Mishonga Inoshandiswa kuOsteopenia (Kuderera Kwemapfupa Akadzika)
Kana iwe wakamboonekwa uine osteopenia (kurema kwepafupa) chiremba wako angave akarayira kurapwa. Ndeipi mishonga inoshandiswa inowanikwa kana iwe usati wati "warova" osteoporosis, uye rinobatsirei kuongorora kurapwa?
Osteopenia: Low Bone Density
Osteopenia inoreva kuderera kwepfupa, asi izvi zvinorevei chaizvoizvo? Zviri nyore kunzwisisa osteopenia patinenge tichizvienzanisa nezvose zvinowanzosvika pfupa rehutachiona uye osteoporosis (yakanyanya kuderera masimba).
Kazhinji mapfupa emasvomhu anoreva kuti kuwanda kwevanhu uye mapurisa emapfupa ako ndeyezvakanaka. Pamuviri wepfupa , nhamba yaunogona kuona kana pfupa rako remafupa raive rakanaka raizove rakakwirira kudarika -1.0. Mune mamwe mazwi, mapfupa ako emapfupa angave ari nani kana kuti ari nani kupfuura kumwe kwekutsauka kunowanikwa pasi apa.
Osteoporosis ndiyo mamiriro ayo mapfupa ave akaoma uye anowanzoputsa, kunyange nekukuvara kwakakomba. Kuongorora kwepfupa uye osteoporosis inopa T-zvikamu zve--2.5 kana kupfuura, zvinoreva kuti hutachiona hwemunhu hunokwana 2.5 hunokanganisa hutsika pasi pehuwandu hwemapfupa evanhu vane hutano hwakanaka kana kupfuura.
Osteopenia iri pakati pezviyero izvi, zvine T-zvikwata zvinopfuura -2.5 asi zvakanyanya kudarika -0.1. Mukana wekuti osteopenia ichafambira mberi kuhutachiona hunoenderana nezera rako, mamwe mararamiro aunawo, mishonga yauri kutora, nezvimwewo zvakawanda.
Kurapa Osteopenia
Kune zvikonzero zvakawanda zvokufungisisa usati watora chirwere che osteopenia, uye ichi chiri ikozvino nyaya inokakavara uye inotyisa.
Kana osteopenia inosanganiswa nemarara, zvichida kuti kurapwa kunogona kuita mutsauko. Hazvisi pachena kana kurapa osteopenia pasina kuputika kunobatsira.
Kune mishonga yaDAA-inogamuchirwa nekuda kwekudzivirira osteoporosis (uye nekuda kweasteopenia). Iyi mishonga inobatsira asi dzimwe dzadzo dzine madambudziko makuru.
Vamwe vanachiremba vanozeza kupa mishonga ye osteoporosis ye osteopenia asi vamwe vane utsinye pakuedza kuderedza kurasikirwa kwefupa. Icho chinangwa chaicho mukurapa maviri esteopenia uye osteoporosis iri kudzivirira kuputika, kunyanya muhudyu uye musana. Vanachiremba vanokwanisa kuverenga makore gumi nematambudziko ekuputsika kwako zvichienderana newayo zvino mafupa emaminiti emagetsi uye zvimwe zvipingamupinyi. Iyo ngozi yemakore gumi ndiyo inonyanya kufunga iyo paifunga nezvekutora mishonga ye osteopenia.
Nyaya yepakati, kunyange zvazvo inokosha, ndeyekuti makambani mazhinji ehutano inshuwarisi haatendi osteopenia semamiriro ezvinhu anoda kurapwa uye naizvozvo haagoni kuvhara mari (dzimwe nguva yakawanda) yemishonga iyi.
Apo Osteopenia Inofanira Kuitiwa Rini?
Sezvambotaurwa, kurapa kweasteopenia kunopesana. Izvozvo zvakati, kana kurapwa kwakatanga panguva iyi kuvanhu vanenge vachitarisirwa kufambira mberi kune osteoporosis, kana kuti kune mamwe mamiriro ezvinhu, kurapa osteopenia kunogona kudzivirira kukura kweasteoporosis uye kuputsika. Mamiriro ezvinhu ayo osteopenia angave akaoma zvikuru anosanganisira:
- Osteopenia inowanikwa mumunhu wechidiki, somuenzaniso, munhu ane makore makumi mashanu chete.
- Vanhu vane kenza, kunyanya avo vane kenza yemazamu kana kenza yeprotate avo vachave vachishandisa mahomoni ekurapa.
- Vanhu vagara vari kwenguva yakareba steroid yezviitiko zvakadai seAsphma, COPD, kana kuvhiringidza arthritis.
- Avo vane mamiriro ekubatana nehuwandu hwehutano hwehutano hwehutano hwakadai se lupus, rheumatoid arthritis, nezvimwe zvizhinji.
- Avo avo vanowanzowira nekuda kwehutano hwakadai sehutano hwekubata kana zvimwe zvirwere zvepfungwa.
- Avo vane mhuri dzakasimba nhoroondo yeasteoporosis.
- Avo avo vakatambura kuputsika uye vane uwandu hwepfupa.
Mishonga Yokudzivirira Osteoporosis (Kurapa kweOsteopenia)
Kune mishonga yakasiyana-siyana yakagamuchirwa kurapa osteoporosis , asi vashoma chete vanobvumirwa kudzivirira kusanganisira Actonel naEvista.
Tichaverenga maitiro ehutano hwehutachiona, sezvinenge dzimwe nguva mimwe mimwe mitero kunze kweiyo inobvumirwa osteopenia (kudzivirira osteoporosis) inogona kuratidzwa. Mhando dzakasiyana dzemishonga dzakanyorwa pasi apa.
Bisphosphates
Bisphosphonates mishonga inoshanda kuburikidza nekuderedza kuwanda kwemapfupa ekurasikirwa uye kunatsiridza mapfupa emapfupa. Zvizhinji zveizvi zvinoderedza ngozi yekuputika kwemapapu, asi hazvisi zvose zvakaratidzwa kuderedza dambudziko rekuputika kwechiuno. Mimwe yemishonga iyi inotorwa nemuromo kana vamwe vachipiwa nejojo. Actonel, kunyanya, yakagamuchirwa nekuda kwekudzivirira osteoporosis. Zometa ikozvino yakabvumidzwa kushandiswa pamwe chete ne aromatase inhibitor yekurapa kenza yemapenopaopausal.
Mishonga iyi inosanganisira:
- Fosomax (alendronate): Fosomax inoratidzika kuderedza zvose zviputi uye zvipembenene zvinoputika.
- Actonel (risedronate): Actonel inogona kuderedza dambudziko rekuputika uye musana wechipfuva.
- Boniva (ibandronate): Boniva inoderedza ngozi yepaspractic fractures asi kwete hip fractures.
- Zometa kana Reclast (zoledronic acid): Yakapiwa nemajena, Zometa inoderedza ngozi yezvipfeko uye zvipembenene zvinoputika.
Zvimwe zvinokonzerwa ne-bisphosphonates zvakasiyana zvichienderana nekuti zvinoshandiswa mumuromo kana muchijoka. Nomuromo bhosphosphonates, vanhu vanokumbirwa kutora mishonga negizi rose remvura uye vanoramba vakarurama kwemaminetsi makumi matatu nemakumi matanhatu. Iyi mishonga inogona kukonzera kushungurudzika kana kuvharwa kwepfungwa. Injaira mishonga inogona kukonzera zvirwere-zviratidzo zvezuva kana maviri mushure mokujaira uye zvinogona kukonzera maronda uye marwadzo.
Chinhu chisingazivikanwi asi chakashata chakashata chinonzi osteonecrosis yejaya. Vanhu vane chirwere chemaini kana utsanana hwemazino, vane chida chemazino kana kuti zvinoda nzira dzakadai sokugadzirwa kwezino dziri pangozi huru. Zvimwe zvinowanzova nemigumisiro zvinosanganisira atrial fibrillation uye atypical femur fractures.
Selective Estrogen Receptor Modulators (Evista uye Tamoxifen)
Sarudzo yesrogen receptor modulators (SERMS) mishonga inogona kuva yese isrogen-seye uye anti-estrogen madhara zvichienderana nenhengo yemuviri yavanoita. Evista (raloxifene) inogamuchirwa kuti kudzivirirwa kweasteoporosis mumadzimai anonzi postmenopausal uye inofungidzirwa kuderedza mungozi wekenza yepamusoro zvakare. Tamoxifen inoshandiswa zvevakadzi vane premenopausal mazamu emakondomu ayo ari estrogen receptor akanaka kuitira kuti kuderedza dambudziko rekudzoka. Tamoxifen inogonawo kushandiswa kuderedza dambudziko rekuita kenza yebonde.
