Doorashada Dawooyinka loogu talagalay Osteopenia (Mawduuca Lafaha hoose)
Haddii lagugu soo ogaaday osteopenia (lafaha hoose ee hoose) ayaa dhakhtarkaagu kugula talin lahaa daaweyn. Waa maxay ikhtiyaaraadka dawada ee la heli karo haddii aadan weli haysan "ostoporosis oo buuxa", iyo goorma ayay faa'iido u tahay in la tixgeliyo daaweynta?
Osteopenia: Cufnaanta hoose ee lafaha
Cudurka osteopenia micnaheedu waa cufnaanta hoose ee laf dhabarka, laakiin waxa tani micnaheedu yahay macnaheedu? Way fududahay in la fahmo osteopenia marka aynu barbardhigno labadaba cufnaanta caadiga ah iyo lafaha osteoporosis (cufnaanta aadka u hooseeysa).
Cufnaanta caadiga ah ee lafaha macnaheedu waa cufnaanta iyo dhismaha lafahaagu waa caadi. Imtixaanka culeyska lafaha , lambarka aad arki lahayd haddii cufankaaga lafdhabarku caadi yahay uu ka sareeyo -1.0. Si kale haddii loo dhigo, cufnaantaada lafdhabarku waxay noqoneysaa ama ka fiican tahay hal darajo heerka caadiga ka hooseeya.
Cudurka osteoporosis waa xaalad lafaha ay noqdeen kuwo jaban waxayna u badan tahay inay jabaan, xitaa dhaawacyada fudud. Laf-dhiska laf-dhabarka osteoporosis wuxuu siinayaa T-dhibicda -2.5 ama ka sii dareysa, taasoo macnaheedu yahay in cufnaanta lafteeda ay tahay 2.5 heerka isdhaafsiga ee ka hooseeya celceliska cadka lafaha qofka weyn ee caafimaadka qaba ama ka xun.
Osteopenia waxay u dhexeysaa tirooyinkaas, iyadoo T-dhibic ka fiican tahay -2.5 laakiin ka xun -0.1. Fursada uu osteopenia ku dhici doono osteoporosis waxay ku xiran tahay da'daada, xaaladaha kale ee caafimaad ee aad qabtid, daawooyinka aad qaadatid, iyo wax ka badan.
Daweynta Cudurka Osteopenia
Waxaa jira arrimo badan oo la tixgeliyo ka hor inta aan la daaweynin osteopenia, taasina waa mawduuc murugo iyo kulul.
Haddii osteopenia laysku daray jabka, waxaa suurtagal ah in daaweyntu ay saameyn karto. Ma cadda in daawaynta osteopenia oo aan jabin ay faa'iido leedahay.
Waxaa jira daawooyinka FDA ee la ansixiyey si looga hortago osteoporosis (iyo sidaas darteed osteopenia). Daawooyinkaasi waa kuwo waxtar leh, laakiin qaar ka mid ah waxay leeyihiin waxyeelo halis ah.
Dhakhaatiirta qaarkood ayaa ka xishoonaya in ay qoraan dawooyinka osteoporosis ee loo yaqaan 'osteopenia' halka kuwa kale ay kufilanayaan iyagoo isku dayaya in ay lumiyaan lafaha. Hadafka dhabta ah ee daaweynta lafaha osteopenia iyo osteoporosis wuxuu ka hortagayaa jabka, gaar ahaan misigta iyo lafdhabarta. Dhakhaatiirtu waxay ku xisaabin karaan khatarta jabkaaga 10-sano ee ku salaysan xajmigaaga maadada ee hadda ah iyo waxyaabo kale oo halis ah. Khatar 10 sano ah ayaa ah tixgelinta ugu weyn markaad ka fekereyso qaadashada dawooyinka osteopenia.
Qoraal dhinac ah, inkastoo muhiim ah, waa in shirkado badan oo caymiska caafimaadku aanay aqoonsanayn in loo yaqaan "osteopenia" xaalad u baahan daaweyn sidaa darteedna ma dabooli karo kharashka (mararka qaarkood).
Goorma ayay tahay in lagu daweeyo lafaha?
Sida hore loo xusay, daaweynta osteopenia waa muran. Taasi waxay sheegtay, marka daaweyntu ay bilaabanayso marxaladdaan dadka laga filayo in ay u gudbaan osteoporosis, ama ay leeyihiin xaalado kale oo hooseeya, daaweynta osteopenia waxay ka hortagi kartaa horumarinta laf-dhabarka iyo jabka. Xaaladaha ay ka midka yihiin osteopenia waxaa ka mid ah:
- Osteopenia waxaa laga helaa qof dhalinyaro ah, tusaale ahaan, qof 50 jir ah oo kaliya.
