No 4S (2015)

Postmenopausal osteoporosis (PMO) can be justly considered as significant medical and social problem, which is characterized by high prevalence in the population of women over age of 50 years and severity of complications. Bone fractures on the background of the PMO are associated with decreased quality of life, increased mortality, and economic losses of the healthcare system. Wide and timely appointment of effective pathogenetical therapy with a convenient dosage regimen provides high quality of treatment of the disease and allows to reduce the incidence of fractures associated with osteoporosis. Widespread use of bisphosphonates has played an invaluable role in addressing the problem of treatment of osteoporosis. Ibandronic acid is one of the most widely used bisphosphonate in the world.

The article presents and analyzes the first experience of creating of the system of secondary prevention of recurrent osteoporotic bone fractures in a large specialized traumatological and orthopedic hospital (RSRITO n.a. R.R. Vreden). Developed algorithm of actions of medical personnel and the routing scheme for patient with such pathology within the institution are presented. A computer program accompanying the patient at the diagnostic and treatment phases of the period of stay in hospital and further for one year after the fracture is described. The first results of functioning of the program of the secondary prevention of recurrent bone fractures on the background of systemic osteoporosis, indicating its high applicability and relevance, as well as the existing problems of adherence of patients to antiosteoporotic pharmacotherapy, are demonstrated. The ways of solving the existing problems are discussed

The article discusses the problem of the choice of antimicrobial drugs that are optimal for the treatment of orthopedic periprosthetic infection (PPI). Based on the results of a retrospective analysis of the etiological structure of causative agents of PPI (2429 strains) and data of five-year (2010-2014) monitoring of antimicrobial resistance, microbial spectrum of the main etiological factors and ranges of levels of pathogens resistance to commonly used antimicrobial agents are established. It was found that a large proportion of the leading pathogens of PPI has multiple resistance factors: 56.6 and 23.9% of the Staphylococcus epidermidis and Staphylococcus have resistance to methicillin; 25% of the Enterobacteriaceae strains produce β- extended-spectrum β-lactamases; up to 29% of Pseudomonas aeruginosa strains are resistant to carbapenems. Proper analysis of the scientific data and medical literature determines the need for the use of combined antimicrobial therapy in the treatment of PPI and the importance of creating a register of patients with periprosthetic infection to determine the most effective treatment of such severe complications after replacement arthroplasty.

The article presents some historical moments of the use of glucocorticoids in clinical practice, as well as new guidelines on the prevention and treatment of glucocorticoid-induced osteoporosis. In 1950, a group of scientists, which included a rheumatologist Philip Hench, won the Nobel Prize in Physiology or Medicine «for discoveries concerning hormones of the adrenal cortex, their structure and biological effects». The first clinical use of glucocorticoids has been the starting point and marked the beginning of a new era in the treatment of rheumatic diseases. The recent recommendations of the American College of Rheumatology (2010) on the prevention and treatment of glucocorticoid-induced osteoporosis are analyzed in detail. The recommendations were developed taking into account the age groups, as well as the presence or absence of osteoporotic fractures. The development of clinical guidelines aimed at improvement of understanding of the problems of glucocorticoid-induced osteoporosis and improvement of methods of treatment and prevention of this condition.