Kubudirira kwemishonga yekurapa kurasikirwa kwemapfupa kunowedzera kuwedzera kwethambo uye kuderedza ngozi yezvipembenene kune vanhu vane hosteoporosis nemamwe mamiriro. Chii chaunoda kuziva nezvezvirapa izvi?
Kunzwisisa Osteoporosis
Osteoporosis inowanzoenderana nemapfupa akave asina simba uye anokanganisa. Dzimwe nguva dzinonzi "brittle bone disease," kuora mwoyo kunokanganisa mapfupa kuitira kuti kuputika kunogona kuitika nyore nyore.
Izvi zvinokanganisa kwete kungokonzera kukuremara uye hupfupi huri hupenyu hwehupenyu asi huri chikonzero chikuru chinorwara nekufa sezvo vanhu vachikwegura.
Osteopenia haifaniri kuonekwa sehosha asi iri pamatambudziko ekurasikirwa kwefupa. Izvi zviri nyore kurondedzera maererano nehuwandu hwezvidzidzo zveT zvepamusoro pechipfupa chekuongorora kwepfupa, umo mafuta ako epafu akafananidzwa nemunhu mukuru wechidiki. Pamuedzo uyu, chikwata cheT T che1.0 kana kupfuura chinonzi chakanaka. PANE zvikamu zve -2,5 kana zvishoma zvinoratidza osteoporosis. Osteopenia inowanikwa kana T matanho ari akakwirira kudarika -2.5 asi akaderera kupfuura -1.0. (Kune avo vanofarira, nhamba imwe neimwe inoreva kuchinja kwekutsauka kumwechete).
Kune avo vane osteoporosis, tine ropafadzo yekuve nemapoka emhando yemishonga inogona kuwedzera hutachiona hwemapfupa uye kuderedza kuparara kwekuparara. Kunyange zvazvo osteopenia isingaoneki sechirwere, vanhu vane osteopenia vari kuwedzera mungozi yekuvandudza osteoporosis kana kuputsika kungada kufungisisa mishonga pamwe chete.
Kana yakashandiswa kurapa osteopenia, maitiro emimwe yemishonga (asi kwete yose) yakaderera kupfuura iyo inoshandiswa muhutachiona.
Kuedza kweOsteopenia uye / kana Osteoporosis
Vamwe vanhu vanodzidza kuti vane osteoporosis mushure mekunge vakuvadzwa. Chero ani zvake angave aine kuputsika, asi kuputika kunoitika mumapfupa anokonzerwa nehutachiona hunowanzoitika nekushungurudzika kuduku.
Somuenzaniso, mukomana ane hutano anokwanisa anotsigira kuputika kwechiuno mune ngozi yakakura yemotokari. Murume akwegura ane osteoporosis angangodaro anotambura nekuparara kwakangofanana nokudonha kunononoka.
Imwe nzira yekuziva kana iwe wakatambura kurasikirwa nemapfupa ndekuve nechiedza chepfupa chekuedza . Chiyero chinowanzoitwa kakawanda iviri-simba x-ray testptiometry test kana DEXA scan. Iko zvino yakurudzirwa kuti vakadzi vose vanopfuura makore makumi matanhatu nemashanu uye varume vose vanopfuura makore makumi manomwe vanoongororwa. Vamwe vanhu vane mungozi yeasteoporosis vanofanira kuongororwa kare.
Makirasi eMishonga
Kune mhando dzakasiyana siyana dzemishonga inogona kushandiswa kwehutachiona zvichienderana nechinokonzera kurasikirwa kweropa rako nezvimwe zvinhu. Iyi mishonga inoshanda munzira dzakasiyana dzekuvaka pfupa kana kudzivirira kurasikirwa kwefupa. Izvo zvinoshandiswa mukenza zvinogona kunyange kudzivirira masastases emapfupa (kupararira kwekenza kufupa) kune vamwe vanhu. Aya mapoka emishonga anosanganisira:
- Bisphosphonates
- Sarudzo estrogen receptor modulators (SERMS)
- Hormone replacement therapy (estrogen)
- Calcitonin
- Parathyroid hormone
- Bhiza-zvinodhaka zvinodhaka kune vanhu vane kenza
Ngatitangei nekuongorora kwenguva pfupi kwemafupa ekutema uye basa kuitira kuti tsanangudzo yekuti madhiragi aya anoshanda zvakajeka sei.
