Njira Zothandizira Mankhwala Osteopenia (Kutsika Kwambiri kwa Matenda)
Ngati mwapezeka kuti muli ndi osteopenia (dothi lochepa) dokotala wanu angakhale atalimbikitsa chithandizo. Kodi ndi njira ziti zamankhwala zomwe mungapeze ngati mulibe "matenda opatsirana", ndipo ndi liti kupindulitsa kuchipatala?
Osteopenia: Kutsika Kwambiri kwa Matenda
Osteopenia amatanthauza kuchepa kwa fupa, koma kodi izi zikutanthauza chiyani kwenikweni? Zimakhala zomveka kumvetsa osteopenia tikaziyerekezera ndi kulemera kwake kwa mafupa ndi kufooka kwa mafupa.
Kuchulukanso kwa mafupa kwachibadwa kumatanthauza kuti kuchuluka kwa thupi lanu ndi kumanga mafupa anu ndi koyenera. Powonongeka kwapafupa , nambala yomwe mungayang'ane ngati fupa lanu lapafu ndi labwino kwambiri kuposa 1.0. Mwa kuyankhula kwina, kuchulukana kwa pfupa kwanu kungakhale koposa kapena kuperewera kwabwino komweko pansipa.
Matenda a osteoporosis ndi omwe mafupa akhala akutupa ndipo amatha kuphwanya, ngakhale kuvulala pang'ono. Kuyeza kwapachifupa ndi matenda odwala matenda opatsirana kumapereka T-masentimita a -2.5 kapena oposa, kutanthauza kuti mphamvu yapafupa ya munthu ndi 2.5 yomwe imakhala yochepa kusiyana ndi kuchuluka kwa mafupa a mwana wathanzi wathanzi kapena woipitsitsa.
Osteopenia imakhala pakati pa manambalawa, ndi T-mapiri abwino kuposa -2.5 koma oyipa kuposa -0.1. Mpata wakuti osteopenia idzapitirira kufooka kwa matenda kumadalira zaka zanu, zina zomwe mukudwala, mankhwala omwe mumalandira, ndi zina zambiri.
Kuchiza Osteopenia
Pali zifukwa zambiri zomwe muyenera kuziganizira musanayambe kuchiza osteopenia, ndipo panopa ndi nkhani yowopsya komanso yotentha.
Ngati osteopenia ikuphatikizidwa ndi ziphuphu, ndiye kuti mankhwalawa amatha kusintha. Sizodziwika bwino ngati kuchiza osteopenia popanda kupasuka kumathandiza.
Pali mankhwala a FDA omwe amavomerezedwa kuti athe kupewa matenda osteoporosis (ndipo chifukwa cha osteopenia). Mankhwalawa ndi othandiza koma ena amakhala ndi zotsatira zoopsa.
Madokotala ena amakayikira kupereka mankhwala osteoporosis a osteopenia pamene ena amakhala okwiya pofuna kuchepetsa kuperewera kwa mafupa. Cholinga chenicheni chochizira matenda a osteopenia ndi osteoporosis ndikolepheretsa fractures, makamaka mchiuno ndi msana. Madokotala amatha kudziwa chiopsezo chanu cha zaka khumi zofooka pogwiritsa ntchito minofu yanu ya minofu yamakono komanso zina zoopsa. Kuopsa kwa zaka khumi ndizofunika kwambiri pakuganiza za kumwa mankhwala osteopenia.
Mbali yothandizira, ngakhale yofunikira, ndikuti makampani ambiri a inshuwalansi a zaumoyo samadziwa osteopenia ngati chikhalidwe chomwe chimafuna chithandizo ndipo chotero sichikhoza kubweretsa mtengo (nthawizina waukulu) wa mankhwalawa.
Kodi Osteopenia Iyenera Kuchitiridwa Liti?
Monga tanenera poyamba, chithandizo cha osteopenia chimatsutsana. Izi zati, pamene mankhwala ayamba pa nthawi imeneyi kwa anthu omwe akuyembekezeka kupita patsogolo ku matenda a osteoporosis, kapena kukhala ndi zina zovuta, kuchiza osteopenia kungalepheretse kukula kwa matenda a mitsempha. Zinthu zomwe osteopenia zingakhale zovuta ndizo:
- Osteopenia amapezeka mwachinyamata, mwachitsanzo, munthu yemwe ali ndi zaka 50 zokha.
- Anthu omwe ali ndi khansa, makamaka omwe ali ndi khansara ya m'mawere kapena kansa ya prostate omwe angagwiritse ntchito mankhwala ochizira.
