Microplastics are a pervasive pollutant in aquatic ecosystems, raising critical environmental and public health concerns and driving the need for advanced detection technologies. Microscopic hyperspectral imaging (micro-HSI), known for its ability to simultaneously capture spatial and spectral information, has shown promise in microplastic analysis. However, its widespread application is hindered by limitations such as low signal-to-noise ratios (SNR) and reduced sensitivity to smaller microplastic particles. To address these challenges, this study investigates the use of Ag nanoarrays as reflective substrates for micro-HSI. The localized surface plasmon resonance (LSPR) effect of Ag nanoarrays enhances spectral resolution by suppressing background reflections and isolating microplastic reflection bands from interference. This improvement results in significantly increased SNR and more distinct spectral features. When analyzed using a 3D-2D convolutional neural network (3D-2D CNN), the integration of Ag nanoarrays improved classification accuracy from 90.17% to 98.98%. These enhancements were further validated through Support Vector Machine (SVM) analyses, demonstrating the robustness and reliability of the proposed approach. This study demonstrates the potential of combining Ag nanoarrays with 3D-2D CNN models to enhance micro-HSI performance, offering a novel and effective solution for precise microplastics detection and advancing chemical analysis, environmental monitoring, and related fields.
Lower limb rehabilitation is essential for recovery post-injury, stroke, or surgery, improving functional mobility and quality of life. Traditional therapy, dependent on therapists' expertise, faces challenges that are addressed by rehabilitation robotics. In the domain of lower limb rehabilitation, machine learning is progressively manifesting its capabilities in high personalization and data-driven approaches, gradually transforming methods of optimizing treatment protocols and predicting rehabilitation outcomes. However, this evolution faces obstacles, including model interpretability, economic hurdles, and regulatory constraints. This review explores the synergy between machine learning and robotic-assisted lower limb rehabilitation, summarizing scientific literature and highlighting various models, data, and domains. Challenges are critically addressed, and future directions proposed for more effective clinical integration. Emphasis is placed on upcoming applications such as Virtual Reality and the potential of deep learning in refining rehabilitation training. This examination aims to provide insights into the evolving landscape, spotlighting the potential of machine learning in rehabilitation robotics and encouraging balanced exploration of current challenges and future opportunities.
Objective: To determine the association of visceral organ involvement in non-specific low back pain.Methods: A cross sectional analytical study was conducted at Max Health Hospital and the Islamabad Healing Center Private Limited from March to November 2020. A total of 384 males and females aged 30 to 50 years, having back pain for at least 3 months, were selected through non-probability purposive sampling. The participants were assessed on a numeric pain rating scale, inclinometer, via the straight leg raise and motility tests for visceral organs, including the stomach, liver, intestine, colon and kidneys. All assessments were carried out on the spot and recorded on structured questionnaires.Results: A total of 320 participants responded. Their mean age was 38.9 years. The most common viscera involved in back pain was the stomach, having a frequency of 296 (37%), followed by the small intestine (n=211). For participants in the30- 35-year age group, the highest reported visceral involvement was the stomach (n=114), followed by the small intestine (n=83) and liver (n=55), respectively. The liver, stomach and small intestine were more involved in the females. There were statistical differences between back pain with visceral involvement and back pain without visceral involvement. All the viscera, namely the liver, stomach, small intestine, colon and kidneys, were significantly associated with back pain (p<0.05).Conclusion: In this study, it was concluded that there is a significant association of visceral organ involvement in participants with non-specific back pain. The most common viscera involved in back pain was the stomach followed by the small intestine, liver, colon and kidneys.
Background
Occipito-mastoid structure normalization (OMSN) is an osteopathy manipulative treatment aiming at reducing tensions around the jugular foramen, where cranial nerves IX, X and XI come out of the skull. Tensions in this area may induce compressions of those nerves, which might imply symptoms related to those nerves dysfunctions (e.g., dysphagia, gastrointestinal issues, cardiac issues, upper body muscle pain, fatigue). Vagus nerve X is the main parasympathetic nerves of this area. Heart rate variability (HRV) is a surrogate for vagal modulation, and purpose of this study was to observe how HRV variables evolved before and after an OMSN.
Methods
Pre- and post- intervention HRV was analyzed in two randomly distributed groups of 15 participants. One received the OMSN and the other a SHAM technique. HRV was collected supine 5 min before and 5 min after a10-minute application of either OMSN or SHAM. HRV was analyzed on the last 4 minutes of the 5 minutes sample in time- and frequency-domain.