Bhuna Basa
Vanhu vazhinji havafungi nemapfupa se "vari vapenyu" asi mapfupa edu inzvimbo yakabatikana. Bhuti rinogara riri kuputsika pasi uye rakavakwa zvakare. Kana iwe wakambove nokuputsika izvi zviri pachena. Bvudzi rakaputika rinokwanisa kuporesa nezvose zviito zvekutsvapa mapfupa uye kubviswa kwemafupa akaora.
Kune miviri miviri mikuru yemasero epafupa. Imwe inonzi osteoblasts , masero anovaka pfupa. Icho chinonzi osteoclasts , masero anoputsa uye abvisa bone. Nguva yakawanda nguva iripo kuenzanisa pakati pezviitiko izvi zviviri kuitira kuti mapfupa (mushure mehucheche) arambe akaenzana nekukura uye kufanana kwemazuva.
Horhemone yeParathyroid (PTH) inonzi hormone inogadzirwa mumitumbi yedu iyo inotarisa muyero pakati peasteoblasts uye osteoclasts kuchengetedza mapfupa akasimba uye kugadzirisa chero upi zvake. Zvose vitamini D uye calcium zvakakosha pakuvaka nekugadzirisa mapfupa ane utano.
Ngatitarisei pamapoka akasiyana-siyana ekurasikirwa kwemapfupa uye maitiro avanoita pakuvaka mapfupa uye / kana kudzivirira kurasikirwa.
Bisphosphonates
Bisphosphonates inhengo yerasteoporosis mishonga yakatanga kuwanikwa muma1990. Iyi mishonga inoderedza basa reasteoclasts (rinomisa kuparadzwa kwefupa) kuti kuderedza kurasikirwa kwefupa. Izvi zvinokonzera kuwedzera kwematare ekuwedzera kwepafupa.
Vanopfuura 95 kubva muzana yevarwere vanobatwa ne-bisphosphonates vanowedzera huwandu hwavo pamapfupa ekuyera. Izvozvo zvinodhaka, zvisinei, zvinopesana muhutano hwavo hwekudzivirira kuputsika kwakananga, kuti vanoshandiswa sei, uye zvimwe zvezvikamu zvinowanzovhiringidza.
Pane imwe yataurwa, iwe haufaniri kutora bhosphophonates kwehupenyu hwako hwose. Pashure pemakore matatu kusvika mashanu ekuvakazve mapfupa ako, vanachiremba vanogona kurumbidza kuti varwere vane ngozi shoma yekuputsika vanogona kumira kuitora, maererano nekuongorora kweSouth Food and Drug Administration.
Mishonga mubhasisphophonate yechikoro inosanganisira:
- Actonel (risedronate): Actonel yakaratidzwa kuti inoderedza zvakanyanya ngozi yekuputika kwechiuno kuvakadzi vane osteoporosis (ne60 muzana mumakore matatu) uye maronda emupfupa muvanhu vanotora steroid (ne70 muzana mumwedzi 12).
- Fosamax (alendronate) : Fosamax yakaratidzwawo kuwedzera masimba emapfupa uye kuderedza dambudziko repasta fractures.
- Boniva (ibandronate): Boniva ibhophosphonate inogona kutorwa nemuromo uye inowanikwawo nejojo. Boniva inoderedza ngozi yepaspractic fractures asi haina kuratidzirwa kuderedza dambudziko rekuputika kwechiuno, saka zvingasava sarudzo yakanaka kune avo vane hip kana zvimwe zvisiri zvipembenene zvinoputika.
