Izinketho Zezokwelapha Ze-Osteopenia (Ubuningi Bamathambo Ephansi)
Uma uthola ukuthi unesifo se-osteopenia (udokotela we-bone low) udokotela wakho kungenzeka ukuthi ukhuthaze ukwelashwa. Yiziphi izindlela zokwelapha ezitholakalayo uma ungakabi "nokuphefumula ngokugcwele" kwe-osteoporosis, futhi kunini lapho kunenzuzo ukucabangela ukwelashwa?
I-Osteopenia: Ukuqina Kwamathambo Ephansi
I-osteopenia isho ukuthatha kakhulu amathambo, kodwa lokhu kusho ukuthini ngempela? Kuyinto elula ukuqonda i-osteopenia uma siqhathanisa nokubili kwesisindo samathambo kanye ne-osteoporosis (isisindo samathambo esincane kakhulu).
Ukujwayelekile kwethambo kwamandla amathambo kusho ukuthi ubukhulu bomzimba namathambo akho ajwayelekile. Kuhlolwa kwesitembu samanani , inombolo ozoyibona uma isisindo sakho sesisindo sijwayelekile singaphezulu kwe--1.0. Ngamanye amazwi, amandla akho amathambo angase abe noma angcono kunokuphambuka okujwayelekile okujwayelekile ngezansi okujwayelekile.
I-osteoporosis yisimo lapho amathambo aye ahlukumezeka khona futhi angase aphule, ngisho nokulimala okuncane. Ukuhlolwa kwethambo lokuxilonga nge-osteoporosis kunika i-T-score ye--2.5 noma embi kakhulu, okusho ukuthi isisindo somuntu wesilinganiso singamaphesenti angu-2.5 angaphansi kwesilinganiso samathambo omuntu omdala osemncane noma okubi nakakhulu.
I-Osteopenia ilele phakathi kwalezi zinombolo, nge-T-score engcono kune--2.5 kodwa embi kuna -0.1. Ithuba lokuthi i-osteopenia izoqhubeka nokuguqulwa kwamathambo kuncike eminyakeni yakho, nezinye izimo zezokwelapha onakho, imithi oyithathayo, nokunye okuningi.
Ukwelapha i-Osteopenia
Kunezici eziningi okufanele zicatshangelwe ngaphambi kokwelapha i-osteopenia, futhi lokhu okwamanje kuyisihloko esiyinkinga nesishisayo.
Uma i-osteopenia ihlanganiswe ne-fractures, kungenzeka ukuthi ukwelashwa kungenza umehluko. Akucaci ukuthi ukuphatha i-osteopenia ngaphandle kwemifucuko kuyasiza.
Kukhona imithi evunyelwe i-FDA yokuvimbela i-osteoporosis (ngakho-ke ngenxa ye-osteopenia). Le mithi iyasebenza kodwa ezinye zazo zinemiphumela emibi kakhulu.
Abanye odokotela bayanqikaza ukunikeza imithi yokwelashwa kwe-osteoporosis ye-osteopenia kuyilapho abanye behlukumeza ukuzama ukunciphisa ukulahlekelwa yithemba. Umgomo wangempela wokwelapha i-osteopenia kanye ne-osteoporosis kuvimbela ukuqhuma, ikakhulukazi kwe-hip nomgogodla. Odokotela bangakwazi ukubala ingozi yakho ye-fracture yakho engu-10 ngokusekelwe kwamathambo wakho wamaminerali wamanje kanye nezinye izinto eziyingozi. Le ngozi engama-10 yinto enkulu kakhulu uma ucabanga ngokuthatha imithi ye-osteopenia.
I-note note, nakuba ibalulekile, ukuthi izinkampani eziningi zomshuwalense wezempilo aziqapheli i-osteopenia njengesimo esidinga ukwelashwa ngakho-ke angeke sihlanganise izindleko (ngezinye izikhathi zikhulu) zale mithi.
Ngabe I-Osteopenia Kufanele Iphathwe Nini?
Njengoba kuphawuliwe ekuqaleni, ukwelashwa kwe-osteopenia kunengxabano. Lokho kusho ukuthi, uma ukwelashwa kuqalile kulesi sigaba kubantu abalindeleke ukuba bathuthuke ekubeni ne-osteoporosis, noma babe nezinye izimo ezingezansi, ukwelapha i-osteopenia kungavimbela ukuthuthukiswa kwe-osteoporosis kanye nokwahlukana. Izimo lapho i-osteopenia ingaba yingozi nakakhulu zibandakanya:
- I-Osteopenia etholakala kumuntu osemusha, isibonelo, umuntu oneminyaka engu-50 kuphela.
