В связи с многофакторностью развития постменопаузального остеопороза важно осуществлять комплексный подход к профилактике и лечению данной патологии. Наряду с менопаузальной гормональной терапией значимое место в коррекции остеопоротических изменений занимает использование многокомпонентных препаратов, направленных на компенсацию недостаточности и дефицита в организме кальция, витамина D, а также остеотропных микроэлементов, регулирующих кальциевый обмен, таких как цинк, медь, марганец, бор, магний. Комплекс указанных составляющих обладает остеопротективным действием, повышая эффективность профилактики снижения минеральной плотности кости у женщин в постменопаузальном периоде, что, в свою очередь, позволяет снизить риск развития остеопороза и связанных с ним осложнений, влияющих на качество жизни. Ключевые слова: постменопаузальный остеопороз, коррекция костного метаболизма, кальций, витамин D, цинк, медь, марганец, бор, магний.
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Because of the multifactor development of postmenopausal osteoporosis, it is important to implement a comprehensive approach to the prevention and treatment of this pathology. Along with the menopausal hormone therapy, the use of multicomponent drugs plays an important role in correcting osteoporotic changes. These drugs are aimed at compensating for deficiency and deficiency in the body of calcium, vitamin D, as well as osteotropic microelements that regulate calcium metabolism, such as zinc, copper, manganese, boron, magnesium. Complex of these components has osteoprotective effect, increases the effectiveness of preventing the reduction of bone mineral density in women in the postmenopausal period. These can reduce the risk of osteoporosis and associated complications that affect the quality of life. Key words: postmenopausal osteoporosis, correction of bone metabolism, calcium, vitamin D, zinc, copper, manganese, boron, magnesium.
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1. Postnikova S.L. Features of postmenopausal osteoporosis. Lechebnoye delo. 2004; 4: 41–5. [in Russian]
2. Hernlund E, Svedbom A, Ivergard M et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136.
3. Meditsina klimakteriia. Pod red. V.P.Smetnik. Yaroslavl': Litera, 2006. [in Russian]
4. Kolpinskiy G.I., Zakharov I.S. Diagnostika i prognozirovanie postmenopauzal'nogo osteoporoza. Kemerovo, 2015. [in Russian]
5. Alberts B, Johnson A, Lewis J et al. Molecular Biology of the Cell, 4th edition. New York: Garland Science, 2002.
6. Gelse K, Poschl E, Aigner T. Collagens – structure, function, and biosynthesis. Advanced Drug Delivery Reviews 2003; 55: 1531–46.
7. Gromova O.A., Torshin I.Yu., Tomilova I.K., Gilels A.V. Calcium and collagen biosynthesis: systematic analysis of molecular mechanisms of effect. Lechashchiy vrach. 2016; 9: 96. [in Russian]
8. Goltzman D, Hendy GN The calcium-sensing receptor in bone--mechanistic and therapeutic insights. Nat Rev Endocrinol 2015; 11 (5): 298–307.
9. Santa Maria C, Cheng Z, Li A et al. Interplay between CaSR and PTH1R signaling in skeletal development and osteoanabolism. Semin Cell Dev Biol 2016; 49: 11–23.
10. Beto JA. The role of calcium in human aging. Clin Nutr Res 2015; 4 (1): 1–8.
11. Zakharov I.S., Kolpinskiy G.I., Ushakova G.A. Additional aspects of the prediction of postmenopausal osteoporosis. Gynecology. 2015; 17 (5): 49–51. [in Russian]
12. Marchenkova L.A., Tevosyan L.H. The role of calcium and vitamin D in the prevention of osteoporosis and fractures (literature review). Rus. med. zhurn. 2015; 23 (8): 454–7. [in Russian]
13. Amling M. Calcium and vitamin D in bone metabolism: Clinical importance for fracture treatment. Unfallchirurg 2015; 118 (12): 995–9.
14. McCarron DA, Heaney RP. Estimated healthcare savings associated with adequate dairy food intake. Am J Hypertens 2004; 17: 88–97.
15. Nikitinskaya O.A., Toroptsova N.V. The social program «Osteoscreening Russia» is in action. Farmateka. 2012; 6: 90–3. [in Russian]
16. Shilin D.E., Shilin A.D., Adamyan L.V. Does the Russian population have a link between the risk of fractures on the FRAX scale (WHO 2008) and calcium intake? Osteoporoz i osteopatii. 2010; 13 (1): 53–4. [in Russian]
17. Marchenkova L.A., Dreval A.V., Dobritsyna M.A. Clinical risk factors for osteoporosis and calcium intake from dietary sourses in women living in Moscow region. Lechashchiy vrach. 2014; 5: 89–95. [in Russian]
18. The role of calcium in peri- and postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause 2006; 13 (6): 862–77.
19. Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008; 88 (2): 582–6.
20. Rizzoli R, Boonen S, Brandi ML et al. Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of 2008 recommendations from European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin 2013; 29 (4): 305–13.
