Aim – to study adherence prior hospitalization, and the most important factors of adherence in hospitalized patients with a diagnosis of acute coronary syndrome (ACS). Materials and methods. This study included all patients admitted to the Cardiology Department of the Clinical Hospital № 2 Lyubertsy with a diagnosis of ACS. All the patients were asked to complete a questionnaire on assessing adherence during their stay in hospital. Results. Under obtain preliminary results (six months from the start of the study) the study included 130 patients with ACS: 79 men and 51 women. Half of the patients (n = 61) are constantly observed by a doctor, and the other half almost did not seek for medical help. According to the Moriscos–Green test 71 persons (54.6 %) were adherented to medical treatment, 55 patients were found to have low adherence to therapy. Only 42 patients, one-third of the survey participants took all drugs recommended by the doctor . Less than 9 % of patients hospitalized with diagnosis of ACS took statins, one third of patients were recommended to take aspirin. Primary cause of recommendations for medical therapy is forgetfulness (18.5 %), about 10 % of patients are afraid of the side effects of drugs. The main way to improve patient adherence to therapy was mentioned like information from the doctor about the possibility of improving the life and disease prognosis (62.3 %), quality of life, improving well-being(25.8 %), only 4 patients (3 %) were totally unwilling to comply with medical recommendations. Conclusion. Specially designed questionnaire gave possibility to assess a number of facts (very low prescription of some of the main groups of cardiac drugs, high mortality) identified in the study of the, and their possible causes. In addition to the personal factors of patients (forgetfulness), the main causes of poor adherence to treatment is the lack of awareness of patients about their illness, the possibilities of modern therapy, which has demonstrated the contribution of medical (teaching-information, which forms the motivation) factor in the problem of treatment compliance.

The article presents review of literature dedicated to the contemporary view on the cellular-molecular mechanisms of the bone remodeling and pathogenesis of the osteoporosis. The discovery of the cytokine RANKL-RANK-OPG system and significant role of the cathepsin K in process bone remodeling has made progress in understanding the mechanisms development disease and possible to development drugs of the new generation – denosumab, a fully human RANKL monoclonal antibody and inhibitor cathepsin K odanacatib that inhibits of the bone resorption.

The given clinical example presents a case of concomitant diseases of the heart and axial skeleton. Calcific aortic stenosis detected by chance in an elderly male was associated with osteoporosis of the lumbar spine with moderate perturbation of the calcium–vitamin D–parathyroid hormone axis and with no classical risk factors for impaired bone mineral density. Possible approaches to pathogenetic therapy are described.