- Abantu abanomdlavuza, ikakhulukazi labo abanomdlavuza webele noma umdlavuza wesifo sofuba abazosebenzisa imithi yokwelapha.
- Abantu abaye basesimweni sesikhathi eside steroid ngezimo ezifana ne-asthma, i-COPD, noma isifo samathambo esibangela ukuvuvukala.
- Labo abanemibandela ehambisana nengozi eyengeziwe yokwelapha ngokweqile njengokuphethwe i-lupus, i-rheumatoid arthritis, nabanye abaningi.
- Labo abavame ukuwa ngenxa yezimo zezokwelapha ezifana nesifo sokuthumba noma ezinye izifo ze-neurological.
- Labo abanomlando oqinile womndeni we-osteoporosis.
- Labo abaye bahlukumezeka futhi banesisindo esiphansi samathambo.
Imithi Yokuvimbela I-Osteoporosis (Ukwelashwa Kwe-Osteopenia)
Kunezinhlobo zemithi ehlukene evunyelwe ukwelashwa kwe-osteoporosis , kodwa bambalwa kuphela abavunyelwe ukuvimbela kuhlanganise no-Actonel no-Evista.
Sizohlonza izinketho zokwelashwa kwe-osteoporosis, njengoba imithi ngezinye izikhathi ngaphandle kwalezo ezivunyelwe i-osteopenia (ukuvinjelwa kwe-osteoporosis) ingaboniswa. Izigaba ezahlukene zemithi zibalwe ngezansi.
Bisphosphates
Ama-bisphosphonates yimishanguzo eyenza ngokunciphisa izinga lokulahlekelwa kwethambo nokuthuthukisa ubukhulu bamathambo. Eziningi zalezi zinciphisa ingozi yezifo zomgogodla, kepha akubona bonke abaye baboniswa ukunciphisa ubungozi bokuqhaqhaza kwe-hip. Amanye alawa mithi athathwa ngomlomo kanti amanye anikezwa ngomjovo. I-Actonel, ngokukhethekile, ivunyelwe ukuvimbela ukuphefumula kwamathambo. Manje i-Zometa ivunyelwe ukusebenzisa kanye ne-aromatase inhibitor yokwelashwa komdlavuza webele we-postmenopausal.
Imithi yalesi sigaba ihlanganisa:
- I-Fosomax (i- alendronate ): I-Fosomax ibonakala ukunciphisa kokubili ama-hip and spine fractures.
- I-Actonel (risedronate): i-Actonel inganciphisa ubungozi bobubili be-hip ne-spine fractures.
- I-Boniva (i-ibandronate): I-Boniva inciphisa ingozi yezinhlanzi zomgogodla kodwa ayiqedi imifantu.
- I-Zometa noma i-Reclast (i-zoledronic acid): Inikezwe umjovo, i-Zometa inciphisa ubungozi bobubili be-hip ne-spine fractures.
Imiphumela emibi ye-bisphosphonates iyahlukahluka ngokuthi isetshenziselwa ngomlomo noma ngomjovo. Ngomlomo we-bisphosphonates, abantu bayacelwa ukuba bathathe imithi ngeglasi yamanzi egcwele futhi bahlale beqondile imizuzu engama-30 kuya kwangu-60. Lezi zidakamizwa zingabangela ukugubha noma ukucasula. Imithi engajoqayo ingabangela izimpawu ezinjengezikhukhula zosuku noma ezimbili ngemva kokujova futhi zingabangela ubuhlungu obukhulu bomzimba.
Umphumela ongavamile kodwa obi kakhulu osteonecrosis womhlathi. Abantu abanesifo sezinsini noma ukuhlanzeka kwamazinyo, banesidingo samazinyo noma badinga izinqubo ezifana nokususwa kwezinyo kuyingozi kakhulu. Eminye imiphumela emibi engavamile ihlanganisa i-fibrillation ye-atrial kanye nama-femy fractures atypical.
Ama-Modulators aqokiwe e-Estrogen (Evista no-Tamoxifen)
Izilawuli ze-estrogen receptor (SERMS) ziyimithi ingaba nemiphumela emibili ye-estrogen-ne-anti-estrogen kuye ngokuthi ingxenye yomzimba abakwenzayo. I-Evista (raloxifene) ivunyelwe ukuvimbela ukuphefumula kwamathambo kwabesifazane be-postmenopausal futhi kucatshangwa ukunciphisa ingozi yomdlavuza webele. I-Tamoxifen isetshenziselwa abesifazane abane-cancer ye-premenopausal yamabele okuyi-receptor e-estrogen enhle ukuze kuncishiswe ingozi yokuphindaphinda. I-Tamoxifen ingasetshenziselwa ukunciphisa ingozi yokuthuthukisa umdlavuza webele.
