Loãng xương do corticoid: Biện pháp phòng chữa

Loang xirong do co

bien phdp phdm

Dgc diem ciia lodng xuftfng

do corticoid

Corticoid gay loang xUcfng do

Uc chtf sU hinh thanh protein

collagen gdy trd ngai cho sU Idng

dgng xUcfng; giam tai hap thu calci

phosphor d o'ng than va tang bai

tiet chung ra ngoai; do^i khang vdi

vitamin D, Uc che sU ha'p thu calci,

ha tha'p nong dp calci mau; khi

nong do calci mau giam, hormon

cdn giap trang tie't ra nhieu,

chuyen tricalciphosphat khong tan

d trong xuong thanh muoi calci tan

phdng thich vao mau, Iam cho mat

dS xuong giam, tang sU huy xUUng.

Khi dimg prednisolon 5mg/ngay

hay lieu tUcfng ducfng cac corticoid

khac CO the ddn tdi giam mat do

xUOng, tang nhanh nguy CO gay

xUcfng. Nguy CO gay xUcfng tang

nhanh trong 3 thang dau, roi trd

ve binh thudng khi ngflng dimg.

Sau mot nam dCing lien tuc, mat dp

xuung giam tdi 10 - 15%. Nguy co

gay xUcfng tang cao ngay khi diing

d ngudi CO chi so T-score thap hon

(-1,5). Mat do xuong giam sdm

chu yeu d cac vung xUcfng xop nhu

xUOng cot song, xUOng sUdn va ca

d nhUng viJng xUOng khac. Khoang

30 - 50% ngUdi dCing hydrocortisol

lieu cao, ldu dai thudng

bi loang xUOng.

vi.oi.y do c'urtiLui.l

Neu can thiet phai

dling, chi dung lieu

vCfa dii. Kmh nghiem

lam sang cho thay vdi

prednisolon, diing lieu

<5mg tuong ddi an

toan, lieu > lOmg de

xay ra nguy co loang

xUtfng. Thdi gian diing

khong qua 10 ngay.

Khi dung Iau dai dieu tri cac

benh tU miin: Phai dimg lieu tha'p

nhd't dat den hieu lUc, dimg tifng

dgt, m6i dgt khong nen qua 3

thang, vi dung lieu cao keo dai hon

de tang nguy ctf loang xuong. Can

chu dpng bo sung calci vitamin D

ngay khi cd y dinh dung corticoid

keo dai. Can do mat dp xUtfng, theo

ddi nguy ctf loang xuOng trong qua

trinh dimg,

Dieu tri loang xUcfng

do corticoid

Thdi diim dieu tri: Can phai

dieu tri ngay khi chi so T-score

khoang -2 , chd khong nen dgi

den khi T-score tha'p htfn -2,5 nhU

trong loang xUong 6 phu nd sau

man kinh. Can thie't tiep tuc dieu

tri sau 3 nam de ngan chan su ma't

xuong tiep theo.

Cac thuo'c thudng dimg:

• Calci vd vitamin D: Chi co

y nghia h6 trO, khong co y nghia

dieu tri, vi chiing khong Iam tang

sU tao XUtