Amachiza aphumelelayo ekuphulukeleni ukulahlekelwa kwethambo kukwandisa uxinano lweethambo kwaye unciphise umngcipheko wezahluko kubantu abane-osteoporosis nezinye iimeko. Yintoni oyifunayo ukuba uyazi malunga nalezi zonyango?
Ukuqonda i-Osteoporosis
I-osteoporosis yinto eqhelekileyo equka amathambo aphelelwe amandla kwaye aphefumle. Ngamanye amaxesha kuthiwa "isifo sesifuba esibangeleyo," i-osteoporosis ithathaka amathambo ukuze i-fracture ikwazi ukuqhuma ngakumbi.
Ezi fracture azikho nje kuphela ezikhokelela ekukhubazekeni kunye nomgangatho oswelekileyo wobomi kodwa zibangelwa imbangela yokugula nokufa njengabantu abadala.
I-Osteopenia ayithathwa njengesi sifo kodwa isifo selahleko. Oku kulula ukuchazela ngokumalunga no-T amanqaku kwiimvavanyo zokuxinwa kwethambo, apho ubukhulu bakho beethambo bufaniswa nomntu omdala osempilweni. Kulo vavanyo, amanqaku a-T oku--1.0 okanye ngaphezulu ajongwa njengesiqhelo. Iinqanaba ezi--2,5 okanye ezantsi zibonisa i-osteoporosis. I-Osteopenia ikhoyo ukuba amanqaku aphezulu aphezulu kune--2.5 kodwa ngaphantsi kwe--1.0. (Kwabo abanomdla, inani ngalinye libhekisela kutshintsho lomgangatho omnye).
Kulabo abane-osteoporosis, sinenhlanhla yokuba neentlobo ezininzi zeemithi ezinokuphucula ubuxhakaxhaka bamathambo nokunciphisa ingozi yokuphazamiseka. Nangona i-osteopenia ingabonwa njengesifo, abantu abane-osteopenia abasengozini yokwanda kwe-osteoporosis okanye i-fractures banokufuna ukuqwalasela imishanguzo.
Xa zisetyenziselwa ukunyanga i-osteopenia, amanani athile ala mayeza (kodwa awona onke) aphantsi kunezo ezisetyenziselwa i-osteoporosis.
Uvavanyo lwe-Osteopenia kunye / okanye i-Osteoporosis
Abanye abantu bafunda ukuba bane-osteoporosis emva kokuphuka. Nawuphi na umntu unokufumana ukuphuka, kodwa ukuqubuka okuvela emathanjeni achaphazeleka yi-osteoporosis ngokuqhelekileyo kuvela ngexinzelelo.
Ngokomzekelo, inkwenkwe enempilo inokuthi iqhubeke nokuphulwa kwe-hip kwingozi engozi yemoto. Indoda ekhulile ene-osteoporosis inokuthi ihlupheke ngokufanayo ukuwa kwebala.
Enye indlela yokufumanisa ukuba ngaba ulahlekelwe yimfuyo kukuba uvavanyo lweethambo . Uvavanyo olwenziwa rhoqo kaninzi luvavanyo lwe-x-rayi-absorptiometry okanye i-DEXA. Ngoku kuyacetyiswa ukuba bonke abafazi abangaphezu kweminyaka engama-65 kunye nabo bonke abantu abangaphezu kweminyaka engama-70 bavavanywa. Abanye abantu abanomngcipheko we-osteoporosis kufuneka bavavanywe kwangaphambili.
Iiklasi zamaMedi
Kukho iintlobo ezahlukahlukeneyo zonyango ezingasetyenziselwa i-osteoporosis kuxhomekeke kwisizathu sokulahlekelwa kwethambo lakho kunye nezinye izinto. La machiza asebenza ngeendlela ezahlukeneyo zokwakha ithambo okanye ukukhusela ukulahleka kwethambo. Abo basebenziselwa umhlaza banokuthi banqande i-boneastases yamathambo (ukusasazeka komhlaza kwisithambo) kwabanye abantu. Ezi klasi zamachiza ziquka:
- Bisphosphonates
- Iimoduli ze-estrogen receptor (SERMS)
- I-hormone yonyango yokuguqula (estrogen)
- Calcitonin
- I-hormone ye-Parathyroid
- Iziyobisi eziguqula izifo kubantu abanomdlavuza
Masiqale ngokuphononongwa okufutshane kwe-bone anatomy kunye nomsebenzi ukwenzela ukuba inkcazo malunga nalezi ziyobisi zisebenza ngokucacileyo.
