Imithi ephumelelayo yokwelapha ukulahleka kwethambo kwandisa isibalo se-bone nokunciphisa ingozi yezinsalela kubantu abane-osteoporosis nezinye izimo. Yini okudingeka ukwazi mayelana nalezi zokwelapha?
Ukuqonda i-Osteoporosis
I-osteoporosis yisimo esivamile esithinta amathambo asebuthakathaka futhi ehlushwa. Ngezinye izikhathi okubizwa ngokuthi "isifo se-bone obuthakathaka," ukuguqulwa kwamathambo kunciphisa amathambo ukuze i-fracture ivele kalula.
Lezi zinkinga azigcini nje ekuholelekeni ekukhubazekeni nasezingeni elinciphile lokuphila kodwa liyisizathu esiyinhloko sokugula nokufa njengoba abantu bekhula.
I-Osteopenia ayithathwa njengesifo kepha ilahlekelwa yithemba. Lokhu kulula ukuchaza ngokuphathelene nezibalo ze-T ekuhlolweni kwethambo, lapho ubukhulu bethambo bakho buqhathaniswa nomuntu omdala onempilo. Kulesi sivivinyo, isilinganiso se-T se--1.0 noma ngaphezulu sithathwa njengokujwayelekile. I-score ye--2.5 noma ephansi ibonisa ukuhlinzeka ngokwe-osteoporosis. I-Osteopenia ikhona uma i-T isiphezulu kune--2.5 kepha ingaphansi kwe--1.0. (Kulabo abanesithakazelo, inombolo ngayinye ibhekisela ekushintsheni kokuphambuka okuvamile).
Kulabo abane-osteoporosis, sinenhlanhla yokuba nezigaba eziningana zemithi ezingase zithuthukise amathambo futhi zinciphise ingozi yokuhlukana. Nakuba i-osteopenia ingabhekwa njengesifo, abantu abane-osteopenia abasengozini yokwanda kwe-osteoporosis noma i-fractures bangase bafise ukucabangela imithi kanye.
Uma isetshenziselwa ukwelapha i-osteopenia, ukulingana kwamanye ala mithi (kodwa hhayi konke) kuncane kunelawo asetshenziselwa ukwelashwa kwe-osteoporosis.
Ukuvivinya i-Osteopenia kanye / noma i-Osteoporosis
Abanye abantu bafunda ukuthi bane-osteoporosis ngemva kokuhlukana. Noma ubani angase aphule, kodwa ukuqhuma okwenzeka emathanjeni abathinteka ukuphefumula kwamandla ngokuvamile kwenzeka ngokuhlukunyezwa okuncane.
Isibonelo, umfana onempilo enhle angase asekele ukuqhuma kwe-hip engozini enkulu yemoto. Umuntu osekhulile ophethwe yi-osteoporosis angase ahlupheke ngokufanayo ukuwa okuncane.
Enye indlela yokuthola ukuthi ulahlekelwe yini amathambo ukuhlolwa kwesithambo . Isivivinyo esenziwa kaningi kaningi ukuhlolwa kwe-x-ray absorptiometry noma i-DEXA ukuskena. Manje kunconywa ukuthi bonke abesifazane abangaphezu kweminyaka engu-65 nabo bonke amadoda abangaphezu kweminyaka engu-70 bahlolwe. Abanye abantu abanezingozi zokuphefumula kwegazi kufanele bahlolwe ngaphambili.
Amakilasi Imithi
Kunezinhlobo eziningana zemithi engase isetshenziselwe i-osteoporosis kuye ngokuthi imbangela yokulahlekelwa kwethambo lakho nezinye izici. Lezi zidakamizwa zisebenza ngezindlela ezahlukene zokwakha amathambo noma ukuvimbela ukulahleka kwethambo. Labo asetshenziselwa umdlavuza bangavimba ngisho nokuvimbela ama-metastase amathambo (ukusakazeka komdlavuza oswini) kwabanye abantu. Lezi zigaba zemithi zihlanganisa:
- Bisphosphonates
- Izixazululo ze-estrogen receptor (SERMS) ezikhethiwe
- I-hormone therapy esikhundleni (estrogen)
- I-Calcitonin
- I-hormone ye-parathyroid
- Izidakamizwa eziguqula izifo kubantu abanomdlavuza
Ake siqale ngokubuyekezwa okufushane kwe-bones anatomy kanye nokusebenza ukuze incazelo yokuthi lezi zidakamizwa zisebenza kanjani ngokucacile.
