scholarly journals Hypercalcemia in a Patient Treated With Abaloparatide

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A196-A197
Author(s):  
Chheki Sherpa ◽  
Bishow Chandra Shrestha ◽  
Deepika Nallala ◽  
Ilan Gabriely
Keyword(s):  
Serum Calcium ◽  
Osteoporotic Fractures ◽  
Renal Stones ◽  
Mineral Density ◽  
Intact Pth ◽  
Laboratory Findings ◽  
Dxa Scan ◽  
Autoimmune Myositis ◽  
Major Osteoporotic Fractures ◽  
Leg Edema

Abstract Introduction: The antifracture efficacy of newer agents like PTHrP analogues is promising but knowledge about the mechanism of action and safety profile is needed in order to use these agents effectively. The reported incidence of hypercalcemia defined as albumin-adjusted serum calcium ≥10.7mg/dL was 3.4% in Abaloparitide. Case Presentation: A 59 year-old female with past medical history significant for diabetes mellitus type 2, hypothyroidism, necrotizing autoimmune myositis, osteoporosis and renal stones presented with complaints of generalized body aches and pains with swelling and redness of the left leg. The patient was diagnosed with osteoporosis based on atraumatic L4 compressive injury involving superior end plate. Her only DXA scan was 8 years ago which showed osteopenia, with the lowest T score of -1.2 at lumbar spine. Subsequent evaluation with DXA scan was unable to be performed due to physical disabilities. She was intolerant to oral bisphosphonates and was started on abaloparatide subcutaneous injections 2 weeks prior to her current admission. Her physical examination was positive for obesity, proximal muscle weakness and bilateral leg edema with bruises and left leg erythema. Laboratory findings showed hypercalcemia with corrected calcium levels of 12.48 mg/dl, suppressed intact PTH 4 pg/ml. Evaluations for secondary causes of hypercalcemia were negative. Her last dose of abaloparatide injection was the morning prior to her presentation to the emergency room. The patient was treated with IV fluids and her calcium level improved within 24 hours with normalization of intact PTH level in 72hrs. Abaloparatide injection was suspended on admission. Hypercalcemia with suppressed PTH was most likely secondary to abaloparatide given the timing of the hypercalcemia after the injection and resolution of hypercalcemia and normalization of PTH. Conclusions: Abaloparatide is a peptide that selectively binds to the RG conformation of the parathyroid hormone type 1 receptor. Abaloparatide is increasingly used following the results from the ACTIVE and ACTIVExtend trials which demonstrate significant increase in bone mineral density and risk reduction of vertebral, nonvertebral, clinical, and major osteoporotic fractures. Hypercalcemia was reported as a side effect, but there is no guidance on further evaluation or management of these patients. The incidence of hypercalcemia defined as albumin-adjusted serum calcium ≥10.7mg/dL is 3.4 % and risk is increased in patients with renal impairment. As in our case, transient hypercalcemia and PTH suppression may be associated with abaloparatide. Efficacy of abaloparatide and impact on bone density with delay or interrupted treatment are not available. Further studies are needed to guide monitoring and treatment of clinically symptomatic transient hypercalcemia in patients taking abaloparatide.

scholarly journals SAT-369 Parathyroid Microadenomas as a Cause of Normocalcemic Primary Hyperparathyroidism (PHPT) and a Surgical Challenge

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Tiffany Nguyen ◽  
Marc D Coltrera ◽  
Jing H Chao
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Compression Fracture ◽  
Extended Period ◽  
Significant Loss ◽  
Mineral Density ◽  
Dxa Scan ◽  
Normal Bone Mineral Density ◽  
Pth Level