- Dadka qaba kansarka, gaar ahaan kuwa qaba kansarka naasaha ama kansarka qanjirka 'prostate' kaasoo isticmaali doona daaweynta hoormoonka.
- Dadka ku jiray steroids muddo dheer ee xaaladaha sida neefta, COPD, ama bararka xannuunka bararka.
- Kuwa leh xaalado la xiriira khatarta kordhaysa ee lafdhabarta sida lupus, rheumatoid arthritis, iyo kuwo kale oo badan.
- Kuwa u dhawdahay in ay ku dhacaan xaalado caafimaad sida jahwareerka suuxdinta ama cudurrada kale ee xanuunka.
- Kuwa haysta taariikh qoys oo xoog leh oo lafdhabar u ah.
- Kuwa soo gaaray jabka iyo lafdhabarta lafaha hoose.
Daawooyinka looga hortago Cudurka Osteoporosis (Daaweynta Cudurka Osteopenia)
Waxaa jira dhowr daawo oo kala duwan oo loo ogolaaday daaweynta lafdhabarta , laakiin qaar yar ayaa loo ogolaaday ka-hortagga ay ka mid yihiin Actonel iyo Evista.
Waxaanu liis-garayn doonaa fursadaha daaweynta lafdhabarta, sida mararka qaarkood daawooyinka kale ee aan ahayn kuwa loo oggol yahay in lafaha (ka hortagga osteoporosis) ayaa laga yaabaa in la tilmaamo. Qaybaha kala duwan ee daawooyinka ayaa hoos ku taxan.
Bisfosphates
Bisfosphonates waa daawooyin u shaqeynaya iyada oo la yareeyo heerka lafaha loona hagaajiyo cufnaanta lafaha. Inta badan kuwani waxay yareeyaan khatarta jabka ee lafdhabarta, laakiin dhammaantood lama muujin inay hoos u dhigto halista jabka jabka. Qaar ka mid ah daawooyinkan ayaa afka laga qaataa halka kuwa kale lagu siiyo cirbad. Actonel, gaar ahaan, ayaa loo ansixiyey ka hortagga osteoporosis. Zometa hadda waxaa loo ogolaaday in la isticmaalo daawada aromatase ee daweynta kansarka naasaha ee postmenopausal.
Daawooyinka ku jira qaybtan waxaa ka mid ah:
- Fosomax (alendronate): Fosomax wuxuu u muuqdaa inuu yaraynayo lafaha iyo lafdhabarta lafdhabarta.
- Actonel (risedronate): Actonel wuxuu yareyn karaa khatarta suuxdinta iyo lafdhabarta lafdhabarku.
- Boniva (ibandronate): Boniva waxay yaraynaysaa halista jabka lafdhabarta laakiin ma jabka jabka.
- Zometa ama Reclast (zoledronic acid): Marka la fiiriyo cirbadeynta, Zometa wuxuu yareynayaa khatarta suuxdinta iyo lafdhabarta lafdhabarta.
Dhibaatooyinka kale ee bosfosphonates way kala duwan yihiin iyadoo ku saleysan haddii loo isticmaalo afka ama cirbadda. Iyadoo afka laga qaato bifosphonates, dadka ayaa laga codsanayaa inay qaataan daawada leh galaas oo buuxa oo biyo ah kuna sii wad 30 ilaa 60 daqiiqo. Daroogooyinkaasi waxay keeni karaan cuncun ama cuncun maskaxeed. Dawooyinka leysku duro waxay keeni karaan calaamado ifilada ah maalin ama laba maalmo kaddib oo laga yaabo inay keento muruq iyo xanuun wadajir ah.
Waxyeellada aan caadi ahayn ee daran ee daran waa osteonecrosis daanka. Dadka qaba xanuunka ciridka ama nadaafadda ilkaha, waxay leeyihiin qalab ilkaha ah ama waxay u baahan yihiin nidaamyo sida ka saarista ilkaha halis weyn. Waxyeellooyinka kale ee aan caadiga ahayn waxaa ka mid ah foosheelka atrial-ka iyo jabka dhiciska ah ee femur.
Kala-duwanaanta Xayeysiinta Estrogen-ka (Evista iyo Tamoxifen)
Daawooyinka xaddidan ee hormoonka estrogen (SERMS) waa daawooyinka waxay yeelan karaan saameynta estrogen-ka iyo sidoo kale anti-estrogen labadaba, taas oo ku xiran qaybta jirka ee ay ku dhaqmaan. Evista (raloxifene) ayaa loo ansixiyey ka hortagga osteoporosis haweenka postmenopausal waxaana loo maleynayaa inay yareyso halista kansarka naasaha. Tamoxifen waxaa loogu talagalay haweenka qaba kansarrada naasaha ee uurjiifka ah kuwaas oo ah hormoonada hormoonka estrogen si loo yareeyo halista soo noqoshada. Tamoxifen ayaa sidoo kale loo isticmaali karaa si loo yareeyo khatarta ah inuu ku dhaco kansarka naasaha.
