Mankhwala othandiza kuthandizira kupuma kwa mafupa amachititsa kuti mafupa awonjezeke kwambiri ndipo amachititsa kuti anthu omwe ali ndi matenda odwala matenda odwala matenda odwala matenda odwala matenda odwala matenda odwala matenda odwala matenda odwala matendawa azikhala ndi mavuto ena. Kodi muyenera kudziwa chiyani za mankhwalawa?
Kumvetsa Kufooka kwa Mitsempha
Matenda a osteoporosis ndi ofala kwambiri omwe amaphatikizapo mafupa omwe afooka komanso akutupa. Nthaŵi zina amatchedwa "matenda otupa mafupa," matenda otupa mafupa amafooketsa mafupa kuti mitsempha ingathe kuchitika mosavuta.
Izi zowonongeka sizongowonjezera kulemala komanso kukhala ndi moyo wochepa koma ndizo zimayambitsa matenda komanso imfa pamene anthu akula.
Osteopenia sikuti ndi matenda koma imakhala ndi mafupa ambiri. Izi ndi zosavuta kufotokoza poyerekezera ndi zilembo za T pamayesero amphamvu a mafupa, omwe minofu yanu imakhala yofanana ndi munthu wamkulu wathanzi. Pachiyeso ichi, zilembo za T za 1.0 kapena zapamwamba zimaonedwa ngati zachilendo. Mphindi ya -2.5 kapena kuchepa amasonyeza kuti matendawa ndi osteoporosis. Osteopenia alipo ngati zilembo T zili zazikulu kuposa -2.5 koma zochepa kuposa -1.0. (Kwa iwo omwe ali ndi chidwi, chiwerengero chilichonse chimatanthawuza kusintha kwa chikhalidwe chimodzi).
Kwa omwe ali ndi matenda ofooka, tili ndi mwayi wokhala ndi magulu angapo a mankhwala omwe angapangitse kuti mafupa asapangidwe komanso kuchepetsa ngozi. Ngakhale kuti matenda a osteopenia sagwidwa ndi matenda, anthu omwe ali ndi matenda a osteopenia omwe ali pangozi yowonjezera matenda odwala matenda odwala matenda a mitsempha kapena ofooka amatha kuganizira mankhwala.
Pogwiritsidwa ntchito pofuna kuchiza osteopenia, mlingo wa mankhwala ena (koma osati onse) ndi ochepa kuposa omwe amagwiritsidwa ntchito pa matenda a osteoporosis.
Kuyesedwa kwa Osteopenia ndi / kapena Matenda Osteoporosis
Anthu ena amadziwa kuti ali ndi matenda odwala matenda a mitsempha atagwidwa. Aliyense akhoza kuthyoka, koma ziphuphu zomwe zimapezeka m'mapfupa omwe amakhudzidwa ndi matenda a mitsempha nthawi zambiri zimakhala ndi zovuta zochepa.
Mwachitsanzo, mnyamata wathanzi akhoza kuthandizira kupweteka kwa m'chiuno mwa ngozi yaikulu ya galimoto. Mwamuna wachikulire amene ali ndi matenda odwala matenda a m'magazi amatha kugwa mofanana ndi kugwa kofatsa.
Njira yina yodziwira ngati mwataya mafupa ndi kukhala ndi mayeso opafupa . Mayeso omwe amachitika kawirikawiri ndi mayesero awiri a mphamvu ya absorptiometry kapena DEXA. Ndikofunika kuti amayi onse opitirira zaka 65 ndi amuna onse opitirira zaka makumi asanu ndi awiri (70) ayesedwe. Anthu ena omwe ali ndi chiopsezo cha matenda odwala matenda a mitsempha ayenera kuyesedwa kale.
