{"id":23868,"date":"2015-12-15T15:20:09","date_gmt":"2015-12-15T14:20:09","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=23868"},"modified":"2015-12-15T15:20:09","modified_gmt":"2015-12-15T14:20:09","slug":"povedomi-o-osteoporoze-je-nedostatecne-u-laiku-i-odborniku","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=23868","title":{"rendered":"Pov\u011bdom\u00ed o osteopor\u00f3ze je nedostate\u010dn\u00e9 u laik\u016f i odborn\u00edk\u016f"},"content":{"rendered":"

Osteopor\u00f3za je pomalu vyv\u00edjej\u00edc\u00ed se onemocn\u011bn\u00ed, kter\u00e9 \u0159adu let prob\u00edh\u00e1 skryt\u011b bez p\u0159\u00edznak\u016f. U osteopor\u00f3zy doch\u00e1z\u00ed k postupn\u00e9mu \u00fabytku kostn\u00ed hmoty a k naru\u0161en\u00ed mikroarchitektury kost\u00ed a vede k vy\u0161\u0161\u00edmu riziku vzniku zlomenin. Ne nadarmo se osteopor\u00f3za n\u011bkdy ozna\u010duje za tich\u00e9ho zabij\u00e1ka kost\u00ed.<\/strong> <\/p>\n

Praha \u2013 P\u0159ednosta Klinick\u00fdch laborato\u0159\u00ed a kostn\u00edho metabolizmu z Klatovsk\u00e9 nemocnice Richard Pikner p\u0159ipom\u00edn\u00e1, \u017ee pr\u00e1v\u011b v zim\u011b se zv\u011bt\u0161uje po\u010det zlomenin.<\/p>\n

– Jak vznik\u00e1 osteopor\u00f3za?<\/p>\n

Hlavn\u00ed p\u0159\u00ed\u010dinou vzniku osteopor\u00f3zy je n\u00e1hl\u00fd \u00fabytek pohlavn\u00edch hormon\u016f u \u017een po menopauze a postupn\u00fd \u00fabytek testosteronu u mu\u017e\u016f ve st\u00e1\u0159\u00ed. Prvn\u00ed osteoporotick\u00e9 zlomeniny se u \u017een objevuj\u00ed n\u011bkolik let po menopauze typicky na p\u0159edlokt\u00ed a u mu\u017e\u016f o 10 a\u017e 15 let pozd\u011bji.<\/p>\n

– Jak pozn\u00e1me, \u017ee jde o tuto nemoc?<\/p>\n

Typick\u00fdm a \u010dasto jedin\u00fdm p\u0159\u00edznakem je prod\u011blan\u00e1 osteoporotick\u00e1 zlomenina. Jde o zlomeniny vznikl\u00e9 p\u0159i minim\u00e1ln\u00edm \u00farazu, co\u017e je p\u00e1d ze stoje. Osteoporotick\u00e9 zlomeniny vznikaj\u00ed obvykle na p\u0159edlokt\u00ed, pa\u017en\u00ed kosti, obratl\u00edch a horn\u00edm konci kosti stehenn\u00ed.<\/p>\n

– Jde o hodn\u011b roz\u0161\u00ed\u0159enou chorobu?<\/p>\n

V pades\u00e1ti letech m\u00e1 ka\u017ed\u00e1 druh\u00e1 \u017eena a p\u00e1t\u00fd mu\u017e riziko, \u017ee prod\u011bl\u00e1 n\u011bkterou osteoporotickou zlomeninu. Sv\u011btov\u00e1 zdravotnick\u00e1 organizace v roce 2013 ud\u00e1v\u00e1, \u017ee v EU trp\u00ed osteopor\u00f3zou 21 procent \u017een a \u0161est procent mu\u017e\u016f ve v\u011bku 50 a\u017e 84 let.<\/p>\n

– Kter\u00e9 zlomeniny kost\u00ed jsou nejz\u00e1va\u017en\u011bj\u0161\u00ed?<\/p>\n

Pat\u0159\u00ed sem zlomenina horn\u00edho konce kosti stehenn\u00ed, kter\u00e1 je i v laick\u00e9 ve\u0159ejnosti zn\u00e1m\u00e1 jako zlomenina kr\u010dku stehenn\u00ed kosti. V letech 2010 a\u017e 2014 utrp\u011blo v \u010cesk\u00e9 republice ka\u017edoro\u010dn\u011b zlomeninu 16 tis\u00edc \u017een a \u0161est a p\u016fl tis\u00edce mu\u017e\u016f. Tyto zlomeniny vedou u dvaceti procent posti\u017een\u00fdch osob b\u011bhem prvn\u00edho roku po \u00farazu k \u00famrt\u00ed a a\u017e u pades\u00e1ti procent k z\u00e1vislosti na trval\u00e9 dopomoci. Druhou nejz\u00e1va\u017en\u011bj\u0161\u00ed osteoporotickou zlomeninou jsou zlomeniny obratle. Zde p\u0159esn\u00e1 \u010d\u00edsla o po\u010dtech neexistuj\u00ed, proto\u017ee v\u011bt\u0161ina osteoporotick\u00fdch zlomenin obratle prob\u011bhne, ani\u017e pacient vyhled\u00e1 l\u00e9ka\u0159e.<\/p>\n