Kufanana nesrogen (sezvinoita hormone replacement therapy) basa ravo pamapfupa rinowedzera bone mineral mass uye rinoderedza ngozi yepinhared (spinal) fractures. Kusiyana neHRT, zvisinei, Evista ane anti-estrogen migumisiro pazamu mazamu uye inogona kuderedza dambudziko rekudzidzira kenza yemazamu. Kunyange zvazvo SERMS isingawedzere mashizha emapfupa kusvika kumazinga ayo bisphosphonate, vanogona kuderedza dambudziko rekuputika kwemasana (asi kwete kuputika kwemafupa) nekuvandudza mapfupa emapfupa.
Zvimwe zvikanganiso zveSERMS zvinosanganisira kupisa kunopisa, kubatanidza aches, uye kutuka. Zvinogonawo kuwedzera njodzi yekuvhara ropa semvura yakadzika yepinein thrombosis, pulmonary emboli (blood clots muhudyu inopera uye kuenda kumapapu), uye retinal thongsis.
Hormone Replacement Therapy (HRT)
Kunyange zvazvo hormone replacement therapy (HRT) yakambotaurwa nezvayo sechisingaiti chinoshamisa chemishonga yekudzivirira osteoporosis kuvakadzi, haichibvumirwi zvakare nokuda kwechiratidzo ichi. Mukuwedzera, kutsvakurudza kutsvaga kuwedzera kungozi yekenza yepazamu, chirwere chemwoyo, uye kurohwa kwevakadzi vanotora HRT kwakaguma nemishonga iyi inoshandiswa kakawanda.
Zvechokwadi, kuchine vanhu vanoshandisa HRT nokuda kwechiratidzo chemarumeopausal, uye inogona kushanda zvakanaka kwezviratidzo izvi. Chimwe chikonzero chinokonzera kurasikirwa kwemapfupa mumadzimai evanhu vanokonzerwa nemasopausal ndiko kuderedza kuwanda kweesrogen inogadzirwa nemuviri. Zvinonzwisisika saka iyo hormone replacement therapy (HRT) inobatsira kuderedza kurasikirwa kwefupa.
Sezvakaita chero mishonga, iwe unofanira kuongorora njodzi uye kubatsirwa kwemishonga ipi yaunoshandisa. Kune vakadzi vechidiki avo vane chirwere chokuvhiya kwekuvhiya uye vari kutambura nehupenyu-kuderedza kupisa kunopisa, HRT inogona kunge yakanaka. Asi, kunyange mumamiriro ezvinhu aya, chinangwa chekurapa neHRT hachifaniri kunge chiri kuderedzwa kwehutachiona hwehutachiona.
Denosumab (Prolia naXgeva)
Rinowanzoshandiswa nevanhu vanorwara nekenza, denosumab inonzi monoclonal antibody inodzivisa kuumbwa kweasteoclasts, masero anokonzera kuparara kwefupa.
Kune vakadzi vari pane aromatase inhibitors (zvinodhaka zvekenza yemasopotopausal breast) izvo zvinowedzera dambudziko rehasteoporosis, kana varume vari ku androgen inoshaya kurapa kwekenza yeprostate (iyo inowedzerawo mukana we osteoporosis), inogona kuderedza ngozi yezviputsi. Denosumab inoshandiswawo kuvanhu vane chero rudzi rwekenza rwuri rwakapararira kumapfupa avo kuderedza dambudziko rekuparara.
Yakapiwa nejojo, denosumab ine nhengo yechipfuva yakafanana yakafanana ne-bisphosphonates uye inogona kuwedzera kungozi ye osteonecrosis yejaya.
Calcitonin (Miacalcin, Fortical, Calcimar)
Calcitonin ishanduro yakaitwa nevanhu yehomoni mumitumbi yedu iyo inotungamirira bone metabolism uye inobatsira kuchinja chiyero apo muviri unodzokorora bone. Iko inowanikwa zvose sepasip spray uye nejojo uye inogona kuderedza ngozi yepasipo fractures. Miacalcin nasal spray, kunyanya, inogona kuva sarudzo yevakadzi ve postmenopausal vasingakwanisi kutsungirira mimwe migumisiro yemimwe mishonga.
