#1
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Ïðî îñòåîïîðîç.
Óâàæàåìûå êîëëåãè! â íàñòîÿùåå âðåìÿ ó ìåíÿ â ïîëèêëèíèêå ïðîâîäèòüñÿ äåíñèòîìåòðèÿ êîñòåé ïðåäïëå÷üÿ.
Ïîìîãèòå ïîæàëóéñòà îïðåäåëèòüñÿ ñ òàêòèêîé. Åñëè åñòü æåíùèíà ñ ôàêòîðàìè ðèñêà è Ò êðèòåðèé -2.5 è íèæå, íî ïåðåëîìîâ íåò â àíàìíåçå êàê ïîñòóïèòü? 1. ÿ åé äîëæíà íàçíà÷èòü òåðàïèþ áåç äîîáñëåäîâàíèÿ ( íó êàëüöèé òòã ñàõàð ýòî åñòåñòâåííî ïîñìîòðåòü) 2. èëè ïðîâåñòè äåíñèòîìåòðèþ ïîçâîíî÷íèêà è òàçîáåäðåííîé êîñòè ( ò.ê. ïðåäïëå÷üå ýòî ñêðèíèíã). Íî ýòî òîëüêî â Ìîñêâå à çíà÷èò äîðîãà è äåíüãè. 3. åñëè â àíàìíåçå åñòü ïåðåëîìû òî ñðàçó ìîæíî íàçíà÷èòü òåðàïèþ? ïîä òåðàïèåé ÿ ïîäðàçóìåâàþ íàçíà÷åíèå áèñôîñôîíàòîâ èëè ñòðîíöèÿ ðàíåëàòà? |
#2
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Ñòðîíöèÿ ðàíåëàò - òîëüêî åñëè åñòü ïðîòèâîïîêàçàíèÿ ê áèñôîñôîíàòàì ( åñëè åñòü ïåðåëîìû )
À âîïðîñ õîðîøèé - ñðàçó íå îòâå÷ó , ïîñîâåòóþñü ñ Ëß Ðîæèíñîêé È ó íàñ ïå÷àëüíàÿ íîâîñòü - óìåðëà ïðîô Áåíåâîëåíñêàÿ ..
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Ã.À. Ìåëüíè÷åíêî |
#3
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Íàñêîëüêî ÿ ïîíèìàþ, ðå÷ü èä¸ò îá óëüòðàçâóêîâîé äåíñèòîìåòðèè ëó÷åâîé êîñòè.
1.  ðåêîìåíäàöèÿõ Ðîññèéñêîé àññîöèàöèè ïî îñòåîïîðîçó (åñëè ñ 2009 ã. íè÷åãî íå èçìåíèëîñü) ãîâîðèòñÿ î òîì, ÷òî ïðèìåíåíèå êîñòíîé óëüòðàñîíîìåòðèè ìîæåò èñïîëüçîâàòüñÿ íà ýòàïå ñêðèíèíãà, ò.ê. ýòî íåñòàíäàðòèçîâàííûé ìåòîä, ïðè ïðîâåäåíèè êîòîðîãî ìîæåò âëèÿòü ðÿä ñóáúåêòèâíûõ ôàêòîðîâ. Òî÷íîñòü è âîñïðîèçâîäèìîñòü èçìåðåíèé, à òàêæå ÷óâñòâèòåëüíîñòü è ñïåöèôè÷íîñòü êîñòíîé óëüòðàñîíîìåòðèè â äèàãíîñòèêå îñòåîïîðîçà íèæå, ÷åì DXA (Ñ). Êàæäûé ïðîèçâîäèòåëü óñòàíàâëèâàåò íà ñâî¸ì ïðèáîðå ñîáñòâåííûå íîðìàòèâíûå äàííûå è ïî-ñâîåìó èíòåðïðåòèðóåò ðèñê ïåðåëîìîâ. Ïîýòîìó âûñòàâëÿòü äèàãíîç îñòåîïîðîçà ìîæíî òîëüêî íà îñíîâàíèè DEXA çà îäíèì èñêëþ÷àþùèì ïóíêòîì, êîòîðûé ïðîçâó÷àë â Âàøåì âîïðîñå: "êëèíè÷åñêèé äèàãíîç îñòåîïîðîçà ìîæåò áûòü óñòàíîâëåí áåç