Results
HR significantly decreased in both groups (change in mean (CIM) -2.6 (4.3), and -2.3 (2.1) bpm, for NSOM and SHAM, respectively) but without difference between groups (p = 0.245). Vagally-related HRV variable root mean square of successive differences (RMSSD) increased in both groups, but in a significantly higher proportion in OMSN group (CIM 8.1 ±6.4 and 2.8 ±6.2 ms, p = 0.030 for NSOM and SHAM, respectively). No differences between groups were observed on frequency-domain analysis.
Conclusion
Compared to a SHAM technique, OMSN had a significant effect on HRV vagally-related metric RMSSD. This effect was measured in the very short term and thus, OMSN may be used to imply a short-term influence on parasympathetic ANS modulations. Further research are needed to investigate medium and long-term influences of this manipulation.
Adverse events of diabetes mellitus (DM) include bone damages, such as the increased incidence of osteoporosis and bone fractures, which are known as diabetic osteopathy. The pathogenic mechanism of diabetic osteopathy is complex, and hyperglycemia is a vital cause involved in it. Bone marrow mesenchymal stem cells (BMSCs) exert a significant effect on bone formation. Therefore, in this paper, transcriptomic changes of BMSCs cultured in high glucose (35 mM) for 30 days are mainly investigated. In addition, 794 up-regulated genes and 1,162 down-regulated genes were identified. Then, biological functions of the differentially expressed genes in the high glucose microenvironment were investigated by two kinds of functional analyses. Gene Set Enrichment Analysis was also applied to focus on the significant gene sets and it is found that Wnt10b expression witnessed a remarkable decrease in BMSCs under the high glucose microenvironment. At last, in vitro experiments revealed that oleuropein effectively reversed high glucose-induced osteogenic inhibition via activating Wnt10b in BMSCs.
A spatially unambiguous characterization of electrical properties of osseous tissues is important for the therapy of osteopathy via electrical stimulation. Accordingly, the study aimed to characterize the highly inhomogeneous composition and structures of different anatomical regions of trabecular bone based on their electrical properties. The electrical properties of 64 porcine trabecular bone samples were analyzed in a parallel plate electrode configuration and compared with published results. Therefore, a novel method, combining traditional Cole model with a linear discriminant analysis (LDA), was developed to discriminate the different regions, i.e., femur head, greater trochanter, and femur neck. Possible mechanisms behind the distinction for different regions could be interpreted from both methods. Respective adjacent regions with similar structure and composition could be distinguished from statistically significant differences of Cole parameters, i.e., α (p < 0.01) and R∞ (p < 0.05). The latter was correlated especially with water content, indicating an association of individual differences in microstructures in particular with conductivity. Conversely, different regions were unambiguously discriminated with LDA based on permittivity or conductivity. Contributions to the discrimination were explicitly reflected by the coefficients of the derived LDA features. A clear distinction was obtained especially for a frequency response at 950 kHz. Moreover, predictions for the classification of unspecified samples assigned them correctly to their origin with a success of 92.9%. The combination of both methods offers the possibility for a spatially resolved and eventually patient specific discrimination and evaluation of bone tissues and their response to therapies, notably electrical stimulation.
Matthew J. Leach, Per J. Palmgren, Oliver P. Thomson
et al.
Abstract Background Evidence-based practice (EBP) is integral to the delivery of high-quality health care. Chiropractic has been a licensed health profession in Sweden since 1989, but little is known of the uptake of EBP in this professional group. This study explored the self-reported skills, attitudes and uptake of EBP, and the enablers and barriers of EBP uptake, among licensed chiropractors in Sweden. Methods Licensed chiropractors (n = 172) of the Swedish Chiropractic Association (Legitimerade Kiropraktorers Riksorganisation) were invited to participate in an anonymous online questionnaire, using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE) in February 2019. Results Fifty-six (33%) chiropractors completed the survey. Participants were predominantly male, aged 30–49 years, held a Master’s degree, and had received their highest qualification and practiced chiropractic for over a decade. Chiropractors rated their EBP skill-level mostly in the moderate to moderate-high range. The majority of chiropractors reported positive attitudes towards EBP, with most agreeing or strongly agreeing that EBP is necessary in the practice of chiropractic, and that EBP assists in making decisions about patient care. Chiropractors reported an average level of engagement in EBP activities. All participants indicated professional literature and research findings were useful in their day-to-day chiropractic practice. The main perceived enabler of EBP uptake was internet access in the workplace, whereas the main barrier to EBP uptake was lack of clinical evidence in chiropractic. Conclusions Participating chiropractors of the Swedish Chiropractic Association were generally favourable of EBP, though only reported modest levels of EBP-related skills and engagement in EBP activities. Our findings suggest future studies investigating interventions focussed on improving chiropractors’ skills and uptake of EBP are warranted.