Maphunziro a Mankhwala
Pali mitundu yosiyanasiyana ya mankhwala omwe angagwiritsidwe ntchito pa matenda a osteoporosis malingana ndi chifukwa cha fupa lanu lakufa ndi zina. Mankhwalawa amagwira ntchito zosiyanasiyana popanga fupa kapena kuteteza mafupa. Amene amagwiritsidwa ntchito m'kanswe amatha kuteteza mitsempha ya mafupa (kufalikira kwa khansa ku fupa) kwa anthu ena. Maphunziro awa ndi awa:
- Bisphosphonates
- Sewergen receptor modulators (SERMS)
- Chithandizo cham'madzi chosakanikirana (estrogen)
- Calcitonin
- Hormone ya parathyroid
- Mankhwala osokoneza bongo kwa anthu omwe ali ndi khansa
Tiyeni tiyambe ndi ndemanga mwachidule ya mafupa a mafupa ndi ntchito kotero kuti kufotokozera momwe mankhwalawa akugwirira ntchito bwino.
Ntchito Yamtundu
Anthu ambiri amaganiza kuti mafupa ndi "amoyo" koma mafupa athu ndi otanganidwa. Thupa liri kusweka nthawi zonse ndi kumangidwanso. Ngati munayamba mwalakwitsa izi zikuonekeratu. Mphuno ya mafupa imatha kuchiritsa mwazimene zimapanga mafupa atsopano komanso kuchotsa fupa losakaza.
Pali mitundu iwiri ikuluikulu ya maselo a mafupa. Mmodzi ndi osteoblasts , maselo omwe amapanga fupa. Yina ndi osteoclasts , maselo omwe amathyola ndi kuchotsa fupa. Nthaŵi zambiri pali kusiyana pakati pa njira ziwirizi kuti mafupa (atakhala mwana) akhalebe mofanana ndi kukula kwake pa nthawi.
Hormone ya parathyroid (PTH) ndi mahomoni opangidwa m'matupi athu omwe amayendetsa bwino pakati pa mafinya ndi mafinya kuti asunge mafupa amphamvu ndikukonzekera kuwonongeka kulikonse. Mavitamini D ndi calcium onse ndi ofunikira kupanga ndi kukonza mafupa abwino.
Tiyeni tiyang'ane pa magulu osiyana siyana a mankhwala ogwidwa ndi mafupa ndi momwe amachitira kumanga mafupa ndi / kapena kuteteza imfa.
Bisphosphonates
Bisphosphonates ndi gulu la mankhwala opatsirana osteoporosis omwe anayamba kukhalapo m'ma 1990. Mankhwalawa amachepetsa ntchito ya osteoclasts (imasiya kuwonongeka kwa fupa) kuti achepetse mafupa. Izi zimabweretsa chiwongolero chokwanira m'maso.
Oposa 95 peresenti ya odwala omwe amachizidwa ndi bisphosphonates amawonjezera kuchuluka kwa mafupa awo. Mankhwalawa, amasiyana mosiyana ndi momwe amalephera kugwiritsira ntchito fractures, momwe amagwiritsidwira ntchito, ndi zina zomwe zimawopsa.
Ngati mwauzidwa, simuyenera kutenga bisphosphonates kwa moyo wanu wonse. Pambuyo pa zaka zitatu kapena zisanu zokonzanso mafupa anu, madokotala angalimbikitse odwala omwe ali ndi chiwopsezo chochepa cha kuvomereza amatha kuwatenga, malinga ndi momwe bungwe la US Food and Drug Administration likuyendera.
Mankhwala mu kalasi ya bisphosphonate ndi awa:
- Actonel (risedronate): Actonel wakhala akuwonetseredwa kuti amachepetsa kwambiri chiopsezo cha kupweteka kwa m'chiuno mwa amayi omwe ali ndi matenda odwala matenda a m'mimba (60 peresenti mu zaka zitatu) ndi anthu omwe amatenga steroid (mwa 70 peresenti m'miyezi 12).
- Fosamax (alendronate) : Fosamax yasonyezedwanso kuti yowonjezera mitsempha ya mafupa ndipo imachepetsa chiopsezo cha kupweteka kwa msana.
- Boniva (ibandronate): Boniva ndi bisphosphonate yomwe ingatengedwe pamlomo ndipo imapezedwa ndi jekeseni. Boniva amachepetsa chiopsezo cha kupweteka kwa msana koma sichinawonetsedwe kuti achepetse chiwopsezo cha kupweteka kwa m'chiuno, kotero mwina sungasankhe bwino kwa iwo amene ali ndi chiuno kapena zina zomwe sizingaperekere msana.
