Objective. To study restrict fragment length polymorphisms (RFLP) Pvull and Xbal of estrogen gene (EG) receptor sites and its association with bone mineral density (BMD). Material and methods. 96 female with osteoporosis (OP) and 60 female without OP of comparable postmenopausal age (55-83 years) were included. Results. Statistically significant differences of Pvull genotypes frequencies prevalence between women with OP and control group so as absence of differences of Xbal genotypes frequencies prevalence were shown (p<0,05). Similar results were shown for combined genotypes PvuII/Xbal. Genotype ppxx in pts with OP was 3 times more frequent than in control group (29,2% and 10,0% respectively, p<0,05). Among pts with PP genotype mean spine BMD value came to 0,686±0,064 g/cm- and was significantly less (p<0,05) in comparison with Pp and pp genotypes (073310,073 g/cm 2 and 0,739±0,099 g/cm 2 respectively). Mean spine BMD value in pts with PPXx genotype was significantly less than in pts with ppxx genotype (0,66710,076 and 0,74410,102 g/cm2 respectively, p<0,05) and mean femoral neck BMD value in pts with the same genotype (PPXx) was significantly less than in pts with PpXx genotype (0,57710,079 and 0,62710,054 g/cm 2 respectively. Conclusion. We have confirmed that some EG genotypes and their combinations are associated with low spine and femoral neck BMD values in pts with OP.

Objective. To study willingness of pts to pay for osteoporosis (OP) treatment by themselves and analysis of factors influencing this decision. Material and methods. 342 pts (317 female, 25 male, mean age 61,4±8,9 years) required a special consultation for osteoporosis were asked to fill a questionnaire. All answered questions concerning social, demographic, medical data, assessment of pt knowledge about OP, quality of life assessment with QALY score. To assess pts willingness to pay for OP treatment they were asked to determine sum of money they were ready to pay for an appropriate drug decreasing fracture risk in two times. The pt was to consider 4 scenarios: low, small, moderate and high fracture risk during subsequent life. Results. 86% of pts were ready to pay for OP treatment. The main factors associated with absence of such willingness were older age (OR=1,06, 95% confidence interval 1,о2-1,1), invalidity (OR=3,18, 95% confidence interval 1,54-6,60), loneliness (OR=2,4(), 95% confidence interval 1,27-4,50). These pts were also worse informed about the disease. But family income did not influence the decision to pay. Number of pts ready to pay for the treatment and sum which they were ready to pay directly depended on the probability of fracture (rank test r=0,99 and r=0,28 respectively). The most powerful factor determining the sum pt was ready to pay for the treatment was family income. Next on importance were presence of the work and families consisted of 3 or more members. Personal experience of the pt in treatment with such drugs also had some significance. So pts treated with miacalcic were ready to pay significantly larger sums than other pts with equivalent incomes. Conclusion. Pts willingness to pay for OP treatment depends firstly on social factors and his knowledge about OP. The main factor determining the sum the pt is ready to pay is family income. On the whole sums the pts are ready to pay are significantly less than market price of drugs with proved efficacy. Fracture risk value determined by bone densitometry is an important factor influencing decision to pay for OP treatment.

Objective. To study association between bone mineral density (BMD) and clinical and laboratory indices of rheumatoid arthritis (RA) activity Material and methods. 60 women with RA who had not received glucocorticoid and anti-osteoporotic therapy were included. 30 had unchanged menstrual cycle and 30 were postmenopausal. Lumbar spine BMD and proximal femur was studied with double radiological absorptiometry (QDR 1000 Hologic apparatus). W.Wilke indices were used to characterize activity and severity of RA. CRP level was evaluated with quantitative immunoenzyme method. Results. Significant negative association was revealed between spine and femoral neck BMD and RA severity so as between femoral neck BMD and CRP level in pts with unchanged menstrual cycle and in postmenopausal pts.

