Endocrine Abstracts

Introduction: Osteoporosis is a serious problem all over the world. The presence of low-energy fractures increases the risk of repeated fractures twice. Each new fracture increases the risk of a fatal outcome in the future. Globally, the most effective model of re-fractures preventing in patients with osteoporosis is a Fracture Liaison Service (FLS). FLS main objectives are identification of patients, assessment of re-fractures risks, diagnosis and initiation of osteoporosis therapy. In our hospital, this service has been operational since 2017.

Clinical case: Woman, 72 years old, with a fall from the height growth, suffered a fracture of the left proximal shoulder. She was hospitalized in the trauma department of the City Clinical Hospital No. 13. This fracture in the patient is not the first. In 2015, she underwent several compressive vertebral fractures. Currently, anti-osteoporotic drugs do not take. Also, suffers from rheumatoid arthritis. The onset of menopause in 50 age. When examining: there is curvature of the spine by type ‘widow’s hump’. Growth of 146 cm (decreased by 10 cm in height), 46 kg of BMI 21.6 kg/m². According to laboratory tests: vitamin D deficiency was found to be 8.4 ng/ml (<20-deficiency), an increase in the level of alkaline phosphatase 179 (0–120) U/l. The rest of the laboratory parameters were within norms: calcium 2.26 (2.15–2.55) mmol/l, phosphorus 1.38 (0.81–1.45) mmol/l, parathyroid hormone 82.4 (12.0–88.0) pg/ml, creatinine 46 (44–80) umol/l. The result of densitometry (DEXA): severe systemic osteoporosis with a very significant loss of bone mineral density. (T-score L1-L4 -4.5, neck of the left hip -4.4). But the worst result was in calculating the risk of repeated fractures with the FRAX^® Calculation Tool, which showed a more than 50% chance of recurrent fractures and a 32% chance of a hip fracture (this is an extremely high risk). In connection with this, the patient began to take the prescribed pathogenetic anti-osteoporotic therapy and supplements of calcium and vitamin D immediately, in the hospital. We hope that the treatment started will reduce such high risks and protect against the most dangerous fracture of the hip.

Discussion: The introduction of the FLS into the practice of the City Hospital in Moscow is real and justified. This will help identify patients with the highest risks and will allow timely initiation of anti-osteoporotic therapy, thereby reducing the risks of fractures in the future.