Umsebenzi weThambo
Abantu abaninzi abakucingi ngamathambo njengokuba "baphila" kodwa amathambo ethu ayindawo exakekile. I-Bone ihlala iphulwe phantsi iphinde yakhiwe kwakhona. Ukuba uke waphahla le nto ibonakala ngakumbi. I-Bone fractures iyakwazi ukuphilisa ngezo zenzo zethambo olutsha kunye nokususwa kwethambo elonakalisiweyo.
Kukho ezimbini iindidi ezinkulu zeethambo zeseli. Enye i- osteoblasts , iiseli ezakha ithambo. Enye enye i- osteoclasts , iiseli ezidiliza kwaye zisuse amathambo. Uninzi lwexesha kukho ukulinganisela phakathi kwezi zimbini iinkqubo ukuze amathambo (emva kobuntwana) ahlale ngokulinganayo ubukhulu kunye nobuxinininzi ngaphezu kwexesha.
I-hormone ye-Parathyroid (PTH) i-hormone eveliswa emizimbeni yethu elawula ukulinganisela phakathi kwe-osteoblasts kunye ne-osteoclast ukugcina amathambo anamandla nokulungisa umonakalo. Bobabini i-vitamin D kunye ne-calcium zibalulekile ekwakheni nasekulungiseni amathambo enempilo.
Makhe sijonge kwiiklasi ezahlukeneyo zokulahlekelwa ngamathambo kunye nendlela abasebenza ngayo ekutheni amathambo kunye / okanye ukuthintela ukulahleka.
Bisphosphonates
I-Bisphosphonates yileyilwa yeyeza ye-osteoporosis eyaqala ukufumaneka ngawo-1990. Ezi zi yobisi zinciphisa umsebenzi we-osteoclasts (ichithe ukutshabalaliswa kwethambo) ukunciphisa ukulahleka kwethambo. Oku kubangela ukwanda kwenetha kwixinzelelo.
Iipesenti ezingama-95 zezigulane eziphathwe nge-bisphosphonates zandisa amanqaku abo kwisifo soxinzelelo lweethambo. Amachiza athile, nangona kunjalo ahluke kwiimeko zabo zokuthintela ukuhlukana okuthe ngqo, indlela esetyenziswa ngayo kunye nezinye iziphumo eziqhelekileyo.
Xa ushicilelwe, awufanele ufune ukuthatha i-bisphosphonates ebomini bakho bonke. Emva kweminyaka emithathu ukuya kwemihlanu yokwakhiwa kwamathambo akho, oogqirha banokucebisa ukuba izigulane ezinomngcipheko ophantsi wokutshatyalaliswa zingayeka ukuzithatha, ngokutsho kokuhlaziywa kwe-US Food and Drug Administration.
Amachiza kwiiklasi ze-bisphosphonate ziquka:
- I-Actonel (i-risedronate): I-Actonel iboniswe ngokunciphisa kakhulu umngcipheko wokuqhaqhaqhaqha kwabesetyhini abane-osteoporosis (ngamaphesenti angama-60 kwiminyaka emithathu) kunye neentlobo zomgulane kubantu abathatha i-steroids (ngama-70 ekhulwini kwiinyanga ezili-12).
- I-Fosamax (i-alendronate) : I-Fosamax iye yaboniswa nokwandisa ukuxinwa kwethambo nokunciphisa umngcipheko weemfucuza zomthunzi.
- I-Boniva (ibandronate): I-Boniva i-bisphosphonate enokuthi ithathwe ngomlomo kwaye ifumaneka ngejoza. I-Boniva iyanciphisa umngcipheko weentlobo zentlanzana kodwa ayizange iboniswe ukunciphisa umngcipheko we-hip fractures, ngoko kungenako ukukhetha ngokufanelekileyo kwabo baqhekezayo okanye ezinye iziqhekeza ezingezizo.