– Je vy\u0161et\u0159en\u00ed osteopor\u00f3zy n\u00e1ro\u010dn\u00e9 pro pacienty?<\/p>\n

Vy\u0161et\u0159en\u00ed a zhodnocen\u00ed mno\u017estv\u00ed kostn\u00ed hmoty se standardn\u011b prov\u00e1d\u00ed pomoc\u00ed celot\u011blov\u00e9ho denzitometru, kter\u00fd pracuje s n\u00edzkou d\u00e1vkou rentgenov\u00e9ho z\u00e1\u0159en\u00ed. Jedno vy\u0161et\u0159en\u00ed p\u0159edstavuje d\u00e1vku, kter\u00e1 je asi pades\u00e1tkr\u00e1t men\u0161\u00ed ne\u017e rentgenov\u00fd sn\u00edmek p\u00e1te\u0159e. Vy\u0161et\u0159en\u00ed je nebolestiv\u00e9 a trv\u00e1 okolo dvaceti a\u017e t\u0159iceti minut, z\u00e1le\u017e\u00ed na po\u010dtu vy\u0161et\u0159ovan\u00fdch m\u00edst.<\/p>\n

– Doch\u00e1z\u00ed \u010ce\u0161i k vy\u0161et\u0159en\u00ed \u010dasto?<\/p>\n

Pov\u011bdom\u00ed o osteopor\u00f3ze jak v laick\u00e9, tak odborn\u00e9 ve\u0159ejnosti nen\u00ed na dostate\u010dn\u00e9 \u00farovni. Pokud by v\u0161ak m\u011bli b\u00fdt l\u00e9\u010deni v\u0161ichni potencion\u00e1ln\u00ed pacienti, \u010cesko nem\u00e1 dostate\u010dnou s\u00ed\u0165 pracovi\u0161\u0165 zab\u00fdvaj\u00edc\u00edch se l\u00e9\u010dbou. V republice existuje asi p\u011bt celot\u011blov\u00fdch denzitometr\u016f na milion obyvatel a dle Sv\u011btov\u00e9 zdravotnick\u00e9 organizace by se optimum m\u011blo pohybovat okolo deseti p\u0159\u00edstroj\u016f na milion.<\/p>\n

– Jak lidi motivovat k tomu, aby doch\u00e1zeli na vy\u0161et\u0159en\u00ed?<\/p>\n

Nejl\u00e9pe by bylo, aby se pacienti sami zaj\u00edmali o sv\u016fj zdravotn\u00ed stav a po konzultaci se sv\u00fdm praktick\u00fdm l\u00e9ka\u0159em \u010di o\u0161et\u0159uj\u00edc\u00edm specialistou po\u017eadovali denzitometrick\u00e9 vy\u0161et\u0159en\u00ed a p\u0159\u00edpadn\u011b konzultaci u specialisty v klinick\u00e9 osteologii na p\u0159\u00edtomnost osteopor\u00f3zy. Denzitometrick\u00e9 vy\u0161et\u0159en\u00ed, stejn\u011b tak jako dal\u0161\u00ed laboratorn\u00ed a klinick\u00e9 vy\u0161et\u0159en\u00ed, je v indikovan\u00fdch p\u0159\u00edpadech hrazeno z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed. Denzitometrick\u00e9 vy\u0161et\u0159en\u00ed stoj\u00ed necel\u00fdch n\u011bkolik set korun a spolu s dal\u0161\u00edmi pot\u0159ebn\u00fdmi vy\u0161et\u0159en\u00edmi se cena za komplexn\u00ed zhodnocen\u00ed pacienta vy\u0161plh\u00e1 a\u017e na n\u011bkolik tis\u00edc korun.<\/p>\n

– Kdy je optim\u00e1ln\u00ed vyhledat specialistu na l\u00e9\u010dbu osteopor\u00f3zy?<\/p>\n