Abstract Background: Patients with normocalcemic primary hyperparathyroidism (PHPT) share similar risks of osteoporosis and nephrolithiasis with patients having hypercalcemic PHPT. The prevalence and natural history of normocalcemic PHPT is not well defined. Parathyroid microadenomas weighing < 100 mg may present as special clinical challenges in both the diagnosis and surgical resection. Clinical Case: A 55-year-old woman presented for an evaluation of osteoporosis following a non-traumatic L1 compression fracture at the age of 50 years. Noting an initial serum calcium of 10 mg/dL, we diagnosed her with normocalcemic PHPT based on a concurrent parathyroid hormone (PTH) level of 112 pg/mL (12-88 pg/mL) and a lack of other causes for an elevated PTH, including a normal eGFR, serum 25-hydroxyvitamin D, 24-hour urine calcium, and autoantibodies for celiac disease. Initial dual-energy x-ray absorptiometry (DXA) scan from 2015 showed normal bone mineral density (BMD) and T-scores in the L-spine, total hip, and femoral neck. Neck imagings, including ultrasound, sestamibi scan, and 4D CT, failed to localize a parathyroid adenoma. In the absence of a target and indications for parathyroidectomy other than osteoporosis, she was treated with bisphosphonates. While her serum calcium remained normal (9.6-10.2 mg/dL) despite an elevated PTH level (92-116 pg/mL) over a two-year period, subsequent DXA scans showed a significant loss in BMD on the bisphosphonates, prompting a peripheral DXA scan, which revealed severe osteoporosis at the distal third of the forearm (BMD 0.450 g/cm2, T-score -3.7), consistent with PTH-associated bone resorption. Following a 4-gland exploration with removal of 2 parathyroid microadenomas (63 and 100 mg), intra- and post-operative PTH levels normalized. She now awaits a repeat DXA scan at 1 year after a successful parathyroidectomy. Conclusion: Although many patients with normocalcemic PHPT may progress to develop hypercalcemia, some remain normocalcemic over an extended period. We report a patient who maintained normocalcemia for over 2 years. To correctly establish the diagnosis of normocalcemic PHPT, a comprehensive evaluation must be performed to exclude secondary causes of an elevated PTH (renal insufficiency, hypovitaminosis D, hypercalciuria, and malabsorption). Since significant osteoporosis may be preferentially seen in the cortical bone, BMD at the distal 1/3 of forearm should be evaluated in addition to the L-spine, hips and femoral necks. When a parathyroid adenoma cannot be localized in patients with normocalcemic PHPT, a careful 4-gland exploration for parathyroid microadenoma(s), paying special attention to the size, texture, and shape of the glands, and guided by intraoperative PTH levels, ensures the successful removal of the culprit gland(s).

scholarly journals SAT0473 COMPARSION OF THE FRACTURE RISK IN WOMEN WITH AND WITHOUT SCOLIOSIS THROUGH DUAL-ENERGY X-RAY ABSORPTIOMETRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1193.2-1194
Author(s):  
N. Kirilov ◽  
S. Todorov ◽  
N. Nikolov ◽  
M. Nikolov
Keyword(s):  
Fracture Risk ◽  
Hip Fractures ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Mineral Density ◽  
X Ray ◽  
T Score ◽  
Major Osteoporotic Fractures ◽  
Cobb’S Angle ◽  
The Mean