- Kuwombera kapena Zometa (zoledronic acid): Kuwombera kapena Zometa amaperekedwa kokha kamodzi pa chaka (kwa matenda osteoporosis) kapena mwa jekeseni.
Zotsatira za bisphosphonates zimadalira pa mankhwala enieni komanso m'mene zimaperekedwa. Ndi mankhwala am'kamwa, kunyalanyaza, kupweteka kwa mtima, ndi kutupa kochepa kwambiri kungachitike. Anthu akulangizidwa kuti azitenga mankhwalawa ndi madzi (madzi a lalanje ndi khofi akhoza kusokoneza kuyamwa) ndipo akhalebe owongoka kwa mphindi 30 mpaka 60. Kupweteka kwa minofu ndi kupweteka kwa mutu kungathenso kuchitika.
Chinthu chosavuta kwenikweni, makamaka ndi Reclast kapena Zometa, ndi osteonecrosis ya nsagwada. Zotsatira zina zosayembekezereka zingaphatikizepo kuphulika kwa femur ndi mafinyria oopsa.
Selective Estrogen Receptor Modulators (SERM)
SERMS ndi mankhwala osangalatsa kwambiri chifukwa ali ndi zotsatira zotchedwa estrogen pamagulu ena (monga mafupa) ndi zotsatira za anti-estrogen mwa ena (monga minofu ya m'mawere). Pogwiritsa ntchito mavitrowa, amatha kulimbitsa mafupa ofanana ndi chomwe estrogen (hormone replacement therapy) yachita kale.
SERMS ndi yokhayo yothandiza osteoporosis kwa amayi. Amachepetsa kuperewera kwa mafupa ndipo amachepetsa chiopsezo cha msana wam'mimba (koma osati kuphulika kwa fractures).
Popeza kuti mankhwala a etirogen amathandizidwa ndi khansa ya m'mawere, Evista amapindula ndi estrogen mafupa popanda chiopsezo cha khansa ya m'mawere kapena magazi omwe amapezeka ndi ma ARV.
Kuwonjezera pa kumanga mafupa, Evista angachepetse chiopsezo chokhala ndi kansa ya m'mawere ya m'mawere a abambo m'mabanja omwe amachititsa anthu kumbuyo. Mankhwalawa amatha kugwira ntchito ziwiri kwa amayi omwe ali osteoporosis kapena osteopenia komanso mwayi wochulukitsa khansa ya m'mawere.
Zotsatira zake zimaphatikizapo kutentha, kuthamanga, kujambula thukuta, ndi kupweteka mutu. Mankhwala sayenera kugwiritsidwa ntchito kwa iwo omwe ali ndi magazi m'milingo yawo (m'mitsempha ya mitsempha ya thrombosis), mapapo (pulmonary emboli), kapena maso (retinal vein thrombosis).
Mankhwala Othandizira Amadzimadzi Otchedwa Hormone
Nthawi ina atayesetsa kuti athe kuchepetsa chiopsezo cha matenda a osteoporosis, mankhwala odzozako mankhwala a estrogen amayamba chifukwa cha kuwonjezeka kwa khansa ya m'mawere, zilonda, matenda a mtima, ndi magazi. Akuti, amayi ena amapitiliza kugwiritsa ntchito mankhwala omwe amachititsa kuti matendawa asinthe. Kwa omwe amagwiritsa ntchito HRT pachifukwa ichi, phindu lina ndi kuchepetsa kuperewera kwa fupa.
Calcitonin
Calcitonin ndi mahomoni mwachibadwa omwe amapezeka m'matupi athu omwe amagwira ntchito kuti athetse kashiamu ndi mafupa.
Calcitonin amavomerezedwa kuti azitha kuchiza matenda odwala matenda a m'mimba mwa amayi omwe ali osachepera zaka zisanu kupitirira kwa kusamba. Amapangitsa mphamvu ya mafupa, makamaka m'kati mwa msana, ndipo imawoneka kuti imachepetse mpata wa msana. Zingathe kuchepetsanso ululu kwa anthu omwe amathyoka. Zotsatira zake ndizokulu kwambiri m'chaka choyamba cha chithandizo ndipo zimagwa mofulumira pambuyo pake. Nthawi zambiri madokotala amalimbikitsa kugwiritsa ntchito vitamini D ndi supplement calcium pamodzi ndi mankhwalawa koma kulankhula ndi dokotala wanu.
