mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2012-718mrj-403Research ArticleСтатьиArticlesВторичная профилактика остеопороза и остеопоротических переломов в реальной клинической практике и возможности ее повышения с помощью стронция ранелатаSecondary prevention of osteoporosis and osteoporotic fractures in real clinical practice and possibilities of its improvement with strontium ranelateТоропцоваН. В.ToroptsovaNataliya Vladimirovnaepid@irramn.ru20120903201261№1 (2012)6165Copyright © Торопцова Н.В., 20122012Торопцова Н.В.Toroptsova N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/403

Основная конечная цель вторичной профилактики остеопороза (ОП) — снижение риска переломов у пациентов с уже имеющимся заболеванием, причем эффект патогенетических препаратов развивается только в случае их регулярного и длительного применения. Низкая приверженность пациентов лечению сводит к минимуму все усилия, направленные на профилактику осложнений ОП. Отмечена низкая частота назначения патогенетических противоостеопоротических препаратов данной категории больных. На сегодняшний день имеется большой выбор патогенетических противоостеопоротических препаратов. При выборе лекарственного средства врач должен основываться на его доказанной эффективности и безопасности, а также удобстве применения для конкретного пациента. Представлены данные международного клинического исследования, посвященного предотвращению переломов при длительной терапии стронция ранелатом.

The main ultimate goal of secondary prevention of osteoporosis (OP) is to reduce the risk of fracture in patients with the already existing disease; the effect of pathogenetic agents develops only if they are used regularly and long. Low patient adherence to treatment minimizes all efforts to prevent OP complications. There is low-frequency prescription of pathogenetic antiosteoporotic agents to this category of patients. There is a wide range of pathogenetic antiosteoporotic drugs today. On choosing a medicine, a physician should rely on its proven efficacy and safety, as well as its convenience use for a specific patient. The data of an international clinical trial to prevent fractures during long-term therapy with strontium ranelate are given.

остеопорозостеопоротические переломыприверженность лечениюosteoporosisosteoporotic fracturestreatment adherenceReferences<div><p>Brown J.P., Josse R.G. 2002 clinical guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167 (10 Suppl.)S1—S34.</p><p>Papaioannou A., Morin S., Cheung A.M. et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010; 1 —11.</p><p>Kanis J.A., Johnell O., Oden A. et al. FRAXTM and the assessment of fracture probability in men and women from the UK. Osteopor Int 2008; 19(4): 385—97.</p><p>Kanis J.A. On behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary healthcare level. Technical Report. WHO Collaborating Centre, University of Sheffield, Sheffield.</p><p>Остеопороз. Диагностика, профилактика и лечение. Клинические рекомендации. Под ред. О.М. Лесняк, Л.И. Беневоленской. М.: ГЭОТАР-Медиа, 2009; 272 с.</p><p>Jennings L.A., Auerbach A.D., Maselli J. et al. Missed Opportunities for Osteoporosis Treatment in Patients Hospitalized for Hip Fracture. J Am Geriatr Soc 2010; 58(4): 650—7.</p><p>Shu A.D.-H., Stedman M.R., Polinski J.M. et al. Adherence to Osteoporosis Medications After Patient and Physician Brief Education: Post Hoc Analysis of a Randomized Controlled Trial. Am J Manag Care 2009; 15(7): 417—24.</p><p>Gregory P.C., Lam D., Howell P. Osteoporosis treatment following hip fracture: how rates vary by service. South Med J 2010; 103(10): 977—81.</p><p>Rabenda V., Vanoverloop J., Fabri V. et al. Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 2008; 90(10): 2142—8.</p><p>Simonelli C., Chen Y., Morancey J. et al. Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 2003; 18(1): 17—22.