- Ukuqhawula okanye i-Zometa (i-zoledronic acid): Ukuphinda i-Reclast okanye i-Zometa inikezelwa ngexesha elilodwa kuphela ngonyaka (nge-osteoporosis) okanye nge-injection.
Imiphumo emibi ye-bisphosphonates ixhomekeke kwisichengiso esithile kunye nendlela enikwa ngayo. Ngamachiza omlomo, ukunyanzelisa, ukuguquka kwentliziyo, kunye nokuvutha komzimba kungenzeka. Abantu balelwa ukuba bathathe la mayeza ngamanzi (ijusi le-orange kunye nekhofi kunokuphazamisa ukuxhamla) kwaye uhlale ulungelelanise ubuncinane imizuzu engama-30 ukuya kwangama-60. Iintlungu zesisu kunye neentloko ziya kwenzeka.
Impembelelo yecala engavamile, ngokukodwa ngokuFunyanwa okanye kwiZometa, yi-osteonecrosis yomhlathi. Ezinye iimpembelelo eziqhelekanga zingabandakanywa ukuhlukana kwamabhinqa kunye ne-fibrillation ye-atrial.
Iimodyuli zeReceptor Receptor (SERM)
Abathungisi be-esrogen receptor (SERMS) izidakamizwa ezithakazelisayo kuba zineziphumo ezinjenge-estrogen kwezinye izicubu (ezifana namathambo) kunye nemiphumo yokulwa ne-estrogen kwabanye (njengezicubu zesifuba). Ngeempembelelo zabo ezifana ne-estrogen, zinokuqinisa amathambo afana ne-estrogen (i-hormone substitution therapy) eyenzile kwixesha elidlulileyo.
I-SERMS iyasebenza kuphela kwi-osteoporosis kubafazi. Bayekezela ukulahlekelwa kwethambo kwaye banciphise umngcipheko weentlobo zengqamlezo (kodwa kungabikho ukuqhaqhaqhaqha).
Ekubeni i-estrogen yonyango yonyango idibene nomhlaza wesisu, u-Evista unikela inzuzo ye-estrogen emathanjeni ngaphandle komngcipheko wesifo somhlaza okanye ukuphuma kwe-uterine efunyenwe ne-hormone yonyango.
Ukongeza ekwakheni amathambo, i-Evista inokunciphisa ingozi yokuvelisa umdlavuza webele we-hormone-receptor-positive kuma-postmenopausal women. Isilwanyana singenza umsebenzi obini kubasetyhini abane-osteoporosis okanye i-osteopenia kunye nethuba lokunyuka kwengqondo yomhlaza.
Imiphumo emibi ibandakanya ukutshisa okutshisayo, intlungu edibeneyo, ukwanda kwesithuthuthu, kunye neentloko. Amachiza akufanele asetyenziswe kulabo abaye baba negazi emilenzeni yabo (i-vein thrombosis), imiphunga (i-pulmonary emboli), okanye amehlo (i-retinal vein thrombosis).
IHormone Alternative Therapy
Emva kokulungele ukukwazi ukunciphisa ingozi ye-osteoporosis, i-hormone yokwelapha i-estrogen iye yahluleka ngenxa yengozi yokwandisa umdlavuza webele, ukubetha, ukuhlaselwa kwintliziyo, kunye negazi. Oko kwathiwa, abanye besetyhini bayaqhubeka nokusebenzisa i-hormone yonyango yokuguqula ukulawula iimpawu ze-menopausal kwaye kuboniswe ngokucacileyo ukuphucula umgangatho wobomi kwabanye abantu. Kulabo basebenzisa i-HRT ngesi sizathu, inzuzo eyongeziweyo kukuba ukunciphisa ukulahleka kwethambo.
Calcitonin
I-Calcitonin yi-hormone ngokwemvelo ekhoyo emzimbeni wethu esebenza ukulawula i-calcium kunye ne-bone metabolism.