Njenga-estrogen (njengokwelashwa kwe-hormone substitution) isenzo sabo esitheni sandisa isibalo samaminerali esitembu futhi sinciphisa ingozi ye-vertebral (spinal) fractures. Ngokungafani ne-HRT, noma kunjalo, u-Evista unemiphumela yokulwa ne-estrogen kumaseli asebele futhi anganciphisa ingozi yokuthuthukisa umdlavuza webele. Ngenkathi i-SERMS ingakhulisi inani lamathambo ezingeni elibhekwa yi-bisphosphonate, zinganciphisa ingozi yezinhlanzi zomgogodla (kodwa hhayi ukuqhaqhaza ama-fractures) futhi ithuthukise ukuqina kwamathambo.
Imiphumela emibi ye-SERMS ihlanganisa ukukhanya okushisayo, ama-aches ahlangene, nokujuluka. Kungase futhi kwandise ingozi yezindwangu zegazi ezifana ne-vein thrombosis ejulile, i-pulmonary emboli (i-blood clots emlenzeni ophumula futhi uhambe uye emaphashini), kanye ne-retinal thrombosis.
I-Hormone Replacement Therapy (i-HRT)
Nakuba i-hormone replacement therapy (i-HRT) ibilokhu ibizwa ngokuthi cishe isisindo esimangalisayo sokuvimbela i-osteoporosis kwabesifazane, asisavunyelwe kuloluphawu. Ngaphezu kwalokho, ucwaningo oluthola engozini yokwanda komdlavuza webele, isifo senhliziyo, nokushaywa komzimba kwabesifazane abathatha i-HRT kuye kwaba nemiphumela yokuthi le mithi isetshenziswe kaningi.
Ngokuqinisekile, kusekhona abantu abasebenzisa i-HRT yezibonakaliso ze-menopausal, futhi ingasebenza kahle ngalezi zimpawu. Esinye isizathu esibalulekile sokulahlekelwa kwethambo kwabesifazane abanesifo sengculaza kunciphisa inani le- estrogen elikhiqizwa umzimba. Kuyaqondakala ukuthi leyo-hormone replacement therapy (HRT) ingasiza ekunciphiseni ukulahlekelwa kwethambo.
Njenganoma yimiphi imithi, kufanele uhlole izingozi nezinzuzo zanoma yimiphi imithi oyisebenzisayo. Kwabesifazane abasha abaye baba nokuqeda ukuhlinzwa kokubeletha futhi banenkinga yokushisa yokushisa, i-HRT ingahle ibe yindlela enhle. Noma kunjalo, kulokhu kulungiselelwa, umgomo wokwelapha ne-HRT akufanele ube ukunciphisa ingozi yokugula i-osteoporosis.
I-Denosumab (i-Prolia ne-Xgeva)
Esetshenziswa kaningi ngabantu abanomdlavuza, i-denosumab iyi-anti-monoglonal antibody okuvimbela ukubunjwa kwama-osteoclasts, amangqamuzana abangela ukwehla kwethambo.
Kulabo besifazane abane-aromatase inhibitors (izidakamizwa zomdlavuza webele we-postmenopausal) okwandisa ingozi ye-osteoporosis, noma amadoda ase-androgen ekunciphiseni ukwelashwa komdlavuza we-prostate (okwandisa futhi ingozi ye-osteoporosis), anganciphisa ingozi ye-fractures. I-Denosumab isetshenziselwa abantu abanoma yiluphi uhlobo lomdlavuza olwenziwe emathanjeni abo ukunciphisa ingozi yezinsalela.
Njengoba kunikezwe umjovo, i-denosumab inephrofayili yethonya elifanayo elifana ne-bisphosphonates futhi ingangandisa ingozi ye-osteonecrosis yomhlathi.
I-Calcitonin (i-Miacalcin, i-Fortical, i-Calcimar)
I-Calcitonin iyinhlangano eyenziwe ngumuntu we-hormone emizimbeni yethu elawula ithambo le-metabolism futhi isisiza ukushintsha izinga lapho umzimba ulungisa khona amathambo. Itholakala kokubili njengokusifiphaza komzimba kanye nomjovo futhi kunganciphisa ingozi yezinhlanzi zomgogodla. I-Miacalcin nasal spray, ikakhulukazi, ingaba yindlela yokukhetha abesifazane besimo se-postmenopausal abangakwazi ukubekezelela imiphumela emibi yeminye imithi.
I-Hormone ne-Derivatives ye-Parathyroid
I-Forteo (i-teriparatide) inguqulo eyenziwe ngumuntu we-hormone yemvelo yemvelo futhi ijwayele ukusetshenziselwa abantu abane-osteoporosis enamandla abasengozini enkulu yokuhlukana. Nguyena kuphela imithi engashukumisela umzimba ukuba ukhule ithambo elisha. Ukusetshenziswa okwamanje kuvinjelwe iminyaka emibili kuphela. I-Tymlos (i-abaloparatide) ifana futhi inguqulo yokwenziwa kwesinye se-hormone ephathekayo.