Parathyroid Hormone uye Derivatives
Forteo (teriparatide) ishanduro yakagadzirwa nemunhu yemararamiro emutumbi wepathy and hormone uye inowanzoshandiswa chete kune vanhu vane chirwere chakakomba chinonzi osteoporosis avo vari pangozi yekuputsika. Ndiyo chete mishonga inogona chaizvo kukurudzira muviri kuti ukure pfupa idzva. Shandisa ikozvino inongororerwa kwemakore maviri chete. Tymlos (abaloparatide) yakafanana uye inoshandiswa shanduko yeimwe chikamu chehomoni inonzi parathyroid.
Kurapa Zvinodhaka Pasi Pasi
Pane nharo pamusoro pemashandisirwo emishonga yekurapa osteopenia, uye vamwe vanopikisa kuti osteopenia chikamu chepanyama chekukwegura. Asi isu tinoziva kuti vamwe vanhu vachave vari pangozi yakakura yekutambudzika kuputika, uye zvose izvo kuputsika kunogona kureva kana kusara kusatenderwa. Kana iwe uine osteopenia, iwe nachiremba wako unogona kuenzanisa dambudziko rako remakore gumi rekunyora chiputi kana kupona kwepasipo uchishandisa matata nematafura anowanikwa kubva kuWorld Health Organization kana Osteoporosis Foundation.
Kutarisira Osteopenia Kana Kuti Usina Zvinodhaka
Ungave kana usasarudza kushandisa mishonga ye osteopenia, pane zvinhu zvaunogona kuita kuti uderedze njodzi yako yezviputsi . Kubva pakuita kuti matanho ako asasunungurwe kuti ugare kubva pamatanho, pane nzira dzakawanda dzisingakwanisi iwe unogona kuderedza mukana wako wekuwa.
Kuwana calcium yakakwana uye vitamini D kunokosha zvakare. Vanhu vazhinji vanowana calcium yakakwana mukudya kwavo, asi vitamini D yakaoma kusvika, kunyanya muNyakemera. Taura nachiremba wako nezvekuongorora vitamin D yako (vanhu vazhinji havana kukwana). Kana uwandu hwako hwakadzika kana kuti huri pasi pehutano hwakanaka, bvunza kuti kana iwe haufaniri kutora vitamini D3 supplement.
Kugara uchirovedza muviri uye kurega kusvuta zvinonyanya kukosha mukudzivirira kweasteoporosis.
Shoko Rinobva Kurapa yeOsteopenia
Kusiyana neosteoporosis, hapana mazano akajeka ekurapa osteopenia, uye munhu mumwe nomumwe anofanira kuongororwa nokungwarira kuti aone kana mishonga inogona kunge inobatsira. Chimwe chikuru chinonyanya kukosha ndechekuti munhu anotarisirwa kufambira mberi kuva nehasteoporosis kana kuti pane ngozi yakawanda yekutambura kuputsika semubairo weimwe zvirwere.
Kune mishonga yakawanda inogona kubudirira mukuderedza kurasikirwa kwefupa, asi izvi zvose zvinouya nechinetso chemigumisiro pamwe chete. Parizvino, mishonga chete inobvumirwa kuti ive osteopenia (kudzivirira kwehutachiona) ndiyo Actonel uye Evista. Mimwe mishonga, zvisinei, inogona kutaridzirwa kubva kune vanhu chaivo mamiriro ezvinhu.
Kana iwe wakamboonekwa uine osteopenia ukurukure zvakananga nachiremba wako. Taura pamusoro pezvingatarisirwa mumakore anotevera. Taura nezvehutano hwako hwekuparara, uye chii chinokanganisa zvingareva maererano nekufamba kwako uye kuzvimirira. Zvadaro taura pamusoro pemigumisiro yemigumisiro yehupi hupi hwehutano uye ureve izvi zvichienderana nemhando ipi zvayo yaunogona kufanotaura. Zvakakosha kuva mupepeti wako mukutarisira kwako, kunyanya mumamiriro ezvinhu akadai mune izvo zvisarudzo zvekurapa zvinofanira kunyatsotarisana nevamwe.
> Sources:
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> Kasper, Dennis L .., Anthony S. Fauci, naStefano L .. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill yembudzi, 2015. Print.
> Rosen, H. Miridzo yepamusoro: Kudzivirira kweAsteoporosis uye kurapwa (Beyond the Basics). UpToDate . Kushandurwa 03/26/17.