Chiropractic, Diseases of the musculoskeletal system
Abstract Background Patients with celiac disease present with not only gastrointestinal symptoms but also extraintestinal manifestations such as anemia, osteopathy, dermatitis herpetiformis, and celiac neuropathy. Despite a fairly wide range of celiac neuropathies, we report a case of the acrodystrophic variant of celiac polyneuropathy, which has not been previously described. Case presentation A 41-year-old Ukrainian male suffered from symmetric, sensorimotor axonal polyneuropathy and encephalopathy associated with celiac disease, which is characterized by severe trophic disorders in the lower extremities (trophic ulcers, hyperkeratosis, and anhidrosis). Acrodystrophic changes in the lower extremities were due to both neurogenic and direct immunoinflammatory damaging effects. Clinical–electrophysiological dissociation was also noted, which was represented by a gross axonal lesion with the preservation of muscle strength. The absence of enteropathic manifestations was accompanied by the pronounced histological changes in the duodenal mucosa by IIIb stage of Marsh. A gluten-free diet in combination with membrane plasma exchange and intravenous pulse methylprednisolone was prescribed to reduce the severity of sensory disorders and regression of encephalopathy within 7 months. Conclusion Celiac disease may be a potential cause of neuropathy and encephalopathy in adult patients. Further immunosuppressive treatment protocols for both intestinal and extraintestinal manifestations of celiac disease are required.
Luca Carnevali, Luca Carnevali, Luca Lombardi
et al.
The osteopathic community has long hypothesized that the autonomic nervous system (ANS) represents one of the putative substrates through which osteopathic manipulative treatment (OMT) can improve body functions that have been altered by musculoskeletal alterations. Heart rate variability (HRV) is an important physiological measure of cardiac ANS activity. Emerging evidence suggests that OMT is associated with HRV changes that (i) are indicative of a larger cardiac vagal modulation, (ii) are independent from the part of the body needing treatment, (iii) occur even in the absence of musculoskeletal alterations. Yet, many questions remain unanswered, the duration of these effects and the specificity of HRV responses to different OMT techniques being perhaps the most critical. Therefore, this paper discusses prospects for future applications of HRV for the study of the influence of OMT on ANS function. Moreover, based on existing studies and preliminary data on the effects of OMT on HRV in specific pathological (hypertension) and physiological (stress exposure and recovery from sport competition) conditions that are commonly associated with increased sympathetic and/or decreased vagal activity, we propose that HRV analysis could be exploited to evaluate the effectiveness of OMT as a preventive or complementary strategy in clinical and non-clinical conditions characterized by ANS imbalance.
INTRODUCTION: Chronic liver disease is a risk factor for osteoporosis, osteopenia and bone fractures. In this study, osteoporosis prevalence, risk factors, vitamin D deficiency and effects on survival were investigated in 218 chronic liver disease Turkish patients awaiting liver transplantation retrospectively.
METHODS: Risk factors for osteoporosis (gender, age, BMI, etiology, smoking, alcohol use), serum bilirubin, albumin, 25-hydroxy (OH)D, parathyroid hormone levels, bone mineral density (BMD) with DEXA, MELD and Child Pugh(CP) scores were recorded. Effects of vitamin D levels and BMD on survival were evaluated.
RESULTS: 147 (67.4%) patients were female (mean age, 50.4±11.7). Data of the BMD were established in 218 patients and 25-OH D levels in 122 patients. Mean serum 25-OH D level was 14.26±9.44 ng/ml. Osteoporosis was identified in 42 (19.3%) and osteopenia in 115 (52.8%) patients according to BMD (table 1). No statistically difference was found including risk factors, etiology, BMI, CP classification, MELD, albumin, total bilirubin, Ca, PTH between osteoporotic and non-osteoporotic patients. Patients were followed-up for median 30.07±11.83 months after BMD measurement. 54 (24.8%) died during the follow-up period, non of them related bone fracture. There is no statistically difference on survival between osteoporosis group (32.2±2.3 months) and non-osteoporosis group (37.2±1.7 months; p=0.26) (figure1) or between deficieny of vitamin D groups (table 2).