Sida estrogen (sida daaweynta hormoonka beddelidda hormoonka) ficilkooda lafta waxay kordhisaa cufnaanta macdanta lafaha waxayna yareysaa halista jabka (spinal) jaban. Hase yeeshee HRT, si kastaba ha ahaatee, Evista waxay leedahay saameynta antiestrogen ee unugyada naasaha waxayna yareyn kartaa halista sameynta kansarka naasaha. Inkastoo SERMS aysan kobcinayn cufanka heerarka ay bfphosphonate sameeyaan, waxay yareyn karaan halista jabka lafdhabarta (laakiin ma jabka jabka) lana hagaajiyo cufnaanta lafaha.
Dhibaatooyinka kale ee ka yimaada SERMS waxaa ka mid ah dareemada kuleylka leh, isku-xoqid, iyo dhidid. Waxay sidoo kale kordhin karaan khatarta xinjirta dhiigga sida xuubka xididada dhiigga ee qotada dheer, xuubka sanbabada (xinjir dhiig oo lugta ka jaban oo u socdaalaya sanbabada), iyo cirbadeynta xididada 'trombosis'.
Hormoon Daaweynta Hormoonka (HRT)
Inkastoo daaweynta hormoonka beddelidda hormoonka (HRT) mar hore loogu yeeray daroogada mucjiso si looga hortago osteoporosis haweenka, haddana mar dambe laguma ansixin tilmaamkan. Intaa waxa dheer, daraasado lagu ogaanayo khatarta sii kordheysa ee kansarka naasaha, cudurka wadnaha, iyo istaroogga haweenka qaata HRT ayaa sababay in daawooyinkan la isticmaalo wax yar ka yar.
Dhab ahaan, waxaa jira dad weli isticmaala HRT calaamadaha menopausal, waxayna u shaqeyn kartaa calaamadahaas. Mid ka mid ah sababaha ugu weyn ee lafaha lafdhabarka haweenka caadada u ah ayaa ah yareynta qiyaasta estrogen ee uu soo saaro jirka. Waxay macno u tahay marka daaweynta hormoonka beddelidda hormoonka (HRT) ay gacan ka geysato dhimista lafaha.
Sida daawo kasta, waa inaad miisaameysaa halista iyo faa'iidooyinka daawooyinka aad isticmaashid. Dumarka da'da yar ee qaliinka ku jira oo qallafsan iyo kufilan noloshooda xaddidan kuleylka, HRT waxay noqon kartaa ikhtiyaar wanaagsan. Hase yeeshee, xitaa goobtan, ujeeddada daaweynta HRT waa inaysan aheyn hoos u dhaca khatarta lafdhabarta.
Denosumab (Prolia iyo Xgeva)
Caadi ahaan inta badan waxaa isticmaala dadka qaba kansarka, denosumab waa unug monoclonal monoclonal kaas oo ka hortagaya sameynta osteoclasts, unugyada sababa lafaha.
Dumarka ku jira daawada aromatase (daawooyinka loogu talogalay kansarka naasaha ee postmenopausal) taas oo kor u qaadeysa khatarta ah osteoporosis, ama ragga ku jira daaweynta xannibaad iyo inrogen ee kansarka qanjirka 'prostate' (oo sidoo kale kordhiya khatarta cudurka osteoporosis), waxay yareyn kartaa halista jabka. Denosumab waxaa sidoo kale loo isticmaalaa dadka qaba nooc kasta oo kansar ah oo ku faafay lafahooda si loo yareeyo halista jabka.
Marka la eego cirbadeynta, denosumab waxay leedahay qaabka saameynta daawada la mid ah bephosphonates waxayna kordhin kartaa khatarta osteonecrosis ee daanka.
Calcitonin (Miacalcin, Fortical, Calcimar)
Calcitonin waa nooc ka sameysan hormoon jidheed oo xakamaynaya dheef-shiid kiimikaadkuna wuxuu caawiyaa bedelida heerka uu jidhku dib ugu laabto lafaha. Waxaa la heli karaa labadaba sida buufinta sanka iyo cirbadeynta waxayna hoos u dhigi kartaa halista jabka jabka. Noocista sanka ee Miacalcin, gaar ahaan, waxay noqon kartaa ikhtiyaar dumarka postmenopausal kuwaas oo aan u dulqaadan karin saameynta daawooyinka kale.
Paratyroid Hormoon iyo Wicitaanada
Forteo (teriparatide) waa nooc ka kooban qaabdhismeed ee hormoonka caadiga ah ee jidhka ee jirka, waxaana badanaa loo isticmaalaa dadka qaba osteoporosis oo halis ugu jira jabka. Waa daawada keliya ee dhab ahaantii kicin kara jidhka si ay u koraan lafta cusub. Isticmaalka hadda waa xaddidan yahay 2 sano oo keliya. Tymlos (abaloparatide) waa mid la mid ah oo waa qaybta synthetic ee qeyb ka mid ah hormoonka paratyroid.