Background:Osteoporosis is known to be a risk factor for fragility fractures [4, 5]. On one hand, vertebral body fragility fractures often lead to additional spine deformity [2]. On the other hand, it was found that with the progression of the spinal curvature in osteoporotic patients, the fragility fractures develop more frequently. The increased incidence of these fractures could be explained with a predominance of the mechanical forces on the one side of the already weakened osteoporotic vertebrae [3].Objectives:The aim of this study is to compare the fracture risk (FRAX) for major osteoporotic fractures (MOF) and for hip fractures (HF) in women with and without scoliosis through dual-energy X-ray absorptiomentry (DXA)Methods:In the current study, 59 women underwent DXA scans. Scoliosis was defined as Cobb’s angle ≥ 5◦ according to the Chaklin’s classification [6, 7]. Cobb’s angle was measured from DXA images with DICOM software. We evaluated the following risk factors: previous fractures, parental hip fractures, secondary osteoporosis, rheumatoid arthritis, use of corticosteroids, current smoking and alcohol consumption more than 3 units daily. We estimated FRAX MOF and FRAX HF on the basis of these risk factors and on the basis of the femoral neck bone mineral density (BMD). The calculations were done through FRAX tool published on the website of the University of Sheffield [1].Results:The mean age of the women was 63 years (yrs.) ± 10 yrs. (range 43 yrs. – 89 yrs.). Subjects with scoliosis were significantly older (67 yrs.) than those without scoliosis (59 yrs.), (p = 0.004). Mean weight and height didn’t differ between the groups with- and without scoliosis. Mean lumbar spine BMD and T-score differed significantly between the groups, (p = 0.02). Women with scoliosis had lower mean BMD (0.786 g/cm2) and lower mean T-score (-2.1 standard deviations (SDs)) compared to those without scoliosis (mean BMD: 0.912 g/cm2 and mean T-score: 0.9 SDs). The mean FRAX MOF (19.3%) and FRAX HF (5.9%) of the subjects with scoliosis were significantly higher than those of the women without scoliosis (FRAX MOF: 14.9% and FRAX HF: 3.1%), (p = 0.004 for FRAX MOF and p = 0.010 for FRAX HF).Conclusion:Women with scoliosis showed significantly higher fracture risk for major osteoporotic fractures and for hip fractures compared to those without scoliosis.References:[1]https://www.sheffield.ac.uk/FRAX/index.aspx[2]Mao YF, Zhang Y, Li K, et al. Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat. 2018;16:33–39. Published 2018 Oct 10. doi:10.1016/j.jot.2018.08.007.[3]Sabo A, Hatgis J, Granville M, Jacobson RE. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus. 2017;9(12):e1962. Published 2017 Dec 19. doi:10.7759/cureus.1962.[4]Kirilova E, Cherkezov D, Gonchev B, Zheleva Z. OSIRIS Index for the assessment of the risk for osteoporosis in menopausal women, National conference with international participation, 6-7 october 2019, Kardzhali “Science and society 2019”, RKR print OOD ISSN 1314-3425[5]Madzharova R, Kirilova E, Petranova T, Nikolova M. Assessment of the activity for self care in women with osteoporosis, Science and TechnologieVolume VIII, 2018, Number 1: MEDICAL BIOLOGY STUDIES, CLINICAL STUDIES, SOCIAL MEDICINE AND HEALTH CARE,1-6.[6]Chaklin VD, Orthopedy - Moscow: Medgiz – 1965 – C. 209[7]Chaklin VD. Pathology, clinical manifestation and treatment of the scoliosis, 1stcongress of the union of the orthopedists and traumatologists, Moscow: Medgiz, 1957 – T.2. – p 798Disclosure of Interests:None declared

scholarly journals Bone mineral density status in urolithiasis patients with vitamin D inadequacy followed at a tertiary stone centre

2014 ◽  
Vol 8 (9-10) ◽  
pp. 323 ◽  
Author(s):  
Mohamed Aly Elkoushy ◽  
Mazen Jundi ◽  
Terence T.N. Lee ◽  
Sero Andonian
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
High Risk ◽  
Osteoporotic Fractures ◽  
Mineral Density ◽  
Stone Formers ◽  
Major Osteoporotic Fractures ◽  
Recurrent Stone ◽  
Dxa Scans ◽  
Recurrent Stone Formers

Introduction: We assessed abnormalities in bone mineral density (BMD) and the risk of hip and major osteoporotic fractures in urolithiasis patients with vitamin D inadequacy (VDI) followed at a tertiary stone centre.Methods: Stone-free patients with VDI were invited to undergo dual-energy x-ray absorptiometry (DXA) scans to assess for BMD abnormalities at the femoral neck and lumbar spine. The World Health Organization’s validated Fracture Risk Assessment Tool (FRAX) was used to calculate the risk of hip and major osteoporotic fractures within 10 years. Patients with primary hyperparathyroidism or hypercalcemia were excluded.Results: In total, 50 consecutive patients were included between June 2011 and August 2012, including 26 (52%) males. The median age was 51 years and the median 25-hydroxyl vitamin D (25[OH]D) was 18.8 ng/mL. Thirty patients (60%) had abnormal T-scores on DXA studies. This decreased to 22 (44%) when age-matched Z-scores were used; 36% had osteopenia and 8% had osteoporosis. Femoral neck and lumbar spines were affected in 24% and 32% of patients, respectively. Recurrent stone-formers had significantly lower BMD when compared with first-time stone-formers. Median serum 25(OH)D was comparable between patients with normal and abnormal DXA scans (18.6 vs. 18.8 ng/mL; p = 0.91). Five patients (10%) were at high risk (≥3%) of hip fractures within 10 years.Conclusion: A high prevalence of abnormal DXA scans was found in urolithiasis patients with VDI, including 5 patients (10%) at high risk of hip fractures. Future studies need to assess the economic impact of obtaining DXA scans on urolithiasis patients with VDI, especially in recurrent stone-formers.

scholarly journals Normocalcaemic primary hyperparathyroidism: what is the role of parathyroid surgery?