äåíñèòîìåòðè÷åñêîãî èññëåäîâàíèÿ ó æåíùèí ñòàðøå 70 ëåò, ïåðåíåñøèõ ïåðåëîì âñëåäñòâèå ìèíèìàëüíîé òðàâìû (À)" 2. Âîïðîñ âåäü íå òîëüêî â òîì, ÷òîáû óñòàíîâèòü äèàãíîç äëÿ òîãî, ÷òîáû íà÷àòü òåðàïèþ áèñôîñôîíàòàìè, íî è â òîì, ÷òîáû ýôôåêòèâíîñòü ýòîãî ëå÷åíèÿ è ðèñê ïåðåëîìîâ ïîòîì ïðàâèëüíî îöåíèòü â äèíàìèêå. Ïðè êîñòíîé óëüòðàñîíîìåòðèè ýòî ñäåëàòü ïðàêòè÷åñêè íåâîçìîæíî, ëèáî âîçìîæíî, íî î÷åíü ïðèáëèçèòåëüíî. Ãàëèíà Àôàíàñüåâíà, ñêàæèòå, ïîæàëóéñòà, â îòíîøåíèè ñòðîíöèÿ ðàíåëàòà òàêàÿ êàòåãîðè÷íàÿ ïîçèöèÿ ñâÿçàíà ñ ðèñêîì òðîìáîçîâ è òðîìáîýìáîëèé? Ïîÿâèëèñü ëè íîâûå äàííûå ïî ýòîìó âîïðîñó? |
#4
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Èíòåðåñíî, åñëè áû ïàðàëëåëüíî áû ñ ýòîé äåíñèòîìåòðèåé ïðîâîäèòü îöåíêó FRAX.
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#5
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Òðîìáîçû , ýìáîëèè è ñûïü . Íàéäó ñèëû , ïåðåøëþ ïèñüìî .
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Ã.À. Ìåëüíè÷åíêî |
#6
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Ýòè æå ïîáî÷íûå ýôôåêòû òåðàïèè ñòðîíöèÿ ðàíåëàòîì (à òàêæå ãàñòðîèíòåñòèíàëüíûå ïðîÿâëåíèÿ) óêàçàíû â ïîñëåäíåì îáíîâëåíèè (ÿíâàðü 2011) ðóêîâîäÿòâà NICE ïî âòîðè÷íîé ïðîôèëàêòèêå îñòåîïîðîçà "Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women" [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ], è ïðåïàðàò ðåêîìåíäîâàí â êà÷åñòâå òåðàïèè âòîðîé ëèíèè.
À â ñòàòüå Incidence of venous thromboembolism in users of strontium ranelate: an analysis of data from a prescription-event monitoring study in England - Drug Saf. 2010 Jul 1;33(7):579-91 - Osborne V et al ([Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]) ïðè àíàëèçå äàííûõ áîëåå ÷åì 10 òñ ïàöèåíòîâ, ïîëó÷àâøèõ ñòðîíöèé, ÷àñòîòà âåíîçíûõ òðîìáîçîâ â òå÷åíèå 12 ìåñÿöåâ áûëà ñîïîñòàâèìà ñ ïîïóëÿöèîííîé. |
#7
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Ñïàñèáî çà êîììåíòàðèè. Âîò ïîýòîìó ÿ è ñïðàøèâàþ, ò.ê. ïîíèìàþ, ÷òî ýòî ñêðèíèíã.