Obecn\u011b u \u017een je to 65 let a u mu\u017e\u016f 70 let. Vy\u0161et\u0159en\u00ed by se v\u0161ak m\u011blo prov\u00e9st u v\u0161ech \u017een a mu\u017e\u016f nad 50 let v\u011bku, kte\u0159\u00ed prod\u011blali osteoporotickou zlomeninu, p\u0159edev\u0161\u00edm zlomeninu horn\u00edho konce kosti stehenn\u00ed, obratle \u010di humeru. Z\u00e1rove\u0148 by vy\u0161et\u0159en\u00ed m\u011bli podstoupit pacienti, kte\u0159\u00ed u\u017e\u00edvaj\u00ed l\u00e9ky, kter\u00e9 osteopor\u00f3zu urychluj\u00ed \u010di vyvol\u00e1vaj\u00ed, jako kortikoidy, n\u011bkter\u00e9 antihormon\u00e1ln\u00ed l\u00e9ky u pacientek l\u00e9\u010den\u00fdch pro karcinom prsu, \u010di mu\u017e\u016f pro karcinom prostaty, nebo trp\u00edc\u00edch onemocn\u011bn\u00edm, kter\u00e9 osteopor\u00f3zu rovn\u011b\u017e vyvol\u00e1vaj\u00ed jako celiakie, Crohnova choroba, zv\u00fd\u0161en\u00e1 funkce \u0161t\u00edtn\u00e9 \u017el\u00e1zy, dlouhodob\u011b l\u00e9\u010den\u00e1 epilepsie, odn\u011bt\u00ed \u010d\u00e1sti \u017ealudku.<\/p>\n

– Jak prob\u00edh\u00e1 sou\u010dasn\u00e1 l\u00e9\u010dba onemocn\u011bn\u00ed?<\/p>\n

Po zhodnocen\u00ed stavu pacienta specialistou na l\u00e9\u010dbu osteopor\u00f3zy lze opat\u0159en\u00ed rozd\u011blit do n\u011bkolika z\u00e1kladn\u00edch oblast\u00ed. Zajistit dostate\u010dn\u00e9 p\u0159\u00edjmy v\u00e1pn\u00edku a vitaminu D, re\u017eimov\u00e1 opat\u0159en\u00ed a nasadit l\u00e9ky ovliv\u0148uj\u00edc\u00ed kostn\u00ed hmotu a mineralizaci. L\u00e9\u010dba osteopor\u00f3zy je dlouhodob\u00e1, d\u00e1 se \u0159\u00edci, \u017ee do\u017eivotn\u00ed, a to p\u0159edev\u0161\u00edm v oblasti dostate\u010dn\u00e9ho p\u0159\u00edjmu v\u00e1pn\u00edku a vitaminu D a re\u017eimov\u00fdch opat\u0159en\u00edch.<\/p>\n

– V \u010dem spo\u010d\u00edvaj\u00ed re\u017eimov\u00e1 opat\u0159en\u00ed?<\/p>\n

Jsou individu\u00e1ln\u00ed a zahrnuj\u00ed opat\u0159en\u00ed ke sn\u00ed\u017een\u00ed rizika p\u00e1d\u016f. V praxi to znamen\u00e1 motivovat pacienty k pravideln\u00e9mu cvi\u010den\u00ed, spr\u00e1vn\u00e9 korekci zraku, opatrnosti p\u0159i no\u010dn\u00edm vst\u00e1v\u00e1n\u00ed a za situac\u00ed, kdy je zv\u00fd\u0161en\u00e9 riziko p\u00e1d\u016f, jako n\u00e1led\u00ed a podobn\u011b. Sama fyzick\u00e1 aktivita, co\u017e je pravideln\u00e9 zat\u011b\u017eov\u00e1n\u00ed kost\u00ed v\u00fdznamn\u011b napom\u00e1h\u00e1 k udr\u017een\u00ed kostn\u00ed hmoty a mineralizace.<\/p>\n

– Kter\u00e9 l\u00e9ky pom\u00e1haj\u00ed kostn\u00ed hmot\u011b a mineralizaci?<\/p>\n

