I-Corticosteroid-I-Osteoporosis Yenza Kubili Iyakwazi Ukuvimbela futhi Yokwelashwa
I-Corticosteroids yindlela eyodwa yemithi ye-steroid. Ngezinye izikhathi igama elithi "steroid" lisetshenziswe ngokungafani ne "corticosteroid".
Ngokusho kwe-ACR, abangaphezu kwezigidi ezingama-30 baseMelika bangathinteka izifo ezivame ukuphathwa nge-corticosteroids. I-steroids njenge- prednisone , isetshenziselwa ukwelashwa kwezifo eziningi ezivuvukalayo nezizimele , njenge:
- i-asthma
- i-arthritis ye-rheumatoid
- lupus
- isifo sofuba esiswini
Zibuye zisetshenziselwe ukuphatha izimo eziningi ze-allergenic. Nakuba i-steroids isebenza kahle ekwelapheni izifo ezinjalo, yilezi zimbangela ezivame kakhulu zokwelapha izifo ezibangelwa izidakamizwa .
I-Corticosteroids & I-Bone Remodeling
I-Corticosteroids ithinta i-calcium ne-bone metabolism ngezindlela eziningi.
- i-steroid inciphisa inani le-calcium elithwe ngumathumbu
- i-steroids ikhulisa i-calcium excretion ngokusebenzisa izinso
Lezi zici ezimbili zihlanganisa ukukhiqiza ukwehla kokugxilwa kwe-calcium e-ionized. Lokhu kubangela izinhlayiya ze-parathyroid ukwandisa ukufihla kwe-hormone ye-parathyroid (PTH), isimo esibizwa ngokuthi i-hyperparathyroidism yesibili. Amazinga e-PTH aphakanyisiwe aholela ekwehleni kwethambo, njengoba umzimba uzama ukulungisa amazinga e-calcium ehamba kancane ngokukhulula i-calcium emathanjeni egazini.
I-Corticosteroids inganciphisa izinga lamahomoni ocansi:
- i-estrogen (kwabesifazane)
- i-testosterone (emadodeni)
Ukunciphisa okuholelekile kuhlobene nokulahlekelwa kwethambo okwandisiwe.
I-Corticosteroids ibuye ibangele ubuthakathaka bomzimba, okungabangela ukungasebenzi nokulahlekelwa kwethambo olwengeziwe. Omunye umphumela omkhulu we-corticosteroids wukuthi bangathinta amathambo ngqo ngokucindezela umsebenzi wokwenza amathambo (umsebenzi we-osteoblastic).
Amaphethini Wokulahlekelwa Kwamathambo
Kunezinhlobo ezimbili zamathambo esithambo: ama-cortical ne-trabecular.
- I-cortical bone yenza igobolondo yangaphandle yethambo futhi liqukethe u-80% wamasipha
- I-bone ye-trabecular (i-20% esele) itholakala ngaphakathi kwethambo
Ithemba ngalinye emasakeni liqukethe kokubili izinhlobo zamathambo, kodwa ubukhulu babo buhluka. I-Corticosteroids ngokuyinhloko ibangele ukulahlekelwa yithemba kulezo zindawo zamasaka ezicebile amathambo, njenge-spine.
Dose kanye Nesikhathi
Ukulahlekelwa kwegazi kwenzeka ngokushesha kakhulu ezinyangeni zokuqala eziyisithupha kuya kwezingu-12 zokwelapha futhi kuxhomeke kokubili:
- umthamo
- isikhathi
Ezinye izici ezingozini ze-osteoporosis zingase zibe nomthelela wokwengeza ekulahlekelweni kwethambo, njenge:
- ubudala
- ubulili
- isifo esiyisisekelo
Isibonelo, amadoda asebekhulile ku-steroids angase athole ukulahlekelwa kwethambo elikhulu nangengozi yokuphuka kunamadoda asekhulile. I-ACR ilinganisela ukuthi ngaphandle kwezinyathelo zokuvimbela, abantu abangaba ngu-25% abakhulayo ngesikhathi eside besikhathi eside bazobhekana nokuhlukana.
Umthamo we-corticosteroids uyisimo esiqinile sokwehla kwesifo. Nakuba kungacacile ukuthi kunesibalo esincane sezansi ngaphansi kokulahlekelwa kwethambo, izifundo zamuva zithole i-steroid engatholakali ukuba ibe nomthelela omkhulu ekutheni umthambo uma ulawulwa ngendlela ejwayelekile futhi ngaphandle kwe-systemic steroids.
Ukuphathwa Kwe-Osteoporosis
I-osteoporosis eyenziwa yi-steroid iyakwazi ukugwema futhi ilashwe. Ngokusho kwe-ACR, abantu abakhona ku-corticosteroids kufanele babe nokuhlolwa kwe-bone mineral mass. Lokhu kuhlolwa kuzohlinzeka ngesilinganiso esisezingeni eliphansi lapho kufanele kuqaphe khona ushintsho olulandelayo emathambo. U-ACR uphakamisa nokudla kwansuku zonke kwe-1500 mg. i-calcium ne-400-800 IU ye-vitamin D. I-calcium ne-vitamin D ingasiza ekugcineni ukulinganisela kwe-calcium namazinga ajwayelekile e-hormone ye-parathyroid, futhi ingalondoloza ngisho nesisindo emathambo kwezinye iziguli emithini ephansi ye-steroid therapy.
I-Osteoporosis Izidakamizwa
Imithi ye-osteoporosis eyamukelwa yi-FDA ye-corticosteroid-induced osteoporosis ihlanganisa:
- Actonel (Risedronate) ngokuvikela nokwelashwa
- I-Fosamax (i-Alendronate) yokwelashwa
Emisebenzini ye-corticosteroid, zombili izidakamizwa ziletha imiphumela enenzuzo emgodini we-spin kanye ne-hip bone osaminerali futhi zihambisana nokwehla kwamaphutha emgogodla. Ukwelashwa kwe-Estrogen noMiacalcin (i-Calcitonin) kungasiza ukulondoloza umthambo we-spinal emasimini ase-postmenopausal ku-corticosteroids, kodwa futhi i-FDA ayivunyelwanga ne-corticosteroid-induced osteoporosis.
Ukuguqula indlela yokuphila
- Ukuqeda ukubhema nokuphuza utshwala, kubalulekile ekunciphiseni ingozi ye-steroid-induced osteoporosis.
- Umsebenzi wokuzivocavoca kanye nokuvivinya umzimba kungasiza ekulondolozeni isisindo somzimba nesisindo, kuyilapho ukwandisa amandla emisipha nokunciphisa ingozi yokuwa.
- Ukwelashwa kwe-Slip nokuwa kubaluleke ngokukhethekile kubantu asebekhulile nalabo abaye babhekana nobuthakathaka obuthakathaka besisindo steroid.
Okubalulekile
Izinyathelo zokuvimbela i-osteoporosis kufanele ziqale ekuqaleni, kahle lapho kuqala ukwelashwa kwe-corticosteroid. Ochwepheshe batusa ukusebenzisa umthamo we-steroid esezansi kunazo zonke isikhathi esifushane futhi kungenzeka, uma kungenzeka, inhaled noma corticosteroids yama-topical kufanele isetshenziswe.
Umthombo:
I-glucocorticoid-Induced Osteoporosis, NIH ORBD ~ NRC, 12/2000