I-Bone Umsebenzi
Abantu abaningi abacabangi ngamathambo ngokuthi "baphile" kodwa amathambo ethu ayindawo ematasa. I-Bone idilizwa njalo futhi yakhiwe kabusha. Uma ngabe uke wahlukana lokhu kubonakala ngokucacile. I-bone fractures iyakwazi ukuphulukisa kokubili izenzo zokwenza amathambo amasha nokususwa kwethambo elonakalisiwe.
Kunezinhlobo ezimbili ezinkulu zamathambo esithambo. Enye i- osteoblasts , amangqamuzana akha ifu. Enye i- osteoclasts , amangqamuzana aphula futhi asuse amathambo. Esikhathini esiningi kukhona ukulingana phakathi kwalezi zinqubo ezimbili ukuze amathambo (emva kokubuntwana) ahlale ubukhulu obufanayo nobukhulu ngaphezu kwesikhathi.
I-hormone ye-parathyroid (i-PTH) i-hormone eyenziwa emizimbeni yethu elawula ukulinganisa phakathi kwama-osteoblasts nama-osteoclasts ukugcina amathambo aqinile nokulungisa noma yimuphi umonakalo. Kokubili i-vitamin D ne-calcium zibalulekile ekwakhiweni nasekulungiseni amathambo enempilo.
Ake sibheke imilasi ehlukene yokuphulukana namathambo nokuthi isebenza kanjani ekwakheni amathambo kanye / noma ukuvimbela ukulahlekelwa.
Bisphosphonates
Ama-bisphosphonates yizigaba zemithi ye-osteoporosis eyaqala ukutholakala ngawo-1990. Lezi zidakamizwa zinciphisa umsebenzi we-osteoclasts (ivimba ukubhujiswa kwethambo) ukunciphisa ukulahleka kwamathambo. Lokhu kubangela ukwanda kwenetha emithini yethambo.
Amaphesenti angaphezu kwamaphesenti angama-95 aphathwe ama-bisphosphonates akhulisa amanani abo ekuhlolweni kwamathambo. Kodwa-ke, izidakamizwa ezithile zihlukile emathanjeni abo okuvimbela ukuhlukana okuqondile, indlela esetshenziswa ngayo, kanye neminye imiphumela emibi.
Uma usunqunyelwe, kungenzeka ukuthi awudingi ukuthatha ama-bisphosphonates impilo yakho yonke. Ngemuva kweminyaka emithathu kuya kwemihlanu yokwakha amathambo akho, odokotela bangase batuse ukuthi iziguli ezinengozini encane yokuphuka zingayeka ukuzithatha, ngokubuyekezwa kwe-US Food and Drug Administration.
Imithi eklasini le-bisphosphonate ihlanganisa:
- I-Actonel (risedronate): U-Actonel uye waboniswa ngokunciphisa kakhulu ingozi yokuqhaqhaza amaqanda kulabo besifazane abane-osteoporosis (ngamaphesenti angama-60 eminyakeni emithathu) kanye nemifucumfucu yomgogodla kubantu abathatha ama-steroid (ngamaphesenti angu-70 ezinyangeni ezingu-12).
- I-Fosamax (i-alendronate) : I-Fosamax nayo iboniswe ukwandisa isisindo samathambo futhi sinciphise ingozi yezinhlanzi zomgogodla.
- I-Boniva (ibandronate): I-Boniva iyi-bisphosphonate engathathwa ngomlomo futhi itholakala ngomjovo. I-Boniva iyanciphisa ingozi ye-fractures yomgogodla kodwa ayizange iboniswe ukunciphisa ingozi ye-hip fractures, ngakho-ke kungenzeka ukuthi ngeke kube yinto enhle kulabo abanezintambo noma ezinye izinkinga ezingekho emgodini.
- Ukuqothula noma i-Zometa (i-zoledronic acid): Ukuxubha noma i-Zometa kunikwa isikhathi esisodwa ngonyaka (ngenxa ye-osteoporosis) noma ngomjovo.