I-Calcitonin ivunyiwe ukuba unyango lwe-osteoporosis kubasetyhini abangenani ubuncinane kwiminyaka emihlanu ngaphaya komva. Yandisa ukwanda kweethambo, ngokukodwa emgodini kwaye kubonakala kunciphisa umngcipheko weentlobo zengxantathu. Inokunciphisa intlungu kubantu abaye baqhekeka. Isiphumo sibaluleke kakhulu kunyaka wokuqala wonyango kwaye siwa ngokukhawuleza emva kwelo xesha. Oogqirha bahlala becebisa ukusebenzisa i-vitamin D kunye ne-calcium yongezelelo kunye nala mayeza kodwa uthetha ugqirha.
Amayeza afaka:
- I-Miacalcin nasal spray (calcitonin) ifumaneka njengombini we-nasal spray kunye nejoyi (jonga ngezantsi). Kuvunyiwe kwisifo sePaget, i-hypercalcemia (izinga eliphezulu le-calcium egazini), kunye ne-postmenopausal osteoporosis kwabasetyhini.
- I-friton (calcitonin): Nangona isithako esisisiseko esifanayo, i-Fortical ifumaneka kuphela kwi-spray spray kwaye ivunyiwe kuphela yonyango lwe-postmenopausal osteoporosis kwabasetyhini.
- I-Calcimar (calcitonin): I-calcimar iyatholakala njengenjenge kwaye ivunyiwe ukuba unyango lwe-Paget, i-hypercalcemia, kunye ne-postmenopausal osteoporosis kwabasetyhini.
Imiphumo emibi ye-spray spray ingabandakanywa ukucasuka komzimba kodwa ixhomekeke kakuhle. Ifom ye-calcitonin inokutsha ingabangela ukukhwabanisa isikhumba, ukugqithisa, isisindo somhlaza, kunye nexesha lokuvuthwa.
I-Parathyroid Hormone (PTH)
I-hormone ye-Parathyroid i-hormone ngokwemvelo eyenziwa emzimbeni. Ishukumisa ukwakheka kwethambo ngokunyusa umsebenzi kunye nenani le-osteoblasts, iiseli ezenza amathambo, kunye nokunciphisa umsebenzi we-osteoclasts, ukunciphisa i-bone resorption. Ngamanye amagama, ngokungafani ne-bisphosphonates eyanciphisa intshabalalo yethambo, i-hormone yokukhathazeka ingakwazi ukwenza umsebenzi wokwakha amathambo angcono kwaye anamandla.
I-hormone ye-Parathyroid ixhaphake ngokuqhelekileyo kubantu abaye bafumanisa ukuba bane-osteoporosis kwaye banomngcipheko ophezulu wokuphuka, baye bahluleka ukuphendula kwamanye amayeza, okanye baye bafumana iziphumo ezinobungozi kunye nezinye izidakamizwa ze-osteoporosis.
Kwizifundo, i-hormone ye-parathyroid yafunyanwa ukunciphisa umngcipheko weentlobo zomgulane kumabhinqa angama-postmenopausal. Izifundo kwiiTym zifumene nokunciphisa ukungasebenzi kwamagqabi.
Amayeza afaka:
- I-Forteo (i-teriparatide): I-Forteo inguqu ye-synthetic ye-hormone ye-parathyroid eyenziwa njengengeniso yansuku zonke. Yavunywa ngo-2002.
- I-Tymlos (i-abaloparatide) : I-Tymlos ngokwenene yinguqu eyenziwe ngumntu kuphela yecandelo leprotheni ye-PTH efana ne-PTS kwi-PTH receptors kwithambo. Yavunyelwe ngo-2017 ukwenzela unyango lwe-osteoporosis echazwe njengembali yezahlulo, ukuba neengcambu ezininzi zengozi, kunye / okanye ukhathala ezinye iindlela zokwelapha i-osteoporosis.
Iziphumo eziqhelekileyo ezichaphazelekayo ze-Forteo zizondlo kunye neenyawo zomlenze. I-Tymlos iye yadibaniswa namatye eentso ngenxa yokwanda kwe-calcium kumchamo.
Kunconywa ukuba ukusetyenziswa kwehomoni ye-parathyroid ibe neminyaka emibini. I-hormone ye-Parathyroid ayifanele isetyenziswe kulabo abanesifo sePaget (isifo sethambo), umhlaza wesifuba, amanqanaba aphezulu e-calcium (i-hypercalcemia), okanye abaye baphathwa unyango ngamathambo. Kwiimvavanyo zeclini, kubonakala ngathi ukwanda komhlaza wesifo (osteosarcoma) kwaye ezi zi yobisi zithatha isilumkiso sebhokisi emnyama ngenxa yesizathu.
