Falls in the elderly require close attention from specialists of various profiles due to their high frequency, association with severe injuries, and the risk of death, loss of autonomy. Falls determine the prognosis of life and are closely related to other geriatric syndromes. Falls in patients with osteoporosis increase the probability of fractures, in particular, hip fractures. Unjustified refusal of surgical treatment for elderly patients with hip fractures leads to death or loss of autonomy within a year after the injury. The lack of drug therapy for osteoporosis after surgical treatment of a fracture significantly worsens its results, leads to the risk of repeated fractures, and increases the burden on the healthcare system. The guidelines/methodological recommendations contain structured information on the organization of falls prevention, primary and secondary prevention of fractures from low-energy trauma related to osteoporosis, the organization of medical care for patients with hip fractures, and the infrastructure of medical and social care for elderly and senile patients. Their implementation at all stages of medical and social care will ensure healthy aging, preserve the quality of life and autonomy of the elderly.

BACKGROUND. Nutritional status plays a key role in determining the functional state of older adults. According to global literature, insulin-like growth factor 1 (IGF-1) is a reliable biomarker of nutritional status. However, IGF-1 measurement has not yet been integrated into routine clinical practice, and studies investigating its associations with other nutritional markers in long-lived individuals remain limited. Understanding these relationships is particularly important for gaining deeper insights into the metabolic processes influencing health and functional status in advanced age.
OBJECTIVE: to assess the association between IGF-1 levels and markers of nutritional status and inflammation in long-livers.
MATERIALS AND METHODS. It was a cross-sectional study on the cohort of long-livers. The search for participants was carried out with the involvement of social services, nursing homes, geriatric centers, and other geriatric services. The study was reviewed by the ethics committee (№ 30 24.12.2019). The statistical analysis was performed using R version 4.4.0.
RESULTS. The study included 1 450 individuals aged 90 to 104 years who met the inclusion criteria. The median age of the participants was 92 years, and the median IGF-1 level was 101 ng/mL. Regression analysis revealed that higher IGF-1 levels were associated with increased concentrations of hemoglobin, total protein, albumin, creatinine, total cholesterol, vitamin D, and leptin. Conversely, IGF-1 levels were negatively associated with ferritin, Creactive protein, and estimated glomerular filtration rate.
CONCLUSIONS. The findings indicate that IGF-1 is associated with key markers of protein and lipid metabolism, iron status, and inflammation. The strongest inverse association was observed between IGF-1 and ferritin levels, suggesting a potential role of IGF-1 in iron metabolism regulation. However, most of the observed associations, while statistically significant, lack strong clinical relevance. These relationships warrant further investigation in longitudinal studies.

Age-associated changes in the muscular system are traditionally assessed through indicators of strength (dynapenia) and mass (sarcopenia). However, clinical experience suggests that the most significant factor for the quality of life of geriatric patients is the decline in muscle functional capacity. This article proposes defining this condition as ergopenia, i.e., a reduction in muscle functional capacity in the presence of preserved muscle strength and/or mass. It presents an analysis of the pathophysiological mechanisms underlying the decline in muscle function, examines their clinical significance, and describes diagnostic approaches. These approaches are compared with standardized methods for assessing muscle strength and muscle mass.

These guidelines examine the complex relationships between the gut microbiota and the aging process. They analyze the potential of therapeutic approaches aimed at microbiome correction through the use of metabiotics, presenting this as a promising strategy to increase both the lifespan and healthspan in geriatric populations. The advantages of incorporating metabiotics into the comprehensive therapy of certain diseases in elderly and senile patients are detailed.

Increased life expectancy and advances in modern medicine contribute to an annual increase in the number of people over 65. The incidence of most oncological diseases peaks among older age groups. Lung cancer is one of the most serious public health problems worldwide among the elderly. On the one hand, this disease is one of the commonest and most aggressive, requiring comprehensive treatment. On the other hand, choosing the appropriate surgical intervention for the elderly poses a difficult dilemma. From the perspective of oncological radicalism, lobectomy is considered the minimum acceptable surgical treatment for lung cancer. However, elderly and senile patients with comorbidities and geriatric syndromes often cannot undergo such an operation, which is the reason for refusing surgical intervention. In these cases, alternative non-surgical treatments are prescribed, but in most cases they are not sufficiently radical, leading to frequent and rapid relapses of the disease. Recently, thoracic surgeons have actively studied the applicability of sublobar resections for malignant lung pathology, and most scientific studies confirm that lobectomies are more effective than less extensive procedures. Only in rare cases of early-stage IA lung cancer can sublobar resection demonstrate comparable efficacy with lobectomy. The undoubted advantage of less extensive procedures is less surgical trauma, preservation of a portion of lung parenchyma, significant reduction in perioperative complications and improved quality of life for patients undergoing surgery. This advantage can be a valid argument in favor of sublobar resection for early lung cancer in patients with comorbidities as well as elderly and geriatric patients.
MATERIALS AND METHODS: A search for scientific sources was conducted using PubMed, Medline and Elibrary databases. The timeframe for the search was 2019-2025. Based on these and other criteria, 177 articles were analyzed. Of these, 67 met the inclusion criteria.