Imiphumela emibi ye-bisphosphonates incike emthini othile kanye nokuthi inikezwa kanjani. With imithi ngomlomo, indigestion, ukuqubuka kwenhliziyo, nokuvuvukala kokungapheleli kungase kwenzeke. Abantu bafundiswa ukuthatha lezi zidakamizwa ngamanzi (ijusi le-orange kanye nekhofi kungaphazamisa ukumuncwa) futhi uhlale ulungile okungenani imizuzu engu-30 kuya ku-60. Kungenzeka futhi ubuhlungu besisu nobuhlungu bekhanda.
Umphumela wecala ongavamile, ikakhulukazi i-Reclast noma i-Zometa, i-osteonecrosis yomhlathi. Eminye imiphumela emibi engavamile ingabandakanya ama-femur fractures kanye ne-fibrillation ye-atrial.
Ama-modulator e-Selective Acceptor Acceptor (SERM)
Izivikeli ze-estrogen receptor receptor (SERMS) yizidakamizwa ezithakazelisayo ngoba zinemiphumela efana ne-estrogen kwezinye izicubu (njengamathambo) nemiphumela elwa-estrogen kwabanye (njengezicubu zesifuba). Ngezindlela zabo ezifana ne-estrogen, zingase ziqinise amathambo afana nalokho okuyi-estrogen (i-hormone substitution therapy) eyenzile esikhathini esidlule.
I-SERMS iphumelela kuphela ekuhlinzekeni kwe-osteoporosis kwabesifazane. Iphuza ukulahleka kwethambo nokunciphisa ingozi yokuphuza izimpumputhe (kodwa hhayi ukuqhaqhaza ama-fractures).
Njengoba i-estrogen yokuguqula imithi ihlanganiswe nomdlavuza webele, u-Evista unikeza inzuzo ye-estrogen emathanjeni ngaphandle kwengozi yomdlavuza wesifuba noma ukuphuma kwegazi okutholakala ne-hormone replacement therapy.
Ngaphezu kokwakha amathambo, u-Evista anganciphisa ingozi yokuthola umdlavuza webele we-hormone receptor-positive kuma-postmenopausal abesifazane. Isidakamizwa singenza umsebenzi ophindwe kabili kubantu besifazane abanesifo sofuba se-osteoporosis noma i-osteopenia kanye nethuba elikhulayo lokuthuthukisa umdlavuza webele.
Imiphumela emibi ihlanganisa ukukhanya okushisayo, ubuhlungu obuhlangene, ukujuluka okukhulu, nokukhanda ikhanda. Imithi akufanele isetshenziswe kulabo abaye baba namacilongo egazi emilenzeni yabo (imfucuza ejulile ye-vein thrombosis), amaphaphu (i-pulmonary emboli), noma amehlo (i-retinal vein thrombosis).
I-Hormone Alternative Therapy
Uma sekuvele ikhono layo lokunciphisa ingozi ye-osteoporosis, ukwelashwa kwe-hormone esikhundleni se-estrogen sehlulekile ngenxa yengozi yokwanda komdlavuza wesifuba, ukushaya, ukuhlaselwa yinhliziyo, namacici egazi. Lokho kusho ukuthi abanye besifazane bayaqhubeka ukusebenzisa imithi yokwelapha i-hormone ukulawula izimpawu ze-menopausal futhi kuboniswe ngokucacile ukuthuthukisa ikhwalithi yokuphila kwabanye abantu. Kulabo abasebenzisa i-HRT ngalesi sizathu, inzuzo eyengeziwe yanciphisa ukulahlekelwa kwethambo.
I-Calcitonin
I-Calcitonin i-hormone ngokwemvelo ikhona emizimbeni yethu esebenza ukulawula i-calcium ne-bone metabolism.
I-Calcitonin ivunyelwe ukwelashwa kwe-osteoporosis kwabesifazane okungenani iminyaka emihlanu ngaphesheya kokuya esikhathini. Ukwandisa isisindo samathambo, ikakhulukazi emgodleni futhi kubonakala kunciphisa ingozi yokuphuluka komgogodla. Kunganciphisa futhi ubuhlungu kubantu abaye bahlukana. Umphumela omkhulu kunawo wonke ngonyaka wokuqala wezokwelapha futhi wehla ngokushesha ngemva kwalesi sikhathi. Odokotela bavame ukuncoma ukusebenzisa i-vitamin D ne-calcium ukwengezela kanye nale mithi kodwa ukhulume nodokotela wakho.