CONCLUSION: The prevalence of osteoporosis and osteopenia were consistent with the prevalence of osteoporosis reported 12-55% in the literature. Although we didn’t identify any factors that statistically influence the relationship between survival and osteoporosis, cirrhotic patients should be screened for osteoporosis and vitamin D deficiency and treated appropriately.
Diseases of the digestive system. Gastroenterology
Purpose Peer assessment provides a framework for developing expected skills and receiving feedback appropriate to the learner’s level. Near-peer (NP) assessment may elevate expectations and motivate learning. Feedback from peers and NPs may be a sustainable way to enhance student assessment feedback. This study analysed relationships among self, peer, NP, and faculty marking of an assessment and students’ attitudes towards marking by those various groups. Methods A cross-sectional study design was used. Year 2 osteopathy students (n= 86) were invited to perform self and peer assessments of a clinical history-taking and communication skills assessment. NPs and faculty also marked the assessment. Year 2 students also completed a questionnaire on their attitudes to peer/NP marking. Descriptive statistics and the Spearman rho coefficient were used to evaluate relationships across marker groups. Results Year 2 students (n= 9), NPs (n= 3), and faculty (n= 5) were recruited. Correlations between self and peer (r= 0.38) and self and faculty (r= 0.43) marks were moderate. A weak correlation was observed between self and NP marks (r= 0.25). Perceptions of peer and NP marking varied, with over half of the cohort suggesting that peer or NP assessments should not contribute to their grade. Conclusion Framing peer and NP assessment as another feedback source may offer a sustainable method for enhancing feedback without overloading faculty resources. Multiple sources of feedback may assist in developing assessment literacy and calibrating students’ self-assessment capability. The small number of students recruited suggests some acceptability of peer and NP assessment; however, further work is required to increase its acceptability.
Bruno Bordoni,1 Fabiola Marelli,2,3 Bruno Morabito,2–4 Francesca Cavallaro,5 David Lintonbon6 1Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific, Milan, Italy; 2CRESO, School of Osteopathic Center for Research and Studies, Department of Fascial Osteopathic Research: FORe, Gorla Minore, Italy; 3CRESO, School of Osteopathic Center for Research and Studies, Department of Fascial Osteopathic Research, Fano, Italy; 4Sapienza University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences, Rome, Italy; 5ICOM, International College of Osteopathic Medicine, Torino, Italy; 6London School of Osteopathy, Department of Osteopathic Technique, London, UK Abstract: Fibromyalgia (FM) syndrome is a chronic condition causing pain, affecting approximately 0.5%–6% of the developed countries’ population, and on average, 2% of the worldwide population. Despite the large amount of scientific literature available, the FM etiology is still uncertain. The diagnosis is based on the clinical presentation and the severity of the symptomatology. Several studies pointed out pathological alterations within the central nervous system, suggesting that FM could originate from a central sensitization of the pain processing centers. Research supports the thesis of a peripheral neuropathic component, with the finding of axonal damages. The fibromyalgia patient has many myofascial system abnormalities, such as pain and fatigue, impairing the symptomatic profile. This paper revises the myopathic compensations, highlighting the possible role of the fascia in generating symptoms, being aware of the new information about the fascia’s activity in stimulating inflammation and fat cell production. Keywords: fibromyalgia, fascia, pain, myofascial, neuropathic pain
In order for osteopathy to be included in the system of medical services in France, it is necessary to assess the effectiveness and its role in public healthcare and preventive care. The article suggests studying the research methods adapted to the applied research of osteopathy, with the integration of human and subjective measurement of this new branch of medicine. It is necessary to do research on separating the technical part of the osteopathic session from the relational part using the tools of analysis of evidence-based medicine in order to offer a rational perception-focused practice. Moreover, the therapeutic status of osteopathy should be discussed.It is important to create epistemology of osteopathy, to defi ne dysfunction, to clarify techniques, their purposes and effectiveness, to evaluate a treatment session from the point of view of psychology, anthropology, sociology, and philosophy, in addition to clinical research.