- Anthu omwe akhala pa steroids nthawi yayitali pa zikhalidwe monga asthma, COPD, kapena kutupa nyamakazi.
- Anthu omwe ali ndi chikhalidwe chokhudzidwa ndi matenda odwala matenda a mitsempha monga lupus, rhumum, nyamakazi, ndi ena ambiri.
- Anthu omwe amatha kugwa chifukwa cha matenda monga matenda opatsirana kapena matenda ena a ubongo.
- Amene ali ndi mbiri yolimba ya banja la matenda a mitsempha.
- Amene adamva zowawa ndipo ali ndi ubongo wambiri.
Mankhwala Oletsa Kutsekula kwa Osteoporosis (Chithandizo cha Osteopenia)
Pali mankhwala angapo ovomerezedwa kuti athe kuchiritsidwa , koma ochepa okha amavomerezedwa kuti athe kupewa kuphatikizapo Actonel ndi Evista.
Tidzalemba mayankho okhudza kupatsirana kwa matenda a mitsempha, monga nthawi zina mankhwala ena osati omwe amavomereza osteopenia (kuteteza matenda a osteoporosis) angasonyezedwe. Mitundu yosiyanasiyana ya mankhwala ili pansipa.
Bisphosphates
Bisphosphonates ndi mankhwala omwe amagwira ntchito pochepetsa kuchepa kwa fupa la mafupa ndi kupititsa patsogolo kupuma kwa mafupa. Zambiri mwazi zimachepetsera chiwopsezo cha mitsempha ya msana, koma sikuti onse asonyezedwa kuti achepetse chiwopsezo cha kupweteka kwa m'chiuno. Ena mwa mankhwalawa amatengedwa pakamwa pamene ena amapatsidwa mwa jekeseni. Actonel, makamaka, yavomerezedwa kuti athetse matenda a mitsempha. Zometa tsopano yavomerezedwa kuti igwiritsidwe ntchito pamodzi ndi aromatase inhibitor pofuna kuchiza khansa ya m'mimba ya postmenopausal.
Mankhwala m'gulu ili ndi awa:
- Fosomax (alendronate): Fosomax ikuwoneka kuchepetsa ziphuphu zonse zamphwa komanso zamphongo.
- Actonel (risedronate): Actonel ingachepetse chiopsezo cha zipsinjo ndi zamphuno.
- Boniva (ibandronate): Boniva amachepetsa chiopsezo cha mitsempha ya msana koma osati kuphulika kwa fractures.
- Zometa kapena Reclast (zoledronic acid): Zoperekedwa ndi jekeseni, Zometa amachepetsa chiopsezo cha mchiuno ndi msana.
Zotsatira za bisphosphonates zimasiyana malinga ngati zimagwiritsidwa ntchito pamlomo kapena mwa jekeseni. Ndi ma oral bisphosphonates, anthu amafunsidwa kumwa mankhwalawo ndi madzi okwanira ndikukhala otsika kwa mphindi 30 mpaka 60. Mankhwalawa angayambitse kupweteketsa mtima kapena kukhumudwitsa. Mankhwala owopsa akhoza kuyambitsa matenda a chimfine a tsiku kapena awiri pambuyo pa jekeseni ndipo akhoza kuyambitsa kupweteka kwa minofu.
Kawirikawiri koma zotsatira zoyipa ndi osteonecrosis wa nsagwada. Anthu omwe ali ndi matenda a chingamu kapena ukhondo wamkati, ali ndi chipangizo cha mano kapena amafuna njira monga kuchotsedwa kwa dzino kuli pangozi yaikulu. Zotsatira zina zosayembekezereka zimaphatikizapo mafilimu oopsa omwe amawombera pansi.
Selective Estrogen Receptor Modulators (Evista ndi Tamoxifen)
SERMS ndi mankhwala osokoneza bongo amatha kukhala ndi zotsatira zowonjezera ndi za anti-estrogen malinga ndi gawo la thupi lomwe amachitapo. Evista (raloxifene) imavomerezedwa kuti athetse matenda a mitsempha ya m'mimba mwa amayi omwe amachititsa mchitidwe wamagazi ndipo akuganiza kuti kuchepetsa chiopsezo cha khansa ya m'mawere. Tamoxifen imagwiritsidwa ntchito kwa amayi omwe ali ndi khansa ya m'mawere ya premenopausal yomwe imalandira chithandizo cha estrogen pofuna kuchepetsa chiopsezo cha kubwereza. Tamoxifen ingagwiritsenso ntchito kuchepetsa chiopsezo chokhala ndi khansa ya m'mawere.