Mankhwalawa ndi awa:
- Miacalcin nasal spray (calcitonin) imapezeka ngati phulusa ndi jekeseni (onani m'munsimu). Amavomerezedwa ku matenda a Paget, hypercalcemia (msinkhu wokwanira wa calcium m'magazi), ndi postmenopausal osteoporosis mwa akazi.
- Zowonongeka (calcitonin): Ngakhale chinthu chofanana chomwecho, Zowonongeka zimapezeka pokhapokha ndizovomerezeka zokhazokha zothandizira odwala matenda opatsirana m'mimba mwa amayi.
- Calcimar (calcitonin): Calcimar imapezeka ngati jekeseni ndipo imavomerezedwa kuchiza matenda a Paget, hypercalcemia, ndi postmenopausal osteoporosis kwa akazi.
Zotsatira zoyipa za mankhwalawa zimaphatikizapo kupsa mtima kwa nasal koma zimakhala bwino. Mavitamini a calcitonin amatha kutulutsa khungu, kuthamanga, msomali, ndi mafupipafupi.
Matenda a Parathyroid Hormone (PTH)
Hormone ya parathyroid ndi hormone mwachilengedwe yomwe imapangidwa m'thupi. Zimachititsa kuti mafupa apangidwe mwa kuwonjezera ntchitoyi ndi kuchuluka kwa mafinya, maselo opanga mafupa, ndi kuchepetsa ntchito ya osteoclasts, kuchepetsa kupuma kwa mafupa. Mwa kuyankhula kwina, mosiyana ndi bisphosphonates zomwe zimachepetsa kuwonongeka kwa mafupa, hormone ya parathyroid ingathe kugwira ntchito kuti imange mafupa abwino ndi amphamvu.
Mahomoni a parathyroid amalembedwa kawirikawiri kwa anthu amene apezeka ndi matenda a osteoporosis ndipo omwe ali ndi chiopsezo chachikulu cha kupweteka kwa magazi, alephera kuyankha mankhwala ena, kapena amamva zowawa ndi mankhwala ena odwala matenda a m'mimba.
Mufukufuku, hormone ya parathyroid inapezeka kuti imachepetse chiwopsezo cha mitsempha ya m'mimba mwa amayi omwe amachititsa anthu kumbuyo. Zofukufuku pa Tymlos zinapezanso kuchepetsa kupweteka kwa msana.
Mankhwalawa ndi awa:
- Forteo (teriparatide): Forteo ndi njira yopangidwa ndi homoniroid hormone yomwe imapatsidwa ngati jekeseni tsiku ndi tsiku. Inavomerezedwa mu 2002.
- Tymlos (abaloparatide) : Tymlos kwenikweni ndi yopangidwa ndi anthu chabe ya mapuloteni a PTH omwe amachita ngati PTS pa PTH receptors mu fupa. Anavomerezedwa mu 2017 kuti azitsatira matenda otupa mafupa omwe amatchulidwa ngati mbiri ya fractures, kukhala ndi ziphuphu zambiri zoopsa, ndi / kapena kutopa njira zina zothandizira osteoporosis.
Zotsatira zofala kwambiri za Forteo ndizozunguza ndi zoponda za mwendo. Tymlos wakhala akugwirizanitsidwa ndi impso miyala chifukwa cha kuchuluka kashiamu mu mkodzo.
Zimalimbikitsa kuti ntchito ya hormone ya parathyroid ikhale zaka ziwiri zokha. Harmoniyoni ya parathyroid sayenera kugwiritsidwa ntchito kwa anthu omwe ali ndi matenda a Paget (matenda a mafupa), khansara ya mafupa, mazira a magazi ambiri (hypercalcemia), kapena omwe athandizidwa ndi mafupa awo. M'mayesero a zachipatala, kunkawoneka ngati kuwonjezeka kwa khansa yapafupa (osteosarcoma) ndipo mankhwalawa amakhala ndi chenjezo lakuda la bokosi pa chifukwa chimenecho.