- Kudzora kana Zometa (zoledronic acid): Kudzora kana Zometa inopiwa kamwe chete pagore (nokuda kweasteoporosis) kana nejojo.
Zvimwe zvinokonzerwa ne-bisphosphonates zvinoenderana nezvimwe zvinodhaka uyewo zvakapiwa sei. Nemishonga yemuromo, indigestion, kuora mwoyo, uye kuvhiringidzika kwepfungwa kunogona kuitika. Vanhu vanorayirwa kutora mishonga iyi nemvura (jinamisi yejinisi uye kofi inogona kukanganisa kuvhara) uye inoramba yakarurama kwemaminitsi anenge 30 kusvika ku60. Kusuruvara kwepachiviri uye misoro inogona kuitika zvakare.
Chimwe chikamu chisingaiti, kunyanya ne Reclast kana Zometa, ndiyo osteonecrosis yejaya. Zvimwe zvisingawanzovi nemigumisiro zvinogona kusanganisira femur fractures uye atrial fibrillation.
Selective Estrogen Receptor Modulators (SERM)
Sarudzo isrogen receptor modulators (SERMS) inonakidza mishonga mune zvekuti vane esrogen-yakafanana nemamwe maviri (akadai semapfupa) uye zvinopesana nemaserogen mune vamwe (zvakadai sehunhu hwemvere). Kupfuura maestrogen-akafanana nemigumisiro, vanogona kusimbisa mapfupa akafanana neomwe estrogen (hormone replacement therapy) yakaita munguva yakapfuura.
SERMS inongoshanda chete kune osteoporosis muvakadzi. Vanoderedza kurasikirwa kwematokari uye kuderedza dambudziko rekuputika kwemapapu (asi kwete hip fractures).
Sezvo isrogen inoshandiswa pakushandiswa kwekenza yakabatanidzwa nekenza yemazamu, Evista inopa kubatsirwa kweesrogen kumapfupa pasina pangozi yekenza yemazamu kana kuti uterine kubuda ropa kunowanikwa nehommone replacement therapy.
Mukuwedzera pakuvaka mapfupa, Evista inogona kuderedza dambudziko rekudzivirira kenza yemukiramu yemakemhoni yemapfupa mumasimopaopausal. Chirwere ichi chinogona kuita mabasa maviri kune vakadzi vane zvose osteoporosis kana osteopenia uye mukana wakawedzerwa wekuvandudza kenza yemvere.
Zvimwe zvinosanganisa zvinosanganisira kupisa kunopisa, kurwadziwa pamwe chete, kuwedzera kwekutuka, uye musoro wemusoro. Mishonga haifaniri kushandiswa kune avo vakave neropa mumakumbo avo (deep vein thrombosis), mapapu (pulmonary emboli), kana maziso (retinal vein thrombosis).
Hormone Replacement Therapy
Pane imwe nguva yakagadzirirwa kukwanisa kuvhara dambudziko rehasteoporosis, hormone replacement therapy ne estrogen haina kubviswa nekuda kwehuwandu hwehutano hwekenza yemazamu, kurohwa, kushungurudzika kwemoyo, uye kuvhara ropa. Izvozvo zvakati, vamwe vakadzi vanoramba vachishandisa hormone replacement therapy kuti varwise zviratidzo zvemenoopausal uye zvakanyatsoratidzwa kuratidza hupenyu hwehupenyu kune vamwe vanhu. Kune avo vanoshandisa HRT nokuda kwechikonzero ichi, chimwe chinhu chinobatsira ndekuderedza kuparara kwepafupa.
Calcitonin
Calcitonin inonzi hormone inowanzovapo mumitumbi yedu iyo inoshanda kuronga calcium uye bone metabolism.