Äëÿ ïðèìåðà: ïðèøëà æåíùèíà 72 ãîäà, ñ ÄÒÇ ( íå ñîãëàøàåòñÿ íà ðàäèêàëüíóþ òåðàïèþ, îòêàçûâàåòñÿ), ñ íîðìàëüíîé ìàññîé òåëà, áëèæå ê íèæíåé ãðàíèöå. áåç ïåðåëîìîâ. Ò êðèòåðèé ïî ñêðèíèíãó -3,5. È êàê ïîñòóïèòü? Íàïðàâëÿòü åå â Ìîíèêè íà DEXA? |
#8
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Âîò ñåé÷àñ óòî÷íèëà äåíñèòîìåòðèÿ íå óëüòðàçâóêîâàÿ à ðåíòãåíîâñêàÿ, îíà òîæå êàê ñêðèíèíã?
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#9
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Çà÷åì âàì ÄÅÕÀ â èñòîðèè ñ äòç?
Áûëî áû ñòðàííî, åñëè áû ó ýòîéæåíùèíû íå áûëî îñòåîïîðîçà Âî âòîðîì ñëó÷àå ïðîâåäåíà äåíñèòîìåòðèÿ è âûÿâëåí îñîòåïîïðîç â ïðåäïëå÷üå Äàâàéòå âñïîìíèì çàêîí Êîêðàíà: ïåðåä ïðîâåäåíèåì èññëåäîâàíèÿ ïîäóìàéòå, ÷òî âû ñäåëàåòå ïðè ïîëîæèòåëüíîì è ÷òî- ïðè îòðèöàòåëüíîì ðåçóëüòàòå, è åñëè äåéñòàèÿ áóäóò îäèíàêîâûå, íå äåëàéòå ýòîãî- çàâòðà óæå íå áóäåò õâàòàòü íå òîëüêî óçèñòîâ, íî è äåíñèòîìåòðèñòîâ - ïîòîìó êàê âñåõ íàäî óçèêàòü è äåíñèòîìåòðèêàòü.. Ìîæåò, êàê- òî íå áóäåì çàìåíÿòü ëå÷åíèå ÷åìîäàíîì èññëåäîâàíèé? Ãàéäû- ãàéëàìè, íî è ãîëîâó íà ïëå÷àõ íàäî èìåòü 87 ëåòíÿÿ äàìà íå ñòàíåò þíîé â îæèäàíèè äåíñèòîìåòðèè âñåãî, êàê ìûöæå ïîíÿëè, ñòðîíöèé äëÿ íåå íàïðÿæåí
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Ã.À. Ìåëüíè÷åíêî |
#10
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à âîò íåïëîõàÿ ìûñëü . Ìîæíî, ÿ êîïè-ïàñòíó ?
Drinking one or two alcoholic beverages several times a week may improve the bone health of older women and reduce their risk for osteoporosis, a small study suggests. Bones are living tissue with old bone continually removed and replaced in a process called remodeling. In people with the bone-thinning disease osteoporosis, more bone is lost than replaced. Postmenopausal women are at particular risk because of reduced estrogen, a hormone essential for bone strength, the researchers explained. "This study clearly demonstrates that even small amounts of alcohol have potent actions and can rapidly impact bone metabolism," said lead researcher Urszula Iwaniec, an associate professor in the College of Public Health and Human Sciences at Oregon State University. "moderate alcohol may slow bone loss by lowering bone turnover," . That means it may lower the risk for osteoporosis. "Reducing bone turnover, however, while beneficial to the aging skeleton, may be detrimental to young adults who are still building bone," Although alcohol abuse is a serious medical and public health problem, the effects of moderate drinking on health have not received a lot of attention, For the study, published in the July 11 online edition of Menopause, Iwaniec's team followed 40 postmenopausal women, average age 56, who drank moderately and were not using hormone replacement therapy. "Moderate" drinking was defined as one-half to two standard drinks a day -- 8 to 10 grams of alcohol -- in the year before the study's start. In the United States, a standard drink is considered a 12-ounce beer, a 5-ounce glass of wine or 1.5 ounces of 80-proof liquor. When the women stopped drinking for two weeks, the researchers found increased evidence in their blood of bone turnover, which is a risk factor