Zombini i-Forteo kunye neTymlos zixabiso elibi kakhulu kwezinye iindlela zonyango kwaye zingadibanisa ukuya kwii-20,000 zamawaka kunyango.
Ukulandela unyango (ukufikelela kwiminyaka emibini) kunconywa ukuba kusetyenziswe i-bisphosphonate ukugcina ukwanda kwentsimbi.
I-Antioclonal Antibody
Udidi lwe-antioclonal anti-antibody luquka amayeza emibini kunye nesakhiwo esifanayo kodwa ngeendlela ezahlukeneyo. UDenosumab yi-antibody monoclonal (antibody-made antibody) ekhusela i-osteoclasts, iiseli ezitshabalalisa amathambo. La machiza asebenza ngokunciphisa ukuphuka kwethambo kunye nokuhlaziywa kwethambo.
Iziphumo eziqhelekileyo ezichaphazelekayo zibandakanya umva, iintambo ezihlangeneyo, iintlungu zomzimba, kunye nezinga le-cholesterol eyandisiweyo kunye nezifo zogcino. Imiphumo emibi ingabandakanya i-osteonecrosis yomhlathi (njengama-bisphosphonates), ingozi eyongeziweyo yezifo (ikakhulukazi izifo zentliziyo yesisu), amandla okwehluka kwe-atypical, kunye nokuphulukiswa kwephulo lokunciphisa.
Amayeza afaka:
- Iprolia (denosumab): Iprolia ifumaneka njengenjova enikwa kanye emva kweenyanga ezintandathu. Iprolia, ngokungafani ne-Xgeva, inemiqondiso emininzi. Inokumiselwa amadoda kunye nabafazi be-postmenopausal abane-osteoporosis abanomngcipheko ophezulu wokuphuka. Njengomlinganiselo wokukhusela, iProlia ingasetyenziselwa bobabini abasetyhini abafumana i-aromatase ye-inhibitor yonyango yomhlaza wesifuba kunye namadoda anomhlaza womhlaza wesifo se-prostate ofumana unyango lwe-androgen.
- I-Xgeva (denosumab): I-Xgeva ifumaneka njengenjova enikezelwa kanye emva kweeveki ezine. I-Xgeva ivunyiwe kubantu abanomdlavuza ophezulu wokubeleka ukunciphisa umngcipheko weentambo ezihlobene neethambo zesifo (i-spread spread of cancer), ukunyanga iintlungu kunye nokunciphisa ingozi yokuqhuma okuqhubekayo. Ingasetyenziselwa (kodwa kunye ne-dosing ehlukeneyo) kubantu abane- hypercalcemia yesifo , kunye nabantu (kwakhona kunye ne-dosing ehlukeneyo) kunye neengxowankulu ezinkulu zeethambo zesithambo.
Efana ne-bisphosphonates, i-denosumab inokunyusa ingozi ye-osteonecrosis yomhlathi. Iprolia kunye no-Xgeva kubonakala benempawu zokuchasana nomhlaza ngaphezu kokunciphisa ingozi yokuphulwa komhlaza.
I-Bone Ukuguqula iMithi
Iyeza-guqula imithi sele isetyenziselwe ukunciphisa umngcipheko wezahluko kubantu abanomdlavuza oye wasasazeka emathanjeni abo. Ukusetyenziswa okuqhelekileyo ngumhlaza wesifuba kunye nethambo ye-boneastases okanye umdlavuza wamaphaphu kunye neethambo zesifo.
Izinyango zokwelapha ziquka i-Zometa (zoledronic acid), i-bisphosphonate echazwe ngasentla, kunye ne-Xgeva (denosumab), isicatshulwa esiye safunyanwa ukunciphisa ukuphuka kwabantu abanomhlaza wesibele osasazeka emathanjeni abo. Zometa kunye no-Xgeva (okanye i-Prolia) nazo zibonakala zinezixhobo ezichasene nomhlaza.