Calcitonin inogamuchirwa kuitira kurapwa kweasteoporosis muvakadzi vane makore anopfuura mashanu kupfuura kumisa. Inowedzera kuwedzera kwepfupa, kunyanya mumusana uye inoita kuderedza mungozi yepasta fractures. Zvinogonawo kuderedza marwadzo kune vanhu vanoputsika. Mhedzisiro inonyanya kukosha mugore rokutanga remishonga uye inowira nokukurumidza pashure penguva iyoyo. Vanachiremba vanowanzokurudzira kushandisa vitamin D uye calcium supplement pamwe nemishonga iyi asi taura nachiremba wako.
Mishonga inosanganisira:
- Miacalcin nasal spray (calcitonin) inowanikwa seyese spray uye injection (ona pasi apa). Inobvumirwa kuti chirwere chePaget, hypercalcemia (yakakwirira yekasiamu muropa), uye postmenopausal osteoporosis muvakadzi.
- Nhengo (calcitonin): Kunyange zvazvo iyo inoshandiswa, iyo inoshandiswa inongowanikwa chete mumvura inoshandiswa uye inogamuchirwa chete pakurapwa kwemasmenopausal osteoporosis muvakadzi.
- Calcimar (calcitonin): Calcimar inowanikwa sejojo uye inogamuchirwa kuitira kurapwa kwechirwere chePaget, hypercalcemia, uye postmenopausal osteoporosis muvakadzi.
Zvimwe zvinokonzerwa nepasal spray zvinogona kusanganisira kusuruvara kwemanzwi asi zvakanyatsorambidzwa. Nzira isina kuvhara ye calcitonin inogona kukonzera ganda, kuputika, kusuruvara, uye urinary frequency.
Parathyroid Hormone (PTH) Kurapa
Horhemone yaHarathy is a hormone naturally produced in the body. Icho chinokurudzira mapfupa ekugadzira nekuwedzera basa uye nhamba yeasteoblasts, mafupa-forming cells, uye nekuderedza basa reosteoclasts, kuderedza bone resorption. Mune mamwe mazwi, kusiyana nema-bisphosphonates anochera kuparadzwa kwemapfupa, hormone inonzwisisika inogona kunyanya kushanda pakuvaka mapfupa ari nani uye akasimba.
Hormone yeParathyroid inowanzotaurwa kune vanhu vakaonekwa kuti vane osteoporosis uye vane ngozi yakawanda yekuputika, vakundikana kupindura kune mamwe mishonga, kana kuti vakave nemigumisiro nemamwe madekari esteoporosis.
Mune zvidzidzo, hormone yepathyroid yakawanikwa yekuderedza mungozi yemapapu inoputika mumadzimai anonzi postmenopausal. Zvidzidzo zveTymlos zvakawanawo kuderedzwa kwekusava nemasana emakumbo.
Mishonga inosanganisira:
- Forteo (teriparatide): Forteo inoshandiswa shanduko ye hormone yepathyroid iyo inopiwa sechijojo chezuva nezuva. Yakabvumirwa muna 2002.
- Tymlos (abaloparatide) : Tymlos inongova shanduro yevanhu inongova chikamu cheprotini yePTH iyo inoita sePTS paPTH receptors mufupa. Yakagamuchirwa muna 2017 kuitira kurapwa kwehutachiona hwehasteoporosis inotsanangurwa seyi nhoroondo yezvakavhunika, kuva nehuwandu hwekuparara kwehutachiona, uye / kana kuti wakaneta mamwe maitiro ekurapwa kweasteoporosis.
Zvipembenene zvinowanzozivikanwa zveForteo ndezveruzhinji uye makumbo makumbo. Tymlos ave achibatanidzwa neimpimputa matombo nekuda kwekuwedzera calcium mumuguta.
Zvinokurudzirwa kuti kushandiswa kweHarmone parathyroid kunopera makore maviri. Hormone yeHarathyroid haifaniri kushandiswa kune avo vane chirwere chePaget (chirwere chepfupa), kenza yemapfupa, yakanyanya ropa calcium levels (hypercalcemia), kana kuti vakave nokurapa mazaisai kumapfupa avo. Mumakiriniki ekuedzwa, kwakaonekwa kuva kuwedzera kwekenza yemapfupa (osteosarcoma) uye mishonga iyi inotakura nyema yebhokisi nyevero nokuda kwechikonzero ichocho.