Imithi ihlanganisa:
- I-Miacalcin nasal spray (calcitonin) itholakala kokubili ukuphambana komzimba kanye nomjovo (bheka ngezansi). Kuvunyelwe isifo se-Paget, i-hypercalcemia (izinga eliphakeme eliphezulu le-calcium egazini), kanye ne-postmenopausal osteoporosis kwabesifazane.
- I-fortical (calcitonin): Nakuba isithako esiyinhloko esifanayo, i-Fortical itholakale kuphela nge-spray ye-nasal futhi ivunyelwe kuphela ukwelashwa kwe-postmenopausal ukuphefumula kwamathambo kwabesifazane.
- I-Calcimar (i-calcitonin): I-Calcimar iyatholakala njengomjovo futhi ivunyelwe ukwelashwa kwesifo se-Paget, i-hypercalcemia, kanye ne-postmenopausal osteoporosis kwabesifazane.
Imiphumela emibi ye-spray ye-nasal ingabandakanya ukucasuka komzimba kodwa kubekezelelwe kahle. Ifomu elingenakulungiswa le-calcitonin lingabangela ukukhwabanisa isikhumba, i-rash, i-nausea, kanye nemvamisa ye-urinary.
I-Parathyroid Hormone (PTH) yezokwelapha
I-hormone ye-parathyroid i-hormone ngokwemvelo eyenziwa emzimbeni. Ivuselela ukwakheka kwamathambo ngokwandisa umsebenzi kanye nenani lama-osteoblasts, amaseli okwenza amathambo, nokunciphisa umsebenzi we-osteoclasts, ukunciphisa ukuguqulwa kwamathambo. Ngamanye amazwi, ngokungafani nama-bisphosphonates okunciphisa ukubhujiswa kwethambo, i-hormone yokukhathazeka ingase isebenze ukwakha amathambo angcono futhi anamandla.
I-hormone ye-parathyroid ivame ukuqondiswa kubantu abaye bathola ukuthi bane-osteoporosis futhi abanengozi enkulu yokuhlukana, baye bahluleka ukuphendula eminye imithi, noma baye babhekana nemiphumela emibi nezinye izidakamizwa ze-osteoporosis.
Ezicwaningweni, i-hormone ye-parathyroid itholakale ukunciphisa ingozi yokuphuka komgogodla kubesifazane be-postmenopausal. Izifundo eziseTymlos nazo zathola ukunciphisa ama-fractures okungewona amagciwane.
Imithi ihlanganisa:
- I-Forteo (i-teriparatide): I-Forteo iyinhlangano yokwenziwa kwe-hormone ephathekayo ehlinzekwa njengomjovo wansuku zonke. Kwavunyelwa ngo-2002.
- I-Tymlos (i-abaloparatide) : I-Tymlos empeleni inguqulo eyenziwe ngumuntu kuphela ingxenye yeprotheyini ye-PTH efana ne-PTS kuma-PTH receptors esitokisini. Yavunyelwa ngo-2017 yokwelashwa kwe-osteoporosis ejulile echazwa njengomlando wezinhlanzi, enezinkinga eziningi eziyingozi, kanye / noma ukhathele ezinye izindlela zokwelashwa kwe-osteoporosis.
Imiphumela emibi ejwayelekile ye-Forteo yizizungu kanye namagundane omlenze. I-Tymlos ihlotshaniswe nezinso zezinso ngenxa yokwanda kwe-calcium emcinini.
Kunconywa ukuthi ukusetshenziswa kwehomoni ye-parathyroid kungalinganiselwe iminyaka emibili. I-hormone ye-parathyroid ayifanele isetshenziselwe labo abanesifo se- Paget (isifo sethambo), umdlavuza wethambo, amazinga aphezulu we-calcium (i-hypercalcemia), noma abaye baphathwa ngemithi emathanjeni abo. Ezilingo zomtholampilo, kubonakala sengathi ukwanda komdlavuza wamathambo (i-osteosarcoma) futhi lezi zidakamizwa zithwala isixwayiso sebhokisi elimnyama ngalesi sizathu.