Lze je rozd\u011blit do t\u0159\u00ed skupin. Antiresorp\u010dn\u00ed jsou l\u00e9ky, kter\u00e9 aktivn\u011b zabra\u0148uj\u00ed odbour\u00e1v\u00e1n\u00ed kostn\u00ed tk\u00e1n\u011b a zlep\u0161uj\u00ed jej\u00ed mineralizaci. Hormon\u00e1ln\u00ed terapie zahrnuj\u00ed hormon\u00e1ln\u00ed substituci v obdob\u00ed po n\u00e1stupu menopauzy a oddaluje ztr\u00e1tu kostn\u00ed hmoty. D\u00e1le stimuluj\u00edc\u00ed l\u00e9ky, kam pat\u0159\u00ed u\u017e deset let u\u017e\u00edvan\u00fd denn\u011b podko\u017en\u011b pod\u00e1van\u00fd l\u00e9k. Pod\u00e1v\u00e1 se po dobu dvou let a je vyhrazen pacient\u016fm s t\u011b\u017ekou formou osteopor\u00f3zy nebo pacient\u016fm s osteopor\u00f3zou vyvolanou kortikoidy. V sou\u010dasnosti prob\u00edh\u00e1 n\u011bkolik mezin\u00e1rodn\u00edch klinick\u00fdch ov\u011b\u0159ov\u00e1n\u00ed nov\u00fdch l\u00e9k\u016f v t\u00e9to oblasti a v\u00fdsledky se jev\u00ed velmi slibn\u011b.<\/p>\n

– Jak\u00e9 v\u00fdhody p\u0159in\u00e1\u0161\u00ed sou\u010dasn\u00e1 modern\u00ed l\u00e9\u010dba?<\/p>\n

Obecn\u011b lze \u0159\u00edci, \u017ee i jako v jin\u00fdch oblastech medic\u00edny doch\u00e1z\u00ed k postupn\u00e9mu p\u0159echodu od takzvan\u011b chemick\u00fdch l\u00e9k\u016f k c\u00edlen\u00e9 biologick\u00e9 l\u00e9\u010db\u011b. Jejich nespornou v\u00fdhodou je m\u00e9n\u011b ne\u017e\u00e1douc\u00edch \u00fa\u010dink\u016f, lep\u0161\u00ed tolerance l\u00e9\u010dby a v\u011bt\u0161\u00ed efekt.<\/p>\n

– Existuje \u00fa\u010dinn\u00e1 prevence osteopor\u00f3zy?<\/p>\n

Ned\u00edlnou sou\u010d\u00e1st\u00ed l\u00e9\u010dby jak\u00e9hokoliv z\u00e1va\u017en\u00e9ho onemocn\u011bn\u00ed je v\u017edy prevence. U osteopor\u00f3zy je v\u0161ak slo\u017eit\u011bj\u0161\u00ed, nebo\u0165 z\u00e1klad kostn\u00ed hmoty vznik\u00e1 v obdob\u00ed dosp\u00edv\u00e1n\u00ed. Krom\u011b genetick\u00fdch faktor\u016f je zcela z\u00e1sadn\u00ed dostate\u010dn\u00e1 pravideln\u00e1 fyzick\u00e1 aktivita aspo\u0148 hodina denn\u011b a p\u0159\u00edjem v\u00e1pn\u00edku a vitaminu D. Tyto faktory zcela z\u00e1sadn\u011b ovlivn\u00ed na\u0161i maxim\u00e1ln\u00ed kostn\u00ed hmotu v p\u011btadvaceti a\u017e t\u0159iceti letech, kterou si pak s sebou neseme po zbytek \u017eivota.<\/p>\n

– Je d\u016fle\u017eit\u00e9 za\u010d\u00edt s prevenc\u00ed co nejd\u0159\u00edve.<\/p>\n

D\u00e1 se \u0159\u00edci, \u017ee z\u00e1klad pro vznik osteopor\u00f3zy ud\u011bl\u00e1me v d\u011btstv\u00ed, ale projev\u00ed se ve st\u00e1\u0159\u00ed. Ale i nad 50 let je nesm\u00edrn\u011b d\u016fle\u017eit\u00e1 pravideln\u00e1 fyzick\u00e1 aktivita a p\u0159\u00edjem v\u00e1pn\u00edku a vitaminu D tak, abychom udr\u017eeli dostate\u010dnou kostn\u00ed hmotu co nejd\u00e9le. Tud\u00ed\u017e i v tomto obdob\u00ed se lze aktivn\u011b a preventivn\u011b br\u00e1nit vzniku osteopor\u00f3zy.<\/p>\n

PAVLA JANOU\u0160KOV\u00c1
\nPra\u017esk\u00fd den\u00edk
\nhttp:\/\/www.prazsky.denik.cz\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Osteopor\u00f3za je pomalu vyv\u00edjej\u00edc\u00ed se onemocn\u011bn\u00ed, kter\u00e9 \u0159adu let prob\u00edh\u00e1 skryt\u011b bez p\u0159\u00edznak\u016f. U osteopor\u00f3zy doch\u00e1z\u00ed k postupn\u00e9mu \u00fabytku kostn\u00ed hmoty a k naru\u0161en\u00ed mikroarchitektury […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":22868,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-23868","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23868","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23868"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23868\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/22868"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23868"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23868"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23868"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}