Zvose Forteo neTymlos zvakadhura zvikuru kune dzimwe mishonga uye zvinogona kuwedzera kusvika ku $ 20,000 pagore pakubatwa.
Kutevera kurapwa (kusvika kumakore maviri) zvinokurudzirwa kuti kushandiswa kwebhisiphosphonate kunotanga kuchengetedza kuwedzera kwepafupa.
Monoclonal Antibody Therapy
Chikamu che monoclonal antibody therapy chinosanganisira mishonga miviri ine chimiro chimwechete asi nemiratidzo yakasiyana. Denosumab inonzi monoclonal antibody (anti-made antibody) iyo inodzivirira maosteoclasts, masero-kupisa masero kubva pakuumba. Iyi mishonga inoshanda nekuderedza kuputsa kwefupa uye pfupa rekugadzirisa.
Zvipembenene zvinowanzoonekwa zvinosanganisira kumashure, kubatanidza aches, kurwadziwa kwemisonda, uye kuwedzerwa kwehushutoriol uye urinary zvirwere. Zvinosvibisa zvinogona kusanganisira osteonecrosis yejaya (sezvinoitwa bisphosphonates), kuwedzera kwehutachiona hwehutachiona (zvikurukuru hutachiona hwemutsipa wemwoyo), hutachiona hwezvinyama zvepamuviri, uye kupora kwepachivara zvishoma.
Mishonga inosanganisira:
- Prolia (denosumab): Prolia inowanikwa sejojo inopiwa kamwe kamwe mwedzi mitanhatu. Prolia, kusiyana neXgeva, ine zviratidzo zvakawanda. Ingave yakanyorerwa varume nevakadzi ve postmenopausal vane osteoporosis vane ngozi yakawanda yekuparara. Sekudzivirira, Prolia inogona kushandiswa kune vose vakadzi vari kugamuchira aromatase inhibitor therapy nokuda kwekenza yepamu nevarume vane kenza isingaiti metastatic prostate iyo iri kugamuchira androgen kubviswa kwechirwere.
- Xgeva (denosumab): Xgeva inowanikwa sejojo inopiwa kamwe kamwe masvondo mana. Xgeva inogamuchirwa kuvanhu vane kenza yepamusoro yepabonde kuderedza dambudziko rezviputi zvakabatana nemasitoshe emapfupa (kupararira kwekenza yepafu kumapfupa), kurapa marwadzo, uye kuderedza dambudziko rekuwedzera kuputsika. Inogonawo kushandiswa (asi ine dosing yakasiyana) yevanhu vane hypercalcemia yezvakaipa , uye vanhu (zvakare vane dosing yakasiyana) ne giant cell tumorumine yepfupa.
Kufanana ne-bisphosphonates, denosumab inogona kuwedzera njodzi yeosteonecrosis yetsanga. Prolia uye Xgeva vanoita sevanopesana nekenza zvinhu pamwe nekuderedza kudengenyeka kwekuparara.
Bhudzi Kuchinja Mishonga
Mishonga inotapura-inoshandiswa yakashandiswa kuderedza dambudziko rekuparara kune vanhu vane kenza yakapararira kumapfupa avo. Kushandiswa kwakajairika kwekenza yepamu ne bone metastase kana mutsa wemapapu nemasitoshe emapfupa.
Zvirwere zvinosanganisira Zometa (zoledronic acid), bisphosphonate inokurukurwa pamusoro, uye Xgeva (denosumab), mishonga yakawanikwa ichideredza kuputsika kwevanhu vane kenza yemazamu yakapararira kumapfupa avo. Zometa uye Xgeva (kana kuti Prolia) zvakare vanoita sevanopesana nekenza zvinhu.