Mofanana ndi estrogen (monga mankhwala opatsirana amadzimadzi) pamatenda amachititsa kuti minofu ya mafupa ikhale yowonjezera ndipo imachepetsa kuopsa kwa fractures. Mosiyana ndi HRT, Komabe, Evista ali ndi zotsatira zotsutsa-estrogen pa maselo a m'mawere ndipo akhoza kuchepetsa chiopsezo chokhala ndi khansa ya m'mawere. Ngakhale kuti SERMS sichikuwonjezera kuchulukitsa kwa mafupa mpaka momwe bisphosphonate imachitira, ingachepetse chiwopsezo cha mitsempha ya msana (koma osati kuphulika kwa fractures) ndi kupititsa patsogolo kulemera kwa mafupa.
Zotsatira zoyipa za SERMS zimaphatikizapo kutentha, kuziphatika, ndi thukuta. Zingathe kuonjezeranso chiopsezo cha mitsempha ya magazi monga mitsempha yambiri ya mitsempha ya mitsempha, pulmonary emboli (magazi ammimba mwendo umene amachoka ndikupita kumapapo), ndi matenda a retin thrombosis.
Hormone Replacement Therapy (HRT)
Ngakhale kuti mankhwala opatsirana amadzimadzi (HRT) anayamba kutchulidwa kuti pafupifupi mankhwala ozizwitsa oletsa kutsekula kwa odwala m'mimba mwa amayi, sichivomerezedwanso kuti izi ziwonetsedwe. Kuphatikiza apo, kufufuza kuwonjezeka kwa chiopsezo cha khansa ya m'mawere, matenda a mtima, ndi zikwapu kwa amayi omwe amatenga HRT kwachititsa kuti mankhwalawa agwiritsidwe ntchito mobwerezabwereza.
Ndithudi, palinso anthu omwe amagwiritsa ntchito HRT kwa zizindikiro za menopausal, ndipo zimatha kugwira ntchito bwino. Chomwe chimayambitsa kupweteka kwa mafupa kwa amayi am'maopausal ndi kuchepetsa kuchuluka kwa estrogen yopangidwa ndi thupi. Ndizomveka kuti mankhwala oterewa (HRT) angathandize kuchepetsa kuperewera kwa mafupa.
Mofanana ndi mankhwala alionse, muyenera kuyesa kuopsa kwa phindu lililonse ndi mankhwala omwe mumagwiritsa ntchito. Kwa atsikana omwe atha msinkhu wopita opaleshoni ndipo akuvutika ndi kutentha kwa moyo, HRT ikhoza kukhala njira yabwino. Komabe, ngakhale pakadali pano, cholinga cha mankhwala ndi HRT sayenera kuchepetsa chiopsezo cha osteoporosis.
Denosumab (Prolia ndi Xgeva)
Amagwiritsidwa ntchito kawirikawiri ndi anthu omwe ali ndi khansa, denosumab ndi antioclonal antibody yomwe imalepheretsa mapangidwe a osteoclasts, maselo omwe amachititsa kuti mafupa awonongeke.
Kwa amayi omwe ali pa aromatase inhibitors (mankhwala osokoneza bongo wam'mimba a postmenopausal) omwe amachititsa chiopsezo cha matenda a osteoporosis, kapena amuna omwe ali ndi androgen kuchitidwa chithandizo cha khansa ya prostate (yomwe imapangitsanso chiopsezo cha matenda a osteoporosis), ikhoza kuchepetsa ngozi ya fractures. Denosumab imagwiritsidwanso ntchito kwa anthu omwe ali ndi mtundu uliwonse wa khansara umene wafalikira ku mafupa awo kuti athe kuchepetsa chiopsezo cha zophulika.
Kuchokera mwa jekeseni, denosumab ili ndi zotsatira zofanana ndi bisphosphonates ndipo zingapangitse ngozi ya osteonecrosis ya nsagwada.
Calcitonin (Miacalcin, Fortical, Calcimar)
Calcitonin ndi mapangidwe opangidwa ndi anthu opangidwa ndi mahomoni m'matupi athu omwe amachititsa mafupa kusokoneza thupi ndipo amathandiza kusintha mlingo umene thupi limabweretsanso fupa. Zimapezeka zonse monga utsi wamphongo ndi jekeseni ndipo zingachepetse chiwopsezo cha kupweteka kwa msana. Maacalcin nasal spray, makamaka, angakhale mwayi kwa amayi omwe amatha kupha amayi omwe sangathe kulekerera zotsatira za mankhwala ena.