Kokubili i-Forteo ne-Tymlos isihlobo esibi kakhulu kwezinye izifo futhi singangeze ku-$ 20,000 ngonyaka ukuze ukwelashwa.
Ukwelashwa okulandelayo (kuze kube yiminyaka emibili) kunconywa ukuthi ukusetshenziswa kwe-bisphosphonate kuqalwe ukugcina ukwanda kwamathambo.
I-Monoclonal Antibody Therapy
Isigaba se-monoclonal antibody therapy sihlanganisa imithi emibili ngesakhiwo esifanayo kodwa ngezibonakaliso ezahlukene. I-Denosumab iyi-antibody (monoplonal antibody) eyenza abantu ukuthi bavimbele ama-osteoclast, amangqamuzana e-bone-dissolving from forming. Lezi zidakamizwa zisebenza ngokunciphisa ukuphulwa kwethambo ne-bone ukulungiswa.
Imiphumela emibi kakhulu ehlanganisa emuva, ama-aches ahlangene, ubuhlungu be-muscle, kanye nokwanda kwe-cholesterol level kanye nokutheleleka kwe-urinary tract. Imiphumela emibi ingabandakanya i-osteonecrosis yomhlathi (njengama-bisphosphonates), ingozi ekhulayo yezifo (ikakhulukazi izifo zesisu senhliziyo), amandla okwehlukana kwe-atypical, nokuphulukiswa okulimazayo kwesikhumba.
Imithi ihlanganisa:
- I-Prolia (denosumab): I-Prolia itholakala njengomjovo onikezwe kanye njalo ezinyangeni ezingu-6. I-Prolia, ngokungafani ne-Xgeva, inezinkomba eziningana. Kungase kubekwe amadoda nabesifazane be-postmenopausal abane-osteoporosis abanengozi enkulu yokuhlukana. Njengendlela yokuvimbela, i-Prolia ingasetshenziselwa kokubili abesifazane abathola ukwelashwa kwe-aromatase inhibitor yomdlavuza wesifuba namadoda anomdlavuza we-non-metastatic prostate abamukela ukwelashwa kwe-androgen.
- I-Xgeva (denosumab): i-Xgeva itholakala njengomjovo onikwe kanye njalo ngemva kwamasonto amane. I-Xgeva ivunyelwe abantu abanomdlavuza webele ophuthumayo ukunciphisa ingozi yezinsalela ezihlobene namathambo emasaka (ukusakazeka komdlavuza webele esifubeni), ukuphatha ubuhlungu nokunciphisa ingozi yokuqhuma okuqhubekayo. Kungasetshenziswa futhi (kodwa nge-dosing ehlukile) kubantu abane- hypercalcemia ye-malignancy , kanye nabantu (futhi futhi ne-dosing ehlukile) abanezinambuzane ezinkulu ze-bone.
Ngokufanayo nama-bisphosphonates, i-denosumab ingandisa ingozi ye-osteonecrosis yomhlathi. I-Prolia ne-Xgeva kubonakala sengathi banesakhiwo sokulwa nomdlavuza ngaphezu kokunciphisa ingozi yokuhlukana.
I-Bone Modifying Medication
Imithi yokuguqula i-bone isetshenziselwe ukunciphisa ingozi yezinsalela kubantu abanomdlavuza osakaze emathanjeni abo. Ukusetshenziswa okuvamile kungumdlavuza webele we-bone metastases noma umdlavuza wamaphaphu nge-metastases yamathambo.
Izinketho zokwelashwa zihlanganisa i-Zometa (i-zoledronic acid), i-bisphosphonate ekhulunywe ngenhla, no-Xgeva (denosumab), isidakamizwa esitholakale ukunciphisa ukuhlukana kubantu abanomdlavuza webele osakazeka emathanjeni abo. Bobabili i-Zometa ne-Xgeva (noma i-Prolia) nayo ibonakala sengathi inezindawo zokulwa nomdlavuza.
