Federal clinical guidelines for diagnosis, treatment and prevention of osteoporosis
Authors: Belaya Zh. E. , Belova K. Yu. , Biryukova E. V. , Dedov I. I. , Dzeranova L. K. , Drapkina O. M. , Dreval A. V. , Dubovitskaya T. A. , Dudinskaya E. N. , Ershova O. B. , Zagorodniy N. V. , Ilyukhina O. B. , Kanis J. A. , Kryukova I. V. , Lesnyak O. M. , Mamedova E. O. , Marchenkova L. A. , Mel’nichenko G. A. , Nikankina L. V. , Nikitinskaya O. A. , Petryaikin A. V. , Pigarova E. A. , Rodionova S. S. , Rozhinskaya L. Ya. , Skripnikova I. A. , Tarbaeva N. V. , Tkacheva O. N. , Toroptsova N. V. , Farba L. Ya. , Tsoriev T. T. , Chernova T. O. , Yureneva S. V. , Yakushevskaya O. V. 
Published: November 2021

Due to continuous aging of population and increase in the number of elderly people, osteoporosis became socially significant disease leading to disability, increasing mortality and thereby putting an additional burden on the public healthcare system.

Screening to identify groups with a high probability of fracture is recommended using the FRAX®Tool for all postmenopausal women and men over 50 years old (А1). In the presense of major pathological fractures (hip, spine, multiple fractures) it is recommended to diagnose osteoporosis and prescribe treatment regardless of the results of spine and hip double X-ray absorptiometry (DXA) or FRAX®(B2).

It is recommended to evaluate C-terminal telopeptide when prescribing antiresorptive therapy and procollagen type 1 N-terminal propeptide (P1NP) when prescribing anabolic therapy to patients receiving osteoporosis treatment at baseline and 3 months after the start of therapy in order to assess the effectiveness of treatment early and adherence to the therapy (А2). It is recommended to diagnose osteoporosis and prescribe treatment to patients with high individual 10-year probability of major pathological fractures (FRAX®) regardless of the results of spine and hip DXA (В3).

It is recommended to diagnose osteoporosis and prescribe treatment with a decrease in BMD, measured by DXA, by 2.5 or more T-score standard deviations in femoral neck, and/or in total hip, and/or in lumbar vertebrae, in postmenopausal women and men over 50 years old (А2).

It is recommended to prescribe bisphosphonates, denosumab or teriparatide to prevent pathological fractures and increase BMD in patients with postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis (А2). When the clinical effect of therapy in osteoporotic patients without pathological fractures is achieved (BMD T-score > -2.0 SD in femoral neck and absence of new fractures), it is recommended to interrupt bisphosphonates therapy for 1-2 years with subsequent follow-up (B2). In patients with vertebral fractures, hip fractures or multiple fractures, it is recommended to continue ceaseless long-term treatment of osteoporosis (В3).

All drugs for the treatment of osteoporosis are recommended to be prescribed in combination with calcium and cholecalciferol (А2). In order to reduce the risk of recurrent fractures by prescribing osteoporosis therapy timely and maintaining long-term follow-up of patients over 50 years old with pathological fractures, it is recommended to create Fracture Liaison Services (В2).