Khadadka Daaweynta Astaamaha
Waxaa jira dood ku saabsan isticmaalka daawooyinka lagu daweeyo lafdhabarta, qaar kalena waxay ku doodaan in osteopenia ay tahay qayb dabiici ah oo gabow. Hase ahaatee waxaan ognahay in dadka qaarkiis ay halis weyn ugu jiraan jabka, iyo in kastoo jabta ay macnaheedu tahay haddii aan la daaweyn. Haddii aad qabtid osteopenia, adiga iyo dhakhtarkaaga ayaa kuu qiyaasi kara khatartaada 10-sano ee aad ku sameyso jab ama laf dhabarka iyadoo la isticmaalayo jaantusyada iyo jadwalka laga heli karo Ururka Caafimaadka Adduunka ama Osteoporosis Foundation.
Maamulidda Cudurka Osteopenia ee leh ama aan Laheyn Daroogo
Haddii aad dooratid inaad isticmaasho daawooyinka loo yaqaan 'osteopenia', waxaa jira waxyaabo aad sameyn kartid si aad u yareyso khatarta jabka . Marka aad hubiso inaad jaranjaradaadu ka madax bannaantahay inay ka baxaan jaranjarooyinka, waxaa jira dhowr siyaabood oo fudud oo aad yareyn kartid fursadda dayrta.
Helitaanka kalsiyum ku filan iyo fitamiin D waa muhiim sidoo kale. Dad badan ayaa hela calcium ku filan cuntada, laakiin fitamiin D waa ay adagtahay in la yimaaddo, gaar ahaan xeebaha Woqooyi. Kala hadal dhakhtarkaaga si aad u hubiso heerka fitamiin D-gaaga (dadka badankoodu waa kuwo aan fiicnayn). Haddii heerkaagu hooseeyo ama qaybta hoose ee qiyaasta caadiga ah, weydii bal in aad qaadatid fitamiin D3 ah iyo in kale.
Jimicsiga joogtada ah iyo joojinta sigaarka ayaa sidoo kale muhiim u ah ka hortagga osteoporosis.
Ereyga laga soo xigtay Daaweynta Cudurka Osteopenia
Si ka duwan sida osteoporosis, ma jiraan tilmaamo cad oo lagu daaweynayo osteopenia, qof kasta waa in si taxadar leh loo qiimeeyaa si loo go'aamiyo in daawooyinka laga yaabo inay waxtar leeyihiin. Mid ka mid ah tixgelinta ugu weyn waa in qofka la filayo inuu horay u sii wado inuu yeesho osteoporosis ama uu halis ugu jiro inuu jabka ka soo gaaro xaalad caafimaad oo kale.
Waxaa jira daawooyin badan oo waxtar u leh yareynta lafaha luminta, laakiin dhammaantood waxay la yimaadaan halista saameynaha kale. Xilligan, daawooyinka kaliya ee loo yaqaan 'osteopenia' (ka hortagga osteoporosis) waa Actonel iyo Evista. Daawooyinka kale, si kastaba ha ahaatee, waxaa loo tixgelin karaa iyada oo ku saleysan xaalado gaar ah.
Haddii lagugu soo ogaado osteopenia ayaa si taxaddar leh uula hadla dhakhtarkaaga. Kala hadal waxa laga filayo sanadaha soo socda. Kala hadal khatarta aad u leedahay jabka, iyo jabka dabiiciga ah oo macnaheedu yahay marka la eego dhaqdhaqaaqaaga iyo xoriyadaada. Ka dibna ka hadal waxyeellooyinka daaweyneed ee ka iman kara oo ka miisaan kari maysid faa'iido kasta ee aad saadaalin karto. Waxaa muhiim ah in aad u noqoto qof kuu qareemeynaya daryeelkaaga, gaar ahaan xaalad sidan oo kale ah taas oo ah hababka daaweyntu ay tahay in si khaas ah loo shakhsiyadeeyo.
> Ilo:
> Eriksen, E. Daaweynta Osteopenia. Baadhitaanada Endocrinology iyo Metabolic Disorders . 2012. 13 (3): 209-223.
> Kasper, Dennis L .., Anthony S. Fauci, iyo Stephen L .. Hauser. Mabaadii'da Harrison ee Daawooyinka Gudaha. New York: Waxbarashada Mc Graw Hill, 2015. Daabac.
> Rosen, H. Waxbarashada bukaan-socodka: Ka-hortagga iyo daaweynta cudurrada lafdhabarka ah (Ka gudubka asaasiga ah). UpToDate . La daabacay 03/26/17.