Kusanganiswa uye Sequential Kushandisa Osteoporosis Zvinodhaka
Sezvo pane zvakawanda zvezvikamu zvehutano hwehasteoporosis, zvose zvinoshanda nenzira dzakasiyana, unganetseka kana mimwe mishonga iyi ingashandiswa pamwe chete kuderedza dambudziko rekuparara. Kunyange zvazvo iri pfungwa yakanaka, pane uchapupu hushoma hwokuti kubatanidza akawanda kupfuura imwe boka remishonga iyi ndeyekubatsira.
Zvimwe zvingave zviri kutangira bisphosphonate kana uchirega kushandiswa kweProlia / Xgeva kana Forteo, umo kuwirirana kwemwedzi 6 kusvika kune 12 kunogona kubatsira kuti urambe uchinatsiridza muhutano hwemapfupa.
Calcium uye Vitamin D muOsteoporosis Prevention
Nezvizhinji zvemishonga iyi inokurudzirwa kuti vanhu vagone kuwanika zvakakwana zve calcium uye vitamini D. Kudya kwakanaka kunowanzopa calcium yakakwana, asi taura nachiremba wako. Vitamini D, zvisinei, zvakaoma kupinda muzvokudya zvine utano (funga: makirasi akawanda emukaka uye salmoni zuva rega rega), uye kwete vanhu vose vari kwose vanogona kuwana mukana wakakwana kuburikidza nezuva kunze. Taura nachiremba wako nezvekuongorora vitamin D yako (iyo inongororwa ropa) uye kurumbidza vitamini D3 kuwedzera kana zvichidikanwa. Kunyange zvazvo yakawanda yakakwana ye calcium uye vitamini D inotarisirwa kuti iwane mapfupa chaiwo asi haisi kutsiva kushandiswa kwemishonga ye osteoporosis.
Shoko Rinobva
Sezvakataurwa pamusoro apa, pane makirasi akasiyana-siyana emishonga kune vanhu vane kurasikirwa kwefupa. Chiremba wako anogona kukurukura newe zvikonzero nei imwe kirasi inogona kunge iri nani kune imwe yemamiriro ako ezvinhu, pamwe chete nemishonga ipi mune imwe yemakirasi aya angave akanaka. Kune zvakawanda zvinoshandiswa mukusarudza mishonga yakarurama inosanganisira nhoroondo yezvakaora, mamiriro evanhu, uye zvinogona kuitika.
Kunyange zvazvo mishonga iyi inogona kuwedzeresa mapfupa emapfupa, chinangwa chekurapa ndechokuderedza ngozi yezviputsi. Kuwedzera masimba emapfupa ari oga hazvirevi nguva dzose kuderedza kuputsika. Semuenzaniso, fluoride inogona kuwedzera mashizha ematokari asi haidziviri kutadza kuputsika (uye inogona kuwedzera dambudziko sezvo bone rinoumbwa iri pasi).
Zvakakoshawo kufunga nezvehupenyu hwezvinhu zvinogona kuderedza dambudziko rako rekuputika kana uine osteoporosis. Mafuro ndiwo chinokonzera chirwere chekurwara uye rufu muUnited States pamusana pezviputsi zvinokonzera uye zvinetso zvinotevera. Pasinei nemishonga yaunosarudza, pedza nguva pfupi uchitarisa zvimwe zvinowanzofungwa, uyewo nzira shomanana dzinozivikanwa dzekuderedza ngozi yako yezvimedu uye kuwira .
> Sources:
> Ensrud, K., uye C. Crandall. Osteoporosis. Anals of Internal Medicine . 2017. 167 (3): ITC17-ITC32.
> Khosla, S., naL. Hofbauer. Osteoporosis Mushonga: Kuvandudzwa Kwemazuva Ano uye Matambudziko Anoramba Aripo. Lancet. Chirwere cheshuga uye Endocrinology . 2017 July 6. (Epub mberi kwekudhinda).
> McClung, M. Achishandisa Osteoporosis Therapies muKutanidzwa. Nhoroondo dzeOsteoporosis yemazuva ano . 2017. 15 (4): 343-352.