Ukuhlanganiswa Nokusetshenziswa Okusetshenziswa Kwezidakamizwa Ze-Osteoporosis
Njengoba kunezigaba eziningi zezidakamizwa ze-osteoporosis, konke okusebenza ngezindlela ezahlukene, ungase uzibuze ukuthi yini embalwa yalezi zidakamizwa ezingasetshenziswa ndawonye ukunciphisa ingozi yokuphulwa. Yize lokho kungumcabango omuhle, kunobunye ubufakazi bokuthi ukuhlanganisa amakilasi angaphezulu kweyodwa yalezi zidakamizwa kuzuzisa.
Okuhlukile kungase kuqale i-bisphosphonate uma uvala ukusetshenziswa kwe-Prolia / Xgeva noma i-Forteo, lapho ukuqoqwa kwezinyanga ezingu-6 kuya kwezingu-12 kungasiza ekugcineni ukuthuthukiswa kwamathambo.
I-Calcium ne-Vitamin D ekuvimbeleni kwe-Osteoporosis
Ngamaningi ala mithi kunconywa ukuthi abantu bathole inani elanele le-calcium ne-vithamini D. Ukudla okunempilo kaningi kunikeza ikhalsium eyanele, kodwa khuluma nodokotela wakho. I-Vitamin D, Nokho, kunzima ukuthola ukudla okunempilo (cabanga: izibuko eziningana zobisi kanye ne-saumon usuku ngalunye), futhi akuwona wonke umuntu kuyo yonke indawo ekwazi ukuthola imali eyanele ngokukhanya kwelanga ngaphandle. Khuluma nodokotela wakho mayelana nokuhlola izinga lakho levithamini D (kungukuhlolwa kwegazi okulula) futhi uncoma isithasiselo se-vitamin D3 uma kudingeka. Nakuba inani elanele le-calcium ne-vitamin D liyadingeka ukuze kusetshenziswe kahle amathambo akusilo esikhundleni somuthi we-osteoporosis.
Izwi elivela
Njengoba kuphawuliwe ngenhla, kunezigaba eziningana ezihlukene zemithi yabantu abanokulahleka kwethambo. Udokotela wakho angakhuluma nawe ngezizathu zokuthi kungani elinye iklasi lingase libe ngcono kunezinye ngezimo zakho, kanye nokuthi yisiphi isidakamizwa ngaphakathi kwezinye zezigaba kungaba ngcono kakhulu. Kunezinhlobo eziningi ezikhethwa ekukhetheni isidakamizwa esifanele kubandakanya umlando wezinsalela, isimo samadoda, kanye nemiphumela emibi engase ibe khona.
Nakuba le mithi ingandisa ukwanda kwethambo, umgomo wokwelashwa ukunciphisa ingozi yezinsalela. Ukwandisa amathambo omzimba wodwa akusho ngaso sonke isikhathi ukunciphisa ama-fractures. Isibonelo, i-fluoride ingandisa ukwanda kwethambo kodwa ayiyinciphisi ingozi yokuhlukana (futhi ingase ibe nokwandisa ingozi njengoba ithambo elakhiwe lingaphansi).
Kubalulekile ukucabangela izinto zokuphila ezinganciphisa ingozi yezinkinga uma une-osteoporosis. I-Falls iyimbangela ehamba phambili yokugula nokufa e-United States ngenxa yezinhlupho ezibangelwayo kanye nezinkinga ezilandelayo. Kungakhathaliseki ukuthi imithi oyikhethayo, sebenzisa isikhathi esithile ubuyekeze ezinye izinzwa ezivamile, kanye nezindlela ezincane eziyaziwayo zokunciphisa ingozi yokudonsa nokuwa .
> Imithombo:
> Ensrud, K., noC. Crandall. I-osteoporosis. Ama-Annal of Medicine yangaphakathi . 2017. 167 (3): ITC17-ITC32.
> Khosla, S., noL. Hofbauer. Ukwelashwa Kwe-Osteoporosis: Ukuthuthukiswa Kwamuva Nezingqinamba Eziqhubekayo. I-Lancet. Isifo sikashukela kanye ne-Endocrinology . 2017 July 6. (Epub ngaphambi kokuphrinta).
> McClung, M. Ukusebenzisa ukwelashwa kwe-Osteoporosis in Combination. Imibiko Yamanje Ye-Osteoporosis . 2017. 15 (4): 343-352.