Objective. To study osteoporosis (OP) and osteopenia prevalence in ankylosing spondylitis (AS) by ultrasonographic densitometry of heel bone. Results. Examination of 84 pts showed decrease of bone mineral density in 47,62%. OP and osteopenia were more frequent in pts with high activity and advanced radiological stage of the disease, prominent articular syndrome, visceral pathology, longer disease duration, low body mass index, oral glucocorticoid treatment. In pts with OP and osteopenia markers of osteogenesis (osteocalcin total alkaline phosphatase) were in normal limits but osteoresorption indices (cross-laps, urine calcium) were increased. Treatment with alphacalcidol provided significant improvement of bone mineral density, decrease of bone pain and increase of muscular power. Pts of control group receiving calcium 1000 mg/day as monotherapy showed OP progression. Conclusion. Alphacalcidol 0,5-1,0 mg/day can be considered as drug of choice for the treatment of OP and osteopenia in pts with AS.

Objective. To assess association between bone mineral density (BMD) of parts of femur and tibia gonarthrosis stage. Material and methods. 53 female with bilateral gonarthrosis aged 42 to 84 years with body mass index from 21,2 to 43 kg/m2 were included. Knee joints X-ray examination, densitometry of lumbar spine, femoral neck and condyles of femur and tibia were performed. Subchondral BMD assessment was done in 5 regions of knee. Results. Increase of gonarthrosis stage was accompanied by rise of subchondral tibia BMD values. Increase of medial femur condyles BMD was associated with knee joint space decrease, presence of subchondral osteosclerosis and marginal osteophytes so as knee varus deformity. Subchondral femur BMD values correlated only with the presence of marginal osteophytes.

Objective. To assess efficacy and safety of cheese paste (CP) enriched with calcium and vitamin D3 administered as medical and prophylactic product, an additional substance for prophylaxis and treatment of osteoporosis (OP). Material and methods. Randomized blind placebo-controlled study of CP efficacy was conducted in parallel groups. 100 menopausal women with osteopenia confirmed by bone densitometry were included (50 in the treatment group and 50 in the control group). The main stage of the study consisted of 5 visits lasted 12 months. Pain on visual analog scale, quality of life, serum 25(OH)-vitamin D level, markers of bone metabolism (osteocalcin and С-end telopeptides), spine and femur proximal part bone densitometry, thoracic and lumbar spine X-ray so as cases of new fractures registration were used as outcome measures. Results. The results of the study showed positive influence of CP enriched with calcium and vitamin D3 on spine bone mineral density, 25(OH)-vitamin D and С-end telopeptides levels.

Objective. To assess efficacy of different modes of management in women with osteopenia. Material and methods. 190 women with osteopenia of spine and/or femoral neck aged 50 to 70 years (mean 60,6±5 years) were followed up during a year. Different modes of prophylaxis were applied. 59 pts of group 1 received Calcium D3 Nicomed 2 tablets a day, 25 pts of group 2 - Vitrum Osteomag 2 tablets a day, 46 pts of group 3 - calcium carbonate 2500 mg/day, 60 pts of control group received recommendations about diet and physical activity. Results. 3,5% from 114 pts examined had normal 25(OH)D blood level while 23% showed deficiency of vitamin D. Mean calcium consumption with milk products was 350 mg/day. Bone mineral density (BMD) significantly increased on 1,6-1% in pts older than 60 years receiving Vitrum Osteomag and Calcium D3 Nicomed respectively while younger pts did not show such changes. BMD in pts olderthan 60 years receiving calcium carbonate increased on 0,5% but this difference was not significant. Tolerability of all 3 drugs was comparable.

Objective. To study glucocorticoids (GC) clinical efficacy and their influence on active oxygen forms production by circulating phagocytes (neutrophils and monocytes) in pts with systemic lupus erythe- matosus(SLE) receiving traditional treatment with low and intermediate doses of GC so as with pulse- therapy with mega doses of GC. Material and methods. SLE pts were randomly allocated in two groups (15 pts in each). Group 1 was treated with methylprednisolone (MP) 20-40 mg/day during 3 weeks and Group 2 pts received MP mega doses 10 mg/kg as intravenous drip-feed during 3 days with subsequent decrease to maintaining doses. Luminol-dependent and lucigenin-dependent whole blood leucocytes chemiluminescence separately with neutrophils and monocytes so as phagocytic indices and circulating immune complexes (C1C) level were evaluated Results. SLE pts showed increase of active oxygen forms spontaneous production and CIC level so as decrease of induced chemiluminiscence, phagocytes stimulation coefficient and phagocytosis indices. Treatment with intermediate GC doses provided decrease of active oxygen forms synthesis by neu- trophiles and monocytes so as to cell stimulation coefficients increase along with improvement of their digesting capability and decrease of CIC level