for fractures resulting from osteoporosis. In less than a day after the women resumed drinking, these markers of bone turnover returned to previous levels, the researchers found. Previous studies have found moderate drinkers have higher bone density than nondrinkers or heavy drinkers, but the reasons why have been unclear. It appears that alcohol acts like estrogen in reducing bone turnover, the researchers pointed out. And the alcohol source doesn't seem to matter, Iwaniec said. "Most of the women in our study were wine drinkers," she said. "However, based on our data in rats, it is the alcohol that's important." Whether this same effect would occur in men isn't known, Iwaniec said. Also, the study doesn't prove that moderate alcohol consumption wards off osteoporosis; it merely shows an association between the two. Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City, noted that the study is especially welcome in light of recent U.S. Preventive Services Task Force recommendations against taking calcium and vitamin D supplements to prevent osteoporosis. "From that perspective, this finding is very interesting," she said. "I am telling all of my postmenopausal women not to take calcium any more, and there is this panic about how do we help ourselves in preventing fractures and osteoporosis." This study shows that a couple of drinks might help not only in preventing heart disease, but in preventing osteoporosis, Steinbaum said. "I do not recommend taking a calcium supplement, but I do recommend a healthy diet that is high in nutrients and calcium and also weight-bearing exercises and one to two glasses of wine a day, which I also recommend to prevent heart disease," she said. Êîðî÷å : âûïüåì çà íàøè êîñòè è ñåðäöå è íå óáîèìñÿ ðàêà ìîëî÷íîé æåëåçû ?
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Ã.À. Ìåëüíè÷åíêî |
#11
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Öèòàòà:
Äàííàÿ òåìà áëèçêà ê ìîåìó âîïðîñó, ïîýòîìó çàäàþ åãî òóò. Ïî ðåçóëüòàòàì äåíñèòîìåòðèè (ðåíòãåíîâñêàÿ) ïîÿñíè÷íûé îòäåë ïîçâîíî÷íèêà -1.1; øåéêà ïðàâîé áåäðåííîé -1.5; øåéêà ëåâîé áåäðåííîé - 1.9; â öåëîì ëåâàÿ áåäðåííàÿ -1.7; â öåëîì ïðàâàÿ áåäðåííàÿ -1.4; â äèñòàëüíîì îòäåëå êîñòåé ïðåäïëå÷üÿ ñëåâà -3.5 (èññëåäîâàíèå ñäåëàíî ïîñëå ïåðåëîìà ëåâîãî ïëå÷à è ëó÷à), ñïðàâà -2.9. Âåçäå îñòåîïåíèÿ, ïî ïðåäïëå÷üÿì îñòåîïîðîç. Àíàëèçû (êàëüöèé, ïàðàò, âèòàìèí ä) - â ðàáîòå. Æåíùèíå 57 ëåò, ìåíîïàóçà ñ 52 ëåò.  íîÿáðå 2018 - ïåðåëîì ëåâîãî ïëå÷à è ëó÷à (óïàëà ñ ëåñòíèöû, ìîæíî ëè íàçâàòü òàêîé ïåðåëîì íèçêîòðàâìàòè÷íûì?). Ñóòü âîïðîñà: áûòü ëè áèñôîñôîíàòàì? Ïî ðåêîìåíäàöèÿì îïèñûâàþòñÿ èññëåäîâàíèÿ ïîçâîíî÷íèêà è øåéêè áåäðåííîé êîñòè (â äàííîì ñëó÷àå ïî ýòèì çîíàì îñòåîïåíèÿ). ß ñêëîíÿþñü ê íàçíà÷åíèþ ïðåïàðàòîâ (åñëè ïî àíàëèçàì íå áóäåò ïðîòèâîïîêàçàíèé). Íî ðåøèëà ïîñîâåòîâàòüñÿ ñ îïûòíûìè êîëëåãàìè. |
#12
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Åñòü ïåðåëîìû, îñòåîïîðîç óñòàíîâëåííûé, áèñôîñôîíàòû - ïåðâàÿ ëèíèÿ.
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Ã.À. Ìåëüíè÷åíêî |
#13
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Ñïàñèáî áîëüøîå çà îòâåò!!
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