Bothteo ndi Tymlos ndi okwera mtengo kwambiri poyerekeza ndi mankhwala ena ndipo angaphatikizepo madola 20,000 pachaka kuchipatala.
Potsatira chithandizo (mpaka zaka ziwiri) zimalimbikitsidwa kuti ntchito ya bisphosphonate iyambe kuwonjezeka kuwonjezeka kwa mafupa.
Mankhwala a Antioclonal Antibody
Gawo la mankhwala omwe amachititsa munthu kukhala ndi mankhwalawa amaphatikizapo mankhwala awiri omwe ali ndi dongosolo lomwelo koma ndi zizindikiro zosiyana. Denosumab ndi antioclonal antibody (anti-man-made antibody) yomwe imaletsa osteoclasts, maselo osungunula mafupa kupanga. Mankhwalawa amagwira ntchito pochepetsa kuchepa kwa fupa ndi fupa lokonzanso.
Zotsatira zofala kwambiri zimaphatikizapo kumbuyo, kugwirizanitsa, kupweteka kwa minofu, komanso kuchuluka kwa mafuta a m'magazi komanso matenda a mkodzo. Zoipa zimaphatikizapo osteonecrosis wa nsagwada (monga ndi bisphosphonates), chiopsezo chowonjezeka cha matenda (makamaka matenda a minofu ya mtima), kuthekera kwa ziphuphu zamatenda, ndi machiritso ochepa.
Mankhwalawa ndi awa:
- Prolia (denosumab): Prolia imapezeka ngati jekeseni kamodzi kamodzi pa miyezi isanu ndi umodzi. Prolia, mosiyana ndi Xgeva, ali ndi zizindikiro zingapo. Zingaperekedwe kwa amayi ndi abambo a postmenopausal omwe ali ndi matenda otupa thupi omwe ali ndi chiopsezo chachikulu cha fractures. Monga njira yowononga, Prolia ikhoza kugwiritsidwa ntchito kwa amayi onse omwe akulandira mankhwala a khansa ya m'mawere aromatase ndi abambo omwe alibe khansa ya prostate yomwe siilandira mthupi.
- Xgeva (denosumab): Xgeva imapezeka ngati jekeseni kamodzi pamasabata onse 4. Xgeva imavomerezedwa kwa anthu omwe ali ndi khansara ya m'mawere pofuna kuchepetsa chiopsezo cha fractures zokhudzana ndi mafupa a mitsempha (kufalikira kwa khansa ya m'mawere ku fupa), kuti athetse ululu, ndi kuchepetsa chiopsezo cha mafupa ena. Ikhoza kugwiritsidwanso ntchito (koma ndi dosing yosiyana) ya anthu omwe ali ndi hypercalcemia ya malignancy , ndi anthu (kachiwiri ndi dosing yosiyana) ndi zimphona zazikulu maselo a fupa.
Mofananamo ndi bisphosphonates, denosumab ingawonjezere ngozi ya osteonecrosis ya nsagwada. Prolia ndi Xgeva akuwoneka kuti ali ndi zotsutsana ndi khansa kuphatikizapo kuchepetsa chiopsezo cha kupasuka.
Mankhwala Osintha Mankhwala
Mankhwala osokoneza bongo akhala akugwiritsidwa ntchito kuchepetsa chiopsezo cha zophulika mwa anthu omwe ali ndi khansa yomwe yafalikira ku mafupa awo. Ntchito yofala ndi khansa ya m'mawere ndi metastases ya fupa kapena khansara yamapapo ndi mitsempha ya mafupa.
Njira zothandizira ndizo Zometa (zoledronic acid), bisphosphonate zomwe takambirana pamwambapa, ndi Xgeva (denosumab), mankhwala omwe amapezeka kuti amachepetse kupweteka kwa anthu omwe ali ndi kansa ya m'mawere yomwe yafalikira mafupa awo. Zometa ndi Xgeva (kapena Prolia) amawoneka kuti ali ndi zotsutsana ndi khansa.