Ukudibanisa kunye nokusetyenziswa kwee-Osteoporosis Izidakamizwa
Ekubeni kuninzi iindidi ze-osteoporosis izidakamizwa, zonke ezisebenza ngezindlela ezahlukeneyo, unokuzibuza ukuba ngaba ezinye zezi ziyobisi zingasetyenziselwa kunye ukunciphisa ingozi yokuphulwa. Nangona loo nto ingcinga ecacileyo, akukho ubungqina obuncinane bokuthi ukudibanisa ngaphezu kweyodwa kwiklasi leziyobisi kunenzuzo.
Umnye umzekelo unokuqalisa i-bisphosphonate xa uyeka ukusebenzisa i-Prolia / Xgeva okanye i-Forteo, apho ukunyuka kweenyanga ezi-6 ukuya kwezi-12 kunokunceda ukugcina uphuculo lwentlungu.
I-Calcium ne-Vitamin D kwi-Osteoporosis Prevention
Zininzi zala mayeza ayanconywa ukuba abantu bathole ixabiso elaneleyo le-calcium kunye ne-vithamini D. Ukutya okulungileyo kufuthi kunika i-calcium eyaneleyo, kodwa uthetha ugqirha wakho. Noko ke, i-Vitamin D, kunzima ukufumana ukutya okunempilo (cinga: iiglasi ezininzi zobisi kunye ne-salmon imihla ngemihla), kwaye akubona bonke abantu abakwaziyo ukufumana isixa esaneleyo ngokukhanya kwelanga ngaphandle. Thetha nogqirha wakho malunga nokujonga izinga lakho le-vitamin D (luvavanyo lwegazi olulula) kwaye ukhuthaze isongezelelo se-vitamin D3 xa sidinga. Nangona ixabiso elaneleyo le-calcium kunye ne-vitamin D zifunwa ukuba zenzeke amathambo afanelekileyo azithathi indawo yokusetyenziswa kwemithi ye-osteoporosis.
ILizwi
Njengoko kuphawuliwe ngasentla, kukho iindidi ezahlukeneyo zamachiza kubantu abanokulahleka kwethambo. Ugqirha wakho unokuxoxa nawe izizathu zokuba enye iklasi ingaba bhetele kunezinye kwiimeko zakho ezithile, kunye nesiphina izidakamizwa kwezinye zezi klasi zingcono kakhulu. Kukho iinguqu ezininzi ekukhethweni kwesilwanyana esifanelekileyo kubandakanya imbali yezahluko, isimo se-menopausal, kunye nemiphumo emibi.
Nangona la mayeza anokwandisa ukwanda kweethambo, injongo yokunyanga kukunciphisa ingozi yeentambo. Ukwandisa ukuxinwa kwamathambo kwedwa akuthethi kuthi ukunciphisa i-fractures. Ngokomzekelo, i-fluoride inokunyusa ukwanda kweethambo kodwa ayinciphisi umngcipheko wokungqubuzana (kwaye ingenokwandisa ingozi njengoko ithambo elenziwe lingaphantsi).
Kwakhona kubalulekile ukuqwalasela izinto zokuphila ezinokunciphisa umngcipheko wezinto eziqhekezayo xa unesifo se-osteoporosis. I-Falls iyimbangela ebangela ukugula nokufa eUnited States ngenxa yokuphulwa kwezinto ezibangelwayo kunye neziphumo ezilandelayo. Kungakhathaliseki ukuba unyango olukhethiweyo, sichitha isikhezu sithuba uhlolisise ezinye iinkolelo eziqhelekileyo, kunye nezindlela ezincinci ezichanekileyo zokunciphisa umngcipheko weentlanzi kunye nokuwa .
> Imithombo:
> Ensrud, K., neCC Crandall. Osteoporosis. Amanqaku angamayeza angaphakathi . 2017. 167 (3): ITC17-ITC32.
> Khosla, S., noL. Hofbauer. Ukwelashwa kwe-Osteoporosis: Uphuhliso olutsha kunye neengxaki eziqhubekayo. Lancet. Isifo sikashukela kunye ne-Endocrinology . 2017 Julayi 6. (i-Epub ngaphambi kokuprinta).
> McClung, M. Ukusebenzisa i-Osteoporosis Therapies in Combination. Iingxelo zeOsteoporosis zangoku . 2017. 15 (4): 343-352.