</p><p>Еstrand J., Thorngren K.-G., Еkesson K. et al. 3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program — Fracture patients care. Acta Orthopaed 2008; 79(3): 404—9.</p><p>Kuo I., Ong C., Simmons L. et al. Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteopor Int 2007; 18(12): 1633—9.</p><p>Добровольская О.В., Торопцова Н.В., Никитинская О.А. и др. Лечение остеопороза в реальной клинической практике: частота назначения и приверженность терапии в течение первого года после остеопоротического перелома. Науч.-практич. ревматол. 2011; 5: 24—7.</p><p>Premaor M.O., Pilbrow L., Tonkin C. et al. Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a Fracture Liaison Service. Q J Med 2010; 103: 33—40.</p><p>Roerholt C., Eiken P., Abrahamsen B. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteopor Int 2009; 20(2): 299—307.</p><p>Collette J., Reginster J.-Y., Bruyere O. et al. Dissociation between bone formation and bone resorption evidenced by changes in biochemical markers of bone turnover in patients treated with strontium ranelate. Osteopor Int 2007; 18(1): 125.</p><p>Bonnelye E., Chabadel A., Saltel F. et al. Dual effect of strontium ranelate: Stimulation of osteoblast differentiation and inhibition of osteoclast formation and resorption in vitro. Bone 2008; 42: 129—38.</p><p>Reginster J.-Y., Felsenberg D., Boonen S. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis results of a five-year, randomized, placebocontrolled tria. Arthr Rheum 2008; 58(6): 1687—95.</p><p>Roux C., Fechtenbaum J., Kolta S. et al. Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis 2008; 67: 1736—8.</p><p>Rabenda V., Reginster J.-Y. Positive impact of compliance to strontium ranelate on the risk of nonvertebral osteoporotic fractures. Osteopor Int 2010; 21: 1993—2002.</p><p>Ortolani S., Diaz-Curiel M. Strontium ranelate: changes in BMD and bone markers one year after treatment discontinuation. Osteopor Int 2007; 18(1): 25.</p><p>Reginster J.-Y., Kaufman J.-M., Goemaere S. Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis. Osteopor Int 2012; 23(3): 1115—22.</p><p>Kanis J.A., Johansson H., Oden A. et al. A meta-analysis of the effect of strontium ranelate on the risk of vertebral and nonvertebral fracture in postmenopausal osteoporosis and the interaction with FRAX. Osteopor Int 2011; 22(8): 2347—55.</p><p>Kaufman J.-M., Ringe J.-D., Felsenberg D. et al. Efficacy and safety of stroncium ranelate in the treatment of male osteoporosis. Osteopor Int 2011; 22 (Suppl. 1): S114.</p><p>Bruyere O., Roux C., Detilleux J. et al. Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrin Metab 2007; 92: 3076—81.</p><p>Marquis P., Roux C., de la Loge C. et al. Strontium ranelate prevents quality of life impairment in post-menopausal women with established vertebral osteoporosis. Osteoporosis Int 2008; 19: 503—10.</p></div><br /><div><p>Brown J.P., Josse R.G. 2002 clinical guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167 (10 Suppl.)S1—S34.</p><p>Papaioannou A., Morin S., Cheung A.M. et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010; 1 —11.</p><p>Kanis J.A., Johnell O., Oden A. et al. FRAXTM and the assessment of fracture probability in men and women from the UK. Osteopor Int 2008; 19(4): 385—97.</p><p>Kanis J.A. On behalf of the World Health Organization Scientific Group (2007). Assessment of osteoporosis at the primary healthcare level. Technical Report. WHO Collaborating Centre, University of Sheffield, Sheffield.</p><p>Остеопороз. Диагностика, профилактика и лечение. Клинические рекомендации. Под ред. О.М. Лесняк, Л.И. Беневоленской. М.: ГЭОТАР-Медиа, 2009; 272 с.</p><p>Jennings L.A., Auerbach A.D., Maselli J. et al. Missed Opportunities for Osteoporosis Treatment in Patients Hospitalized for Hip Fracture. J Am Geriatr Soc 2010; 58(4): 650—7.