Objective. To evaluate the actual practice of diagnostics and treatment of patients with acute tonsillitis in order to assess the quality of primary prophylaxis of poststreptococcal diseases in different regions of Russia. Material and methods. The medical charts of 1333 adult outpts with acute tonsillitis in seven cities were analyzed. The data on each pts such as demographics, case history, bacteriological examinations results, prescribed medications, adverse events and outcomes of therapy were documented in case record forms. Data management was carried out using software. Results. Microbiological identifications of group A-streptococcus (GAS) were performed only in 0,3% of analyzed cases, so diagnosis of tonsillitis was based commonly on clinical data. Systemic antimicrobial drugs were prescribed to 95,3% of pts, among them to 91,5% as monotherapy and to 3,8% as combined therapy. Ampicillin was the most often initial antimicrobial (45,0%), other relatively frequently prescribed drugs were erythomycin (19,1%), ciprofloxacin (7,0%), doxycycline (5,6%), amoxycillin (5,2%), midecamycin (4,4%), ampicillin/oxacillin (3,2%). Two courses of antimicrobials were used in 8,5% of pts. The average duration of antibacterial therapy was 7,4 ± 3,4 days. The adverse events were noted in 0,9% of analyzed cases. Conclusion. The main problems of primary prophylaxis of poststreptococcal diseases were: (1) the diagnosis of tonsillitis without microbiological GAS identification, (2) prescribing antimicrobials without consideration of appropriate recommendation and (3) the lack of pathogen eradication control.

Analysis of statistical indices of annual State accounts Kirgizia Ministry of public health for 1995-2000 showed increase of musculoskeletal diseases morbidity on 25,93% and prevalence - on 32,62% among children. General prevalence of rheumatoid arthritis and connective tissue diseases among children increased to 1999 on 38,43% and number of newly recorded cases to 2000 decreased on 14,69%. In structure of rheumatic diseases in rheumatological department of Institute of obstetrics and pediatrics increased part of joint and spine degenerative diseases. In 2001 such pts constituted 47,8% of all pts with musculoskeletal diseases in that department.

Objective. To give clinical assessment of bone mass main indices in healthy children living in Moscow and Moscow region. Material and methods. 357 healthy children aged 5-16 years (194 male, 163 female) were included. Physical development, bone mineral density (BMD) by 2-power radiological absorptiometry, bone mineral content (BMC) were evaluated. Results. Significant variability of height in children age groups was revealed. 40,2% had disharmonious physical development. BMC and BMD were closely associated with height (r=0,8, p=0,0001) and body mass (r=0,7, p=0,0001). Bone mass indices were proved to be significantly less in children with height and body mass less then 10% percentile. BMD growth rate was less than mineral accumulation rate. Method of body mass clinical assessment in children was elaborated. Conclusion. Application of elaborated tables of conjugated values of anthropometric and densitometric indices allows to decrease of osteopenia overdiagnosis in children and determine causes of insufficient bone mineral content.

Objective. To study frequency of vitamin D deficiency among teenagers of a Moscow sample and its possible influence on bone mineral density (BMD) value. Material and methods. 318 teenagers (139 male, 179 female) aged 14 to 18 years were included. Clinical examination, anthropometry, calculation of daily calcium consumption, densitometry, 25(OH)D serum level, total and ionized calcium level evaluation were performed. Results. Boys consumed more calcium with milky products than girls (p<0,0001). Boys also had significantly higher concentration of total calcium (p<0,02) and 25(OH)D (p<0,0001). Frequency of vitamin D deficiency in girls was 10 times higher than among boys and came to 53,6%. Frequency of vitamin D hypovitaminosis and insufficiency was significantly higher among girls examined in February-March and frequency of vitamin D deficiency significantly prevailed in group examined in November- December (58,8%, p<0,0001). Correlation between serum concentration of 25(OH)D and age, height, weight, body mass index, daily calcium consumption, total and ionized calcium levels, BMD were not found. Girls with vitamin D deficiency aged 14-15 years showed increase of BMD in proximal femur.