2021 ◽  
Vol 12 ◽  
pp. 204201882199537
Author(s):  
Nivaran Aojula ◽  
Shahab Khan ◽  
Neil Gittoes ◽  
Zaki Hassan-Smith
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Fragility Fractures ◽  
Renal Stones ◽  
Careful Consideration ◽  
Normal Serum ◽  
Mineral Density ◽  
Normal Serum Calcium ◽  
To Receive

Primary hyperparathyroidism (PHPT) is classically associated with both an elevated or ‘inappropriately normal’ parathyroid hormone (PTH) level and raised serum calcium. However, in clinical practice, increasing numbers of patients present with raised PTH but normal serum calcium, renal function and vitamin D; this is known as normocalcaemic PHPT (nPHPT). Studies investigating the clinical presentation of this condition have shown that patients may present with hypertension, nephrolithiasis, impaired glucose tolerance, osteoporosis and fragility fractures. The prevalence of such complications in nPHPT is similar to that in classical hypercalcaemic PHPT (hPHPT). Although the National Institute for Health and Care Excellence (NICE) have developed guidelines for the management of PHPT generally, a consensus is yet to be reached on the optimal management of nPHPT specifically. A review of the literature on parathyroidectomy in the treatment of nPHPT revealed that nPHPT patients were more likely to present with multi-glandular disease and significantly less nPHPT patients had an intra-operative PTH fall of >50% compared with those with hPHPT. These findings demonstrate that patients with nPHPT are more likely to receive bilateral neck explorations and require remedial surgery compared with hPHPT patients. Following surgery, improvements in bone mineral density (BMD) and renal stones are generally observed in those with nPHPT. Where surgery is not possible, medical management with alendronate has been shown to be effective in nPHPT patients. Given the higher incidence of multi-gland disease and greater possibility of remedial surgery in nPHPT, careful consideration of risks and benefits should be made on an individualised basis and surgery should be performed by surgeons experienced in four gland exploration.

scholarly journals Characteristics of osteoporosis in patients with rheumatic diseases

2021 ◽  
pp. 48-54
Author(s):  
O. Kh. Mirzovaliev ◽  
S. M. Shukurova
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Rheumatic Diseases ◽  
Absolute Risk ◽  
Osteoporotic Fractures ◽  
Case Histories ◽  
Mineral Density ◽  
Major Osteoporotic Fractures ◽  
History Of

Aim. To present a comprehensive assessment of rheumatic diseases in association with osteoporosis.Material and methods. A retrospective analysis was made of 180 case histories with various RDs, who were under inpatient observation at the Sughd Regional Clinical Hospital for the period 2018-2019 for the frequency of osteoporosis (OP). Densitometry was used to determine the projection mineral density (in g / cm2) in various parts of the skeleton.Results. When asked about a history of fractures, every third respondent (33.3%) answered positively. According to the results of densitometry, osteoporosis in patients with inflammatory RD was diagnosed in 32.2% of patients. At the same time, the indicators differed significantly by nosology, and the frequency of OP correlated with the intake of corticosteroids. Osteoporosis was detected in every third patient with OA according to densitometry data and in 25% of cases in patients with gout. The results of the analysis to assess the absolute risk of major osteoporotic fractures according to FRAX showed high risk in 2 groups.Conclusion. Thus, the nature and frequency of risk factors for osteoporosis in patients with RA and OA have their characteristics. A history of fractures in patients with RA is often associated with long-term use of GCS, and the presence of menopause in women and the presence of cardiometabolic concomitant diseases play an important role in the progression of AP in patients with OA.

scholarly journals Experience in using Prolia in patients with postmenopausal osteoporosis in clinical practice