</p><p>Shu A.D.-H., Stedman M.R., Polinski J.M. et al. Adherence to Osteoporosis Medications After Patient and Physician Brief Education: Post Hoc Analysis of a Randomized Controlled Trial. Am J Manag Care 2009; 15(7): 417—24.</p><p>Gregory P.C., Lam D., Howell P. Osteoporosis treatment following hip fracture: how rates vary by service. South Med J 2010; 103(10): 977—81.</p><p>Rabenda V., Vanoverloop J., Fabri V. et al. Low incidence of anti-osteoporosis treatment after hip fracture. J Bone Joint Surg Am 2008; 90(10): 2142—8.</p><p>Simonelli C., Chen Y., Morancey J. et al. Evaluation and management of osteoporosis following hospitalization for low-impact fracture. J Gen Intern Med 2003; 18(1): 17—22.</p><p>Еstrand J., Thorngren K.-G., Еkesson K. et al. 3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program — Fracture patients care. Acta Orthopaed 2008; 79(3): 404—9.</p><p>Kuo I., Ong C., Simmons L. et al. Successful direct intervention for osteoporosis in patients with minimal trauma fractures. Osteopor Int 2007; 18(12): 1633—9.</p><p>Добровольская О.В., Торопцова Н.В., Никитинская О.А. и др. Лечение остеопороза в реальной клинической практике: частота назначения и приверженность терапии в течение первого года после остеопоротического перелома. Науч.-практич. ревматол. 2011; 5: 24—7.</p><p>Premaor M.O., Pilbrow L., Tonkin C. et al. Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a Fracture Liaison Service. Q J Med 2010; 103: 33—40.</p><p>Roerholt C., Eiken P., Abrahamsen B. Initiation of anti-osteoporotic therapy in patients with recent fractures: a nationwide analysis of prescription rates and persistence. Osteopor Int 2009; 20(2): 299—307.</p><p>Collette J., Reginster J.-Y., Bruyere O. et al. Dissociation between bone formation and bone resorption evidenced by changes in biochemical markers of bone turnover in patients treated with strontium ranelate. Osteopor Int 2007; 18(1): 125.</p><p>Bonnelye E., Chabadel A., Saltel F. et al. Dual effect of strontium ranelate: Stimulation of osteoblast differentiation and inhibition of osteoclast formation and resorption in vitro. Bone 2008; 42: 129—38.</p><p>Reginster J.-Y., Felsenberg D., Boonen S. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis results of a five-year, randomized, placebocontrolled tria. Arthr Rheum 2008; 58(6): 1687—95.</p><p>Roux C., Fechtenbaum J., Kolta S. et al. Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis 2008; 67: 1736—8.</p><p>Rabenda V., Reginster J.-Y. Positive impact of compliance to strontium ranelate on the risk of nonvertebral osteoporotic fractures. Osteopor Int 2010; 21: 1993—2002.</p><p>Ortolani S., Diaz-Curiel M. Strontium ranelate: changes in BMD and bone markers one year after treatment discontinuation. Osteopor Int 2007; 18(1): 25.</p><p>Reginster J.-Y., Kaufman J.-M., Goemaere S. Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis. Osteopor Int 2012; 23(3): 1115—22.</p><p>Kanis J.A., Johansson H., Oden A. et al. A meta-analysis of the effect of strontium ranelate on the risk of vertebral and nonvertebral fracture in postmenopausal osteoporosis and the interaction with FRAX. Osteopor Int 2011; 22(8): 2347—55.</p><p>Kaufman J.-M., Ringe J.-D., Felsenberg D. et al. Efficacy and safety of stroncium ranelate in the treatment of male osteoporosis. Osteopor Int 2011; 22 (Suppl. 1): S114.</p><p>Bruyere O., Roux C., Detilleux J. et al. Relationship between bone mineral density changes and fracture risk reduction in patients treated with strontium ranelate. J Clin Endocrin Metab 2007; 92: 3076—81.</p><p>Marquis P., Roux C., de la Loge C. et al. Strontium ranelate prevents quality of life impairment in post-menopausal women with established vertebral osteoporosis. Osteoporosis Int 2008; 19: 503—10.</p></div><br />

The authors declare that there are no conflicts of interest present.