21. Bordakova E.V., Yureneva S.V., Yakushevskaia O.V. i dr. Kliniko-prognosticheskoe znachenie gipovitaminoza D pri postmenopauzal'nom osteoporoze. Akusherstvo i ginekologiia. 2012; 5: 53–7. [in Russian]
22. Karonova T.L., Grineva E.N., Nikitina I.L. et al. The prevalence of vitamin D deficiency in the North-West region of the Russian Federation among residents of St. Petersburg and Petrozavodsk. Osteoporoz i osteopatii. 2013; 16 (3): 3–7. [in Russian]
23. Mithal A. Treatment of vitamin D deficiency. Endocrine case management ICE/ENDO 2014 Meet-the-professor, Endocrine society 2014; p. 37–9.
24. Pogozheva A.V. The value of food macro- and micronutrients in optimizing bone mineral density. Consilium Medicum. 2015; 17 (2): 61–5. [in Russian]
25. Khodyrev V.N., Lesnyak O.M., Martinchik A.N., Maksimov D.M. Real intake and provision with vitamins and calcium in osteoporosis: assessment by measuring intake and plasma concentrations. Al'manakh klin. meditsiny. 2014; 32: 66–72. [in Russian]
26. Avtsyn A.P., Zhavoronkov A.A., Rish M.A., Strochkova L.S. Microelementoses of man: etiology, classification, organopathology. M.: Meditsina, 1991. [in Russian]
27. Wu Q, Zhong ZM, Pan Y et al. Advanced oxidation protein products as a novel marker of oxidative stress in postmenopausal osteoporosis. Med Sci Monit 2015; 21: 2428–32.
28. Zakharov I.S., Kolpinskiy G.I., Ushakova G.A., Wavin G.V. The role of oxidative stress in the formation of postmenopausal osteoporosis. Gynecology. 2014; 16 (1): 41–3. [in Russian]
29. Yan Xu, Morse LR, da Silva R et al. PAMM: A redox regulatory protein that modulates osteoclast differentiation. Antioxid Redox Signal 2010; 13 (1): 27–37.
30. Smietana MJ, Arruda EM, Faulkner JA et al. Reactive oxygen species on bone mineral density and mechanics in Cu, Zn superoxide dismutase (SOD1) knockout mice. Biochem Biophys Res Commun 2010; 403 (1): 149–53.
31. Zakharov I.S., Ushakova G.A., Kolpinskiy G.I. Pathological conditions caused by magnesium deficiency in women at different ages. Gynecology. 2015; 17 (5): 57–60. [in Russian]
32. Kanis JA, McCloskey EV, Johansson H et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24 (1): 23–57.
33. Tang BM, Eslick GD, Nowson C et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fracture sand bone loss in people aged 50 year sandolder: a meta-analysis. Lancet 2007; 370 (9588): 657–66.
34. Ross AC, Taylor CL, Yaktine AL, Del Valle HB Dietary reference in takes for calcium and vitamin D. Washington, DC: The National Academies Press, 2011.
35. Jackson RD, Mysiw WJ. Insights into the epidemiology of postmenopausal osteoporosis: the Women's Health Initiative. Semin Reprod Med 2014; 32 (6): 454–62.
36. Bischoff-Ferrari HA, Willett WC, Wong JB et al. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA 2005; 293 (18): 2257–64.
37. Bischoff-Ferrari H, Dawson-Hughes В, Willet WC et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004; 291 (16): 1999–2006.
38. Dydykina I.S., Dydykina P.S., Alekseyeva O.G. Trace elements (copper, manganese, zinc, boron) and healthy bone: prevention and treatment of osteopenia and osteoporosis. Effektivnaia farmakoterapiia. 2013; 38: 42–9. [in Russian]
39. Polyanskaya R.T., Domracheva M.Ya., Ruppel N.I. et al. Our experience in the prevention and treatment of the main clinical manifestations of the postmenopausal symptom complex with the preparation «Calcemin». Siberian medical review. Sib. med. obozrenie. 2005; 37 (4): 63–5. [in Russian]
40. Nikitinskaya O.A., Toroptsova M.Y., Anikin S.G. et al. Prophylaxis of primary osteoporosis in women with complex drug Calcemin Advance (results of an open year’s study). Nauch.-prakt. revmatologiya. 2008; 3: 73–9. [in Russian]
Авторы
И.С.Захаров*1, Г.И.Колпинский2, М.В.Пономарева2
1. ФГБОУ ВО «Кемеровский государственный медицинский университет» Минздрава России. 650056, Россия, Кемерово, ул. Ворошилова, д. 22а;
2. АО МСЧ «Центр здоровья». 650991, Россия, Кемерово, ул. Кузбасская, д. 37
*isza@mail.ru
________________________________________________
I.S.Zakharov*1, G.I.Kolpinskiy2, M.V.Ponomareva2
1. Kemerovo State Medical University of the Ministry of Health of the Russian Federation. 650056, Russian Federation, Kemerovo, ul. Voroshilova, d. 22a;
2. Medical Health Center. 650991, Russian Federation, Kemerovo, ul. Kuzbasskaya, d. 37
*isza@mail.ru