Mgwirizano ndi Zofunikira Kugwiritsa Ntchito Mankhwala Osokoneza Bongo
Popeza pali mitundu yambiri ya mankhwala ochepetsa matenda a mitsempha, zonse zomwe zimagwira ntchito mosiyana, mungafunse ngati mankhwala ochepawa angagwiritsidwe ntchito pamodzi kuti achepetse ngozi. Ngakhale kuti ndizo lingaliro labwino, pali umboni wochepa wosonyeza kuti kuphatikiza mankhwala oposa oposa awiriwa ndi opindulitsa.
Chinthu chokhacho chingakhale kuyamba bisphosphonate pamene simukugwiritsa ntchito Prolia / Xgeva kapena Forteo, momwe kupitirira kwa miyezi 6 mpaka 12 kungakhale kopindulitsa kuti mupitirize kusintha minofu ya mafupa.
Calcium ndi Vitamini D mu Kuteteza kwa Osteoporosis
Ndi mankhwala ambiriwa amalimbikitsa anthu kupeza calcium ndi vitamini D. Zakudya zabwino nthawi zambiri zimapatsa calcium yokwanira, koma kambiranani ndi dokotala wanu. Vitamini D, komabe, ndi kovuta kudya zakudya zabwino (kuganizira: magalasi ambiri a mkaka ndi nsomba tsiku lililonse), ndipo sikuti kulikonse kulikonse amatha kupeza ndalama zokwanira mwa dzuwa kunja. Lankhulani ndi dokotala wanu za kuyeza mlingo wanu wa vitamini D (ndikuyesera magazi mosavuta) ndikupatsanso mavitamini D3 othandizira ngati mukufunikira. Ngakhale kuti calcium ndi vitamini D zokwanira zimakhala zofunikira kuti apangidwe bwino mafupa sizilowe m'malo mwa mankhwala odwala matenda a mitsempha.
Mawu Ochokera
Monga tanenera kale, pali magulu osiyanasiyana a mankhwala kwa anthu omwe ali ndi mafupa. Dokotala wanu akhoza kukambirana ndi inu zifukwa zomwe gulu lina likhoza kukhala labwino kuposa lina pazochitika zanu, komanso mankhwala omwe ali m'mabungwe ena akhoza kukhala abwino kwambiri. Pali mitundu yambiri yosankha mankhwala abwino kuphatikizapo mbiri ya fractures, vuto la menopausal, ndi zotsatira zake.
Ngakhale mankhwalawa angapangitse mafupa ambiri, cholinga cha mankhwala ndi kuchepetsa chiopsezo cha zophulika. Kuwonjezereka kwa mafupa okha kumatanthauza kuchepetsa kupasuka kwa mafupa. Mwachitsanzo, fluoride ikhoza kuwonjezera kuchulukana kwa mafupa koma imachepetsa chiopsezo cha kugwidwa (ndipo ingapangitse chiopsezo ngati mafupa omwe amapangidwa ali otsika).
Ndikofunikanso kulingalira zinthu zomwe zimakhala ndi moyo zomwe zingachepetse chiopsezo chanu cha fracture ngati muli ndi matenda ofooka. Mapawa ndiwo omwe amachititsa matenda ndi imfa ku United States chifukwa cha zophulika zomwe zimayambitsa ndi mavuto ena. Mosasamala za mankhwala omwe mumasankha, khalani ndi kanthawi kowerengera zochitika zowoneka bwino, komanso njira zochepa zomwe mungadzichepetsere kuti muchepetse chiopsezo chanu .
> Zotsatira:
> Ensrud, K., ndi C. Crandall. Osteoporosis. Annals of Internal Medicine . 2017. 167 (3): ITC17-ITC32.
> Khosla, S., ndi L. Hofbauer. Kuchiza kwa Osteoporosis: Zochitika Zatsopano ndi Mavuto Otsatira. Lancet. Matenda a shuga ndi Endocrinology . 2017 July 6. (Epub patsogolo pa kusindikiza).
> McClung, M. Kugwiritsa Ntchito Mankhwala Ochepetsa Mitsempha Yokhetsa Matenda M'kuphatikiza. Malipoti Amakono Osteoporosis . 2017. 15 (4): 343-352.