г.А., Белая Ж.Е., Рожинская Л.Я. и др. Федеральные клинические рекомендации по диагностике, лечению и профилактике остеопороза. Проблемы эндокринологии. 2017; 63 (6): 392–426.
[Melnichenko G.A., Belaya Zh.E., Rozhinskaya L.Ya. et al. Russian clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy endokrinologii. 2017; 63 (6): 392–426 (in Russian).]
20. Amling M. Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment. Unfallchirurg 2015; 118 (12): 995–9.
21. European Medicines Agency. Summary of product characteristics. www.ema.europa.eu/en/medicines/human/EPAR/prolia
________________________________________________
2. Kolpinskii G.I., Zakharov I.S. Diagnosis and prediction of postmenopausal osteoporosis. Kemerovo, 2015 (in Russian).
3. Zakharov I.S., Ushakova G.A., Kolpinskiy G.I. Complex diagnosis of postmenopausal osteoporosis from a position of obstetrician-gynecologist. Consilium Medicum. 2015; 17 (6): 8–10 (in Russian).
4. Eastell R, Rosen CJ, Black DM et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104 (5): 1595–622.
5. Kanis JA, Cooper C, Rizzoli R, Reginster JY. Executive summary of the European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Calcif Tissue Int 2019; 104 (3): 235–8.
6. These are the Official Positions of the ISCD as updated in 2015. Available at: https://www.iscd.org/official-positions/2015-iscd-official-positions-adult (accessed June 18, 2015)
7. Shkaraburov A.S., Kolpinskiy G.I., Zakharov I.S et al. X-ray techniques for diagnostics of postmenopausal osteoporosis. Fundamental'naia i klinicheskaia meditsina. 2017; 2 (2): 70–6 (in Russian).
8. Marshall D, Johnell O, Wedel H. Metaanalysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J 1996; 312: 1254–9.
9. Barrionuevo P, Kapoor E, Asi N et al. Efficacy of pharmacological therapies for the prevention of fractures in postmenopausal women: a network meta-analysis. J Clin Endocrinol Metab 2019; 104 (5): 1623–30.
10. Black DM, Schwartz AV, Ensrud KE et al.; Flex Research Group. Effects of continuing or stopping alendronate after 5 years of treatment. JAMA 2006; 296 (24): 2927.
11. Black DM, Reid IR, Boonen S et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 2012; 27 (2): 243–54.
12. Adams AL, Adams JL, Raebel MA et al. Bisphosphonate drug holiday and fracture risk: a population-based cohort study. J Bone Miner Res 2018; 33 (7): 1252–9.
13. Bone HG, Wagman RB, Brandi ML et al. 10 Years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017; 5 (7): 513–23.
14. Kendler DL, McClung MR, Freemantle N et al. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int 2011; 22 (6): 1725–35.
15. Brown JP, Roux C, Torring O et al. Discontinuation of denosumab and associated fracture incidence: analysis from the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial. J Bone Miner Res 2013; 28 (4): 746–52.
16. Bone HG, Bolognese MA, Yuen CK et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab 2011; 96 (4): 972–80.
17. Crandall CJ, Newberry SJ, Diamant A et al. Comparative effectiveness of pharmacologic treatments to prevent fractures: an updated systematic review. Ann Intern Med 2014; 161 (10): 711–23.
18. Reid IR, Eastell R, Fogelman I et al. A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women. Arch Intern Med 2004; 164 (8): 871–9.
19. Melnichenko G.A., Belaya Zh.E., Rozhinskaya L.Ya. et al. Russian clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis. Problemy endokrinologii. 2017; 63 (6): 392–426 (in Russian).
20. Amling M. Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment. Unfallchirurg 2015; 118 (12): 995–9.
21. European Medicines Agency. Summary of product characteristics. www.ema.europa.eu/en/medicines/human/EPAR/prolia
Авторы
И.С. Захаров*1,2, Г.И. Колпинский1,2, Н.В. Шаламанова2, И.Ю. Колесник2, Т.В. Лебедева2, О.В. Титаренко2
1 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия;
2 ГБУЗ КО «Кемеровский клинический консультативно-диагностический центр», Кемерово, Россия
*isza@mail.ru
1 ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России, Кемерово, Россия;
2 ГБУЗ КО «Кемеровский клинический консультативно-диагностический центр», Кемерово, Россия
*isza@mail.ru
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1 Kemerovo State Medical University, Kemerovo, Russia;
2 Kemerovo Clinical Advisory and Diagnostic Center, Kemerovo, Russia
*isza@mail.ru
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