Цель. Изучить влияние полиморфизма эстрогеновых рецепторов α (ЭР-α) на показатели минеральной плотности костей (МПК) и риск переломов больных с хронической болезнью почек (ХБП), получающих лечение гемодиализом. Материал и методы. Для изучения полиморфизма генов использовались образцы ДНК, полученные из ядер лимфоцитов крови больных, получающих лечение гемодиализом. Средний возраст исследуемых пациентов составил 43,7±12,5 лет (от 20 до 62 лет). Для анализа полиморфизма ЭР-а была использована 1 Ед Taq полимеразы и 0,4 μМ олигонуклеотидных праймеров. 1,3-kb фрагмент содержащий PvuII или XbaI полиморфизм в интроне 1 гена ЭР-а был получен полимеразной цепной реакцией (ПЦР), которая выполнялась стандартным способом. Затем ПЦР продукт с помощью рестриктивных эндонуклеаз PvuII или XbaI был гидролизован и расщеплен посредством электрофореза в 2,0% агарозном геле. Наличие зоны рестрикции для каждой эндонуклеазы обозначалось малыми буквами (p, x), тогда как отсутствие зоны рестрикции обозначалось прописными буквами P, X. Выделялись генотипы pp, Pp, PP для эндонуклеазы PaulI и xx, Xx, XX для эндонуклеазы XbaI. Пациенты классифицировались как гомозиготные (pp, xx, PP, XX) и гетерозиготные (Pp, Xx). Результаты. Распространенность аллели «X» в изученной выборке пациентов составила 30,2%, аллели «x», соответственно - 69,8%. Пациенты выделенных подгрупп существенно не отличались по возрасту, продолжительности гемодиализа. Также существенно не отличались и основные показатели фосфорно-кальциевого обмена в подгруппах, выделенных по генотипу XX; Xx; xx. Пациенты с дефицитом МПК, по критерию Z, в трех изученных отделах скелета чаще встречались в подгруппе с генотипом Xx. Реже всего дефицит МПК выявлялся у пациентов с генотипом XX. Однако дисперсионный анализ показателей МПК у больных с ХПН в подгруппах, выделенных по генотипу ЭР-а (XX; Xx; xx) не обнаружил статистически достоверных различий (p>0,05). При анализе показателей МПК отдельно у пациентов мужского и женского пола также достоверных различий между генотипами ЭР-а (XX; Xx; xx) не обнаружено (p>0,05). Переломы были зарегистрированы у 3 пациентов с генотипом XX (30%), 8 пациентов с генотипом Xx (25%) и 11 пациентов с генотипом xx (25%). Распространенность аллели «P» в изученной группе пациентов составила 39,5%, аллели «p», соответственно - 60,5%. Пациенты выделенных подгрупп существенно не отличались по возрасту, продолжительности гемодиализа. Достоверно не отличались и основные показатели фосфорно-кальциевого обмена в подгруппах, выделенных по генотипу ЭР-а PP; Pp; pp. Пациенты с дефицитом МПК, по критерию Z, в трех изученных отделах скелета чаще встречались в группе с генотипом PP. Дисперсионный анализ показателей МПК у больных в подгруппах, выделенных по генотипам ЭР-а (PP; Pp; pp), не подтвердил статистически достоверных различий. При анализе показателей МПК у пациентов мужского и женского пола также достоверных различий между обладателями генотипов ЭР-а (PP; Pp; pp) не обнаружено (p>0,05). Переломы были зарегистрированы у 5 пациентов с генотипом PP (26,3%), 8 пациентов с генотипом Pp (26,7%) и 9 пациентов с генотипом pp (24,3%). Выводы. Дефицит МПК чаще встречался у носителей генотипов Xx и PP. При этом процент больных с переломами был больше в подгруппе с генотипом XX. Однако, достоверных различий показателей МПК, оцененных по критерию Z между носителями различных генотипов также обнаружено не было.