Parathyroid Hormone ndi Zowonjezera
Forteo (teriparatide) ndi mtundu wopangidwa ndi munthu wa hormone ya parathyroid ndipo nthawi zambiri amagwiritsidwa ntchito kwa anthu omwe ali ndi vuto lofooka kwambiri lomwe ali pangozi yowonongeka. Ndi mankhwala okha omwe angathe kulimbikitsa thupi kuti limere fupa latsopano. Gwiritsani ntchito pakali pano kungopitirira zaka 2 zokha. Tymlos (abaloparatide) ndi ofanana ndipo amatha kupanga mbali ya hormone ya parathyroid.
Mankhwala Ochepetsa Pansi
Pali kutsutsana pa kugwiritsa ntchito mankhwala opaleshoni ya osteopenia, ndipo ena amanena kuti osteopenia ndi gawo lachibadwa la ukalamba. Komabe tikudziwa kuti anthu ena adzakhala pachiopsezo chachikulu chokumana ndi mavuto, ndipo zonse zomwe zingaphuphuke ngati zitasiyidwa. Ngati muli ndi osteopenia, inu ndi dokotala mungathe kulingalira kuti muli ndi chiopsezo cha zaka khumi kuti mukhale ndi chipsinjo cha msana kapena msana pogwiritsa ntchito mapepala ndi matebulo omwe akupezeka ku World Health Organization kapena Osteoporosis Foundation.
Kusamalira Osteopenia Ndi Mankhwala Osokoneza Bongo
Kaya mumasankha kugwiritsa ntchito mankhwala a osteopenia kapena ayi, pali zinthu zomwe mungachite kuti muchepetse chiopsezo chanu . Kuchokera kuonetsetsa kuti masitepe anu alibe ziphuphu kuti mukhale pa makwerero, pali njira zingapo zomwe mungachepetse mwayi wogwa.
Kupeza calcium yokwanira ndi vitamini D n'kofunika kwambiri. Anthu ambiri amapeza calcium yokwanira pa zakudya zawo, koma vitamini D ndi zovuta kubwera, makamaka kumpoto. Lankhulani ndi dokotala wanu za kuyang'ana mlingo wanu wa vitamini D (anthu ambiri alibe). Ngati msinkhu wanu uli wotsika kapena pansi pamtundu wochepa, funsani ngati mukufuna kumwa vitamini D3 kapena ayi.
Kuchita masewera olimbitsa thupi nthawi zonse komanso kupewa kusuta ndizofunikira kwambiri popewera matenda a osteoporosis.
Mawu ochokera Kuchipatala cha Osteopenia
Mosiyana ndi matenda a osteoporosis, palibe njira zomveka zothandizira osteopenia, ndipo munthu aliyense ayenera kuyang'anitsitsa mosamala kuti adziwe ngati mankhwala angakhale opindulitsa. Chinthu chimodzi chofunika kuganizira ndi ngati munthu akuyenera kupita patsogolo kudwala matenda odwala matenda a mitsempha kapena ali ndi chiopsezo chowonjezereka chifukwa cha matenda enaake.
Pali mankhwala angapo omwe angathe kuthandizira kuchepetsa kupweteka kwa mafupa, koma zonsezi zimakhala ndi chiopsezo cha zotsatirapo. Pakalipano, mankhwala okhawo omwe amavomerezedwa ku osteopenia (kupewa matenda a mitsempha) ndi Actonel ndi Evista. Mankhwala ena, komabe, angaganizidwe motengera zochitika zinazake.
Ngati mwapezeka ndi osteopenia mukambirane mosamala ndi dokotala wanu. Lankhulani za zomwe mungayembekezere m'tsogolomu. Kambiranani za chiopsezo chanu cha zophulika, ndipo kutaya kwanu kungatanthauzanji pakuyenda kwanu ndi ufulu wanu. Kenaka kambiranani za zotsatira zowopsa za mankhwala alionse ndi kuyeza izi potsatsa phindu lililonse lomwe mungathe kulitchula. Ndikofunika kukhala wothandizira pawekha, makamaka pazinthu monga izi zomwe mungasankhe mwachindunji.
> Zotsatira:
> Eriksen, E. Chithandizo cha Osteopenia. Maphunziro mu Endocrinology ndi Matenda a Zamadzimadzi . 2012. 13 (3): 209-223.
Kasper, Dennis L .., Anthony S. Fauci, ndi Stephen L .. Hauser. Mfundo za Harrison za Mankhwala a M'kati. New York: maphunziro a Mc Graw Hill, 2015. Print.
> Rosen, H. Mphunzitsi wodwala: Kupewa ndi kupatsirana kwa mitsempha (Kupitirira Zomwe Zimayambira). Kupititsa patsogolo . Kusinthidwa 03/26/17.