Osteoporosis in the elderly (≥90 years) is a key factor in disability and mortality due to the high risk of fractures, particularly at the hip. The leading role in the pathogenesis is played not so much by decreased bone mineral density but by deterioration of bone microarchitecture, sarcopenia, chronic inflammation, and a high rate of falls. Diagnosis with standard methods is often difficult, and treatment requires a comprehensive geriatric approach. Modern medications (bisphosphonates, denosumab, and teriparatide) are effective; however, their use requires strict individualization, taking into account comorbidities, renal function, and life expectancy. Oral bisphosphonates, particularly ibandronic acid, with once-monthly dosing, demonstrate a favorable safety and efficacy profile even in the very elderly. Fall prevention and nutritional management are key.

Hypertension and osteoporosis are among the most prevalent chronic non-communicable diseases in older adults, often determining their quality of life, disability rates, and mortality. According to large-scale international epidemiological studies, the prevalence of hypertension in adults aged 18 years or older reaches 31 %, while low bone mass (osteopenia/osteoporosis) affects more than 40 % of older individuals. In recent decades, it has been demonstrated that the risk of an osteoporotic fracture in patients with hypertension is 1.33 times higher than in those without hypertension, and the association between hypertension and fractures is stronger in women than in men. In this context, antihypertensive therapy becomes particularly important in the management of patients with both hypertension and bone disorders, which requires evaluating its effects not only on cardiovascular outcomes but also on prevention of osteoporosis and low-energy fractures. We have reviewed current experimental and clinical studies, including meta-analyses, to synthesize the available knowledge in this field. The strongest evidence points to a protective effect on bone metabolism for thiazide diuretics, angiotensin receptor blockers (ARBs), and selective beta-blockers, which may be recommended for patients with hypertension and osteopenia/osteoporosis. Drugs whose use may be associated with an increased risk of developing or worsening osteopenia and osteoporosis include loop diuretics and alpha-blockers; this requires particular attention to fracture risk assessment and prevention when these agents are prescribed. Overall, the data from most studies remains heterogeneous, and their results often conflict. Therefore, further research is needed on the effects of antihypertensive drugs on bone metabolism.

In this article, we present key provisions regarding epidemiology, clinical features, diagnosis and treatment for osteoarthritis as previously published in Methodological Recommendations. We have prepared information aimed at optimizing and personalizing the treatment of patients aged 60 and older with osteoarthritis.

Polymyalgia rheumatica (PMR) is a chronic disease affecting the musculoskeletal system in patients over 50 years of age and is characterized by bilateral restriction of movement in the shoulder and hip joints, as well as prolonged morning stiffness. This disease is characterized by an increase in the erythrocyte sedimentation rate and the concentration of C-reactive protein in the blood. A clinical case of PMR in a 67-year-old patient with postmenopausal osteoporosis, which complicates treatment with glucocorticoids, is described. In addition to the mandatory diagnostic criteria, additional signs were identified, the total of which amounted to 6 points: morning stiffness lasting more than 45 minutes (2 points), pain in the hip joints and limited mobility of those joints (1 point), absence of an increase in the level of rheumatoid factor in the blood serum (2 points), and the presence of ultrasound signs of synovitis and tenosynovitis of the long head of the biceps muscle in both shoulder joints (1 point). A positive trend in clinical condition and laboratory parameters was observed during the treatment of PMR with methylprednisolone. The monitored parameters of bone mineral density of the spine and femoral neck indicated that continuation of denosumab therapy for the prevention of recurrent fractures, initiated even before the diagnosis of PMR due to concomitant postmenopausal osteoporosis, was advisable during glucocorticoid administration.