Медикаментозная терапия постменопаузального остеопороза (ПМО) является основным видом лечения данного заболевания. Длительность лечения - обязательное условие, определяющее эффективность терапии. Способ и метод введения (пероральный или парентеральный) определяют приверженность к данному виду лечения ПМО. Цель. Оценить состояние минеральной плотности костной ткани (МПК), уровень маркеров костного метаболизма, приверженность и переносимость терапии у больных с ПМО при применении пероральных и внутривенных бисфосфонатов. Материал и методы. Обследовано 69 женщин с подтвержденным диагнозом ПМО в возрасте от 46 до 81 года (59,5±8,3 года). Все пациенты были разделены на две группы: первую группу составили 36 женщин, которым назначен комбинированный препарат (алендроновая кислота 70 мг и витамин Д 2800 МЕ, «Фосаванс», MSD) с пероральным приемом 1 раз в неделю, вторую группу - 33 женщины, для лечения ПМО назначена золендроновая кислота 5 мг («Акласта», Novartis), внутривенно 1 раз в год. В обеих группах на протяжении всего лечения пациентки дополнительно принимали препараты кальция и витамина Д. Всем больным выполнялась двухэнергетическая рентгеновская абсорбциометрия с помощью денситометра (Hologic Discovery) в начале исследования, через 12 и 24 месяца лечения. Оценивалась МПК поясничных позвонков (L1-L4) и проксимальных отделов бедра, согласно критериям ВОЗ. Всем пациенткам проводилось определение 25-гидроксивитамина Д, уровня креатинина, паратиреоидного гормона, остеокальцина. Маркер резорбции костной ткани (Сtх) оценивался изначально, через 3 и через 12 месяцев терапии. Результаты. По данным остеоденситометрии остеопороз поясничного отдела позвоночника выявлен у 37 женщин, бедра - у 20, остеопороз обеих локализаций - у 12 больных. Уровень ионизированного кальция в среднем составил 1,11±0,02 ммоль/л, остеокальцина - 26,1±1,7 нг/мл, 25-гидроксивитамина Д - 31,6±2,7 нг/мл, паратиреоидного гормона 52,5±4,3 пг/мл, уровень креатинина был в норме у всех больных. Количество пациентов, полностью завершивших лечение было разным в двух группах: терапию акластой не закончила одна женщина, от приема таблетированных препаратов отказалось 16 пациентов. Причинами для прекращения лечения явились: обострения заболеваний ЖКТ, невозможность соблюдения инструкции приема, снижение МПК по данным денситометрии. Новых переломов за время лечения в обеих группах выявлено не было. Во второй группе после введения препарата гриппоподобный синдром наблюдался у 11 пациентов (33,3±8,2%) с максимальным повышением температуры до 38,4°, данные симптомы купировались в течение 1-2 суток без терапии или с использованием НПВС. В среднем, BMD (L1-L4) до лечения и через 2 года после лечения у женщин первой группы составила 0,780± 0,009 г/см2 и 0,811±0,011 г/см2, соответственно (р<0,05), BMD (шейки бедра) - 0,611±0,046 г/см2 и 0,632±0,042 г/см2 (р>0,05). Во второй группе прирост МПК был более выраженным и наблюдался во всех отделах. Так, в поясничном отделе позвоночника BMD до лечения - 0,748±0,056 г/см2, через 24 месяца - 0,899±0,054 г/см2 (р<0,05). Уровень С1х у всех пациентов достоверно снизился и составил: у женщин первой группы 0,381±0,029 нг/мл, и 0,286±0,027 (р<0,01), у больных второй группы: 0,437±0,025 нг/мл и 0,181± 0,034 нг/мл, (р<0,001). Заключение. Парентеральный способ введения бисфосфонатов показал большую эффективность, хорошую переносимость и более высокую приверженность к проводимой терапии.
This review of the literature has been dedicated to experimental and clinical studies of mechanism of action and efficacy of 1—34 amino acid fragment of parathyroid hormone — teriparatide as well as others contries experience of its prescribtion. Teriparatide is an osteoanabolic agent which stimulates bone formation by affecting bone modeling and by stimulating bone remodeling. The effects on modeling lead to increased bone formation whereas the effects on bone remodeling lead to increased bone turnover. Thus, in its mode of action teriparatide differs from all others medicines currently available to treat osteoporosis. Daily subcutaneous injections of teriparatide are proved to be effective to prevent low-traumatic vertebral and non-vertebral fractures in postmenopausal women with the history of vertebral fractures. Teriparatide is effective to treat osteoporosis in male and even more effective than alendronate to treat glucocorticoid-induced osteoporosis. Due to high cost and some restriction related to the duration of therapy (up to 18 months in Russia and 24 months in others countries) teriparatide should be recommended to treat severe osteoporosis in patients with a history >1 moderate clinical vertebral fracture or two or more vertebral fragility fractures or in case the previous treatment was not effective. Teriparatide should be prescribed after bisphosphonates or other antiosteoporotic treatment, but not in the combination with bisphosphonates. The prescribtion of bisphosphonates after teriparatide is effective to maintaine and further improve the effect. Thus, teriparatide is effective to treat severe osteoporosis and osteoporosis resistant to other therapy.