2017 ◽  
Vol 89 (12-2) ◽  
pp. 190-196 ◽  
Author(s):  
I A Skripnikova ◽  
O V Kosmatova ◽  
E S Abirova ◽  
V E Novikov ◽  
L M Murashko
Keyword(s):  
Lumbar Spine ◽  
Postmenopausal Osteoporosis ◽  
Type I Collagen ◽  
Osteoporotic Fractures ◽  
Outpatient Setting ◽  
Type I ◽  
Mineral Density ◽  
National Medical ◽  
Major Osteoporotic Fractures ◽  
Open Prospective Study

Aim. To evaluate the efficiency and safety of long-term Prolia therapy in patients with postmenopausal osteoporosis (OP). Subjects and methods. The open prospective study enrolled 98 women (mean age, 68±9 years; mean menopause duration, 17±4 years) with postmenopausal OP, who were followed up in an outpatient setting at the National Medical Research Center for Preventive Medicine and who had been treated with denosumab 60 mg subcutaneously every 6 months for 12 months or more. The maximum follow-up period was 4 years: 48, 29, 11, and 10 patients were treated for 12, 24, 36, and 48 months, respectively. The patients were allocated into 2 groups: those who received and those who had not previously received antiosteoporotic therapy. Bone mineral density (BMD) was measured using dual-energy X-ray densitometry of the lumbar spine (L—L) and proximal femur (PF). The ten-year probability of major osteoporotic fractures was estimated once in 72 patients not previously receiving antiosteoporotic therapy before the prescription of denosumab. Results. In the patients not previously receiving therapy, the median 10-year probability of major fractures using the FRAX algorithm was 14.9%; that of femoral neck (FN) fractures was 3.7%. During denosumab treatment, the BMD increase in the lumbar spine was 4.2% at 12 months, 7.5% at 24 months, was 8.8% at 36 months; that in FN was 3.1, 3.9, and 5.3%, that in PF was 2.8, 4.1, and 5%; and that in the 1/3 forearm was 0.9, 1.4, and 2.6%, respectively (p < 0.001). In the persons receiving and not previously receiving the therapy, the BMD increase was similar, i.e. there was an additional positive effect when switching to denosumab. The decrease in the serum concentration of C-terminal telopeptide of type I collagen (CTX-I) was 54% at 6 months after initiation of denosumab therapy (p < 0.001) and 72% at 12 months (p

scholarly journals ACTIVExtend: 24 Months of Alendronate After 18 Months of Abaloparatide or Placebo for Postmenopausal Osteoporosis

2018 ◽  
Vol 103 (8) ◽  
pp. 2949-2957 ◽  
Author(s):  
Henry G Bone ◽  
Felicia Cosman ◽  
Paul D Miller ◽  
Gregory C Williams ◽  
Gary Hattersley ◽  
...  
Keyword(s):  
Postmenopausal Osteoporosis ◽  
Relative Risk Reduction ◽  
Osteoporotic Fractures ◽  
Incidence Rates ◽  
Mineral Density ◽  
Effective Treatment Option ◽  
Kaplan Meier ◽  
Major Osteoporotic Fractures ◽  
Fracture Types ◽  
To Receive

Abstract Purpose In women with postmenopausal osteoporosis, we investigated the effects of 24 months of treatment with alendronate (ALN) following 18 months of treatment with abaloparatide (ABL) or placebo (PBO). Methods Women who completed ABL or PBO treatment in ACTIVE were eligible to receive up to 24 months of ALN. We evaluated the incidence of vertebral and nonvertebral fractures and changes in bone mineral density (BMD) during the entire 43-month period from ACTIVE baseline to the end of ACTIVExtend and for the 24-month extension only. Results Five hundred fifty-eight women from ACTIVE’s ABL group and 581 from its PBO group (92% of ABL and PBO completers) were enrolled. During the full 43-month treatment period, 0.9% of evaluable women in the ABL/ALN group experienced a new radiographic vertebral fracture vs 5.6% of women in the PBO/ALN group, an 84% relative risk reduction (RRR, P &lt; 0.001). Kaplan–Meier incidence rates for other reported fracture types were significantly lower for ABL/ALN vs PBO/ALN (all P &lt; 0.05). Gains in BMD achieved during ACTIVE were further increased during ACTIVExtend. For ACTIVExtend only, RRR for vertebral fractures was 87% with ABL/ALN vs PBO/ALN (P = 0.001). Adverse events were similar between groups. A supplemental analysis for regulatory authorities found no hip fractures in the ABL/ALN group vs five in the PBO/ALN group. Conclusions Eighteen months of ABL followed by 24 months of ALN reduced the risk of vertebral, nonvertebral, clinical, and major osteoporotic fractures and increased BMD. Sequential ABL followed by ALN appears to be an effective treatment option for postmenopausal women at risk for osteoporosis-related fractures.