Ukwelashwa Kwezidakamizwa Ngaphansi
Kukhona impikiswano mayelana nokusetshenziswa kwemithi yokwelapha i-osteopenia, kanti abanye bathi i-osteopenia iyinhlangano engokwemvelo yokuguga. Noma kunjalo siyazi ukuthi abanye abantu bazoba engozini enkulu yokuhlukumezeka, futhi konke okungase kusho uma kushiywa kungaphathwa. Uma une-osteopenia, wena nodokotela wakho ungalinganisa iminyaka engama-10 engozini yokuthuthukisa ukuqhekeka kwe-hip noma imvula ngokusebenzisa amashadi namatafula atholakala ku-World Health Organization noma i-Osteoporosis Foundation.
Ukuphatha i-Osteopenia Ngezidakamizwa noma ezingenayo izidakamizwa
Kungakhathaliseki ukuthi ukhethe noma ungayisebenzisi imithi ye-osteopenia, kunezinto ongayenza ukuze unciphise ingozi yokuhlukana . Ukusuka ekuqinisekiseni ukuthi izitebhisi zakho zikhululekile ukuhlala ezinkathini, kunezindlela eziningi ezilula onganciphisa amathuba okuwa.
Ukuthola i-calcium eyanele ne-vitamin D kubalulekile futhi. Abantu abaningi bathola i-calcium egcwele ekudleni kwabo, kepha i-vitamin D iyanzima ukufika, ikakhulukazi eNyakatho yezimo. Khuluma nodokotela wakho mayelana nokuhlola izinga lakho levithamini D (abantu abaningi abanakho). Uma izinga lakho liphansi noma engxenyeni engezansi ebangeni elijwayelekile, cela mayelana nokuthi kufanele uthathe isithasiselo se-vitamin D3 noma cha.
Ukuzivocavoca njalo nokugwema ukubhema nakho kubaluleke kakhulu ekuvimbeleni i-osteoporosis.
Izwi Elivela Kulashwa Kwe-Osteopenia
Ngokungafani ne-osteoporosis, azikho iziqondiso ezicacile zokwelapha i-osteopenia, futhi umuntu ngamunye kufanele ahlolwe ngokucophelela ukunquma ukuthi imithi ingaba yinzuzo yini. Okunye okucatshangelwayo ukuthi ngabe umuntu kulindeleke ukuba athuthuke ekubeni ne-osteoporosis noma engozini enkulu yokwehlukana kwezidakamizwa ngenxa yeminye yezokwelapha.
Kukhona imithi eminingana engasebenza ngempumelelo ekunciphiseni ukulahleka kwethambo, kepha konke lokhu kuvela engozini yemiphumela emibi. Njengamanje, izidakamizwa kuphela ezivunyelwe ukwelashwa kwe-osteopenia (ukuvimbela i-osteoporosis) yi-Actonel no-Evista. Kodwa ezinye izidakamizwa zingase zithathwe ngokusekelwe kubantu abathile izimo ezithile.
Uma ngabe uthola ukuthi une-osteopenia inengxoxo enengqondo nodokotela wakho. Khuluma ngalokho okungalindelwa eminyakeni ezayo. Khuluma ngengozi yakho yezinsalela, futhi yiziphi izinkinga ezingase zisho mayelana nokuhamba kwakho nokuzimela kwakho. Bese ukhuluma ngemiphumela emibi yokwelapha yimuphi ukwelashwa futhi ulinganise lokhu kunoma iyiphi inzuzo ongase ubikezele. Kubalulekile ukuba ngummeli wakho ekunakekeleni kwakho, ikakhulukazi esimweni esifana nalokhu okukhethwa kukho ukwelashwa okufanele kube ngabanye ngokucophelela.
> Imithombo:
> Eriksen, E. Ukwelashwa kwe-Osteopenia. Ukubuyekezwa ku-Endocrinology kanye nokuphazamiseka kwe-Metabolic . 2012. 13 (3): 209-223.
> Kasper, uDennis L .., u-Anthony S. Fauci, noStephen L .. Hauser. Izimiso zikaHarrison zeMithi yangaphakathi. ENew York: imfundo kaMc Graw Hill, 2015. Print.
> Rosen, H. Imfundo yeziguli: Ukuvinjelwa kwe-Osteoporosis kanye nokwelapha (Ngaphandle Kwezingqalasizinda). UpToDate . Kubuyekezwe 03/26/17.