scholarly journals TBS (Trabecular Bone Score) and Diabetes-Related Fracture Risk

2013 ◽  
Vol 98 (2) ◽  
pp. 602-609 ◽  
Author(s):  
William D. Leslie ◽  
Berengère Aubry-Rozier ◽  
Olivier Lamy ◽  
Didier Hans ◽  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Trabecular Bone Score ◽  
Bone Microarchitecture ◽  
Osteoporotic Fractures ◽  
Hazard Ratio ◽  
Mineral Density ◽  
Major Osteoporotic Fractures ◽  
Lower Lumbar Spine

Abstract Context: Type 2 diabetes is associated with increased fracture risk but paradoxically greater bone mineral density (BMD). Trabecular bone score (TBS) is derived from the texture of the spine dual x-ray absorptiometry (DXA) image and is related to bone microarchitecture and fracture risk, providing information independent of BMD. Objective: This study evaluated the ability of lumbar spine TBS to account for increased fracture risk in diabetes. Design and Setting: We performed a retrospective cohort study using BMD results from a large clinical registry for the province of Manitoba, Canada. Patients: We included 29,407 women 50 years old and older with baseline DXA examinations, among whom 2356 had diagnosed diabetes. Main Outcome Measures: Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident nontraumatic major osteoporotic fractures (mean follow-up 4.7 years). Results: Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P &lt; .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P &lt; .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30–2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P &lt; .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10–1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24–1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. Conclusions: Lumbar spine TBS predicts osteoporotic fractures in those with diabetes, and captures a larger portion of the diabetes-associated fracture risk than BMD.

Progress of osteoporosis: stratification of fracture risk

2018 ◽  
Vol 21 (1) ◽  
pp. 4-9 ◽  
Author(s):  
Oksana A. Nikitinskaya ◽  
Natalya V. Toroptsova
Keyword(s):  
Diagnostic Accuracy ◽  
Osteoporotic Fracture ◽  
Osteoporotic Fractures ◽  
Osteoporosis Treatment ◽  
Axial Skeleton ◽  
Mineral Density ◽  
Major Osteoporotic Fractures ◽  
Age Dependent ◽  
Probability Of Fracture

Background: There are two approaches to identify candidates for the prescription of osteoporosis treatment: identification of patients with low bone mineral density using DEXA of the axial skeleton and calculation of the 10-year probability of major osteoporotic fractures using FRAX®. Aims: to assess the diagnostic accuracy of different FRAX® thresholds in the Russian population. Materials and methods: the value of individual 10-year probability of osteoporotic fracture by FRAX® at the time of inclusion in the study was retrospectively estimated in 224 postmenopausal women, whom the major osteoporotic fractures were recorded over 10 years of prospective observation. The diagnostic accuracy of different thresholds were compared: "European" and Russian age-dependent thresholds, fixed 20% threshold, the average FRAX® of patients who had a major osteoporotic fracture during follow-up (16%), FRAX® value corresponding to the "cut-off point" (12,5%). Results: The Russian FRAX model showed the acceptable diagnostic accuracy of the method (AUC=0.665±0.036; 95% CI 0.595; 0.736). The "European" threshold of therapeutic intervention demonstrated 72% sensitivity and 38% specificity, 20% threshold – 27% and 87%, the Russian threshold – 41% and 77%, 12.5% threshold – 68% and 58%, 16% threshold – 57% and 73%, respectively. The diagnostic precision of the specified thresholds was 54%, 58%, 60%, 63% and 65%, respectively. Conclusions: the Russian age-dependent threshold remains the optimal way to decide whether to initiate anti-osteoporotic therapy based on an assessment of the 10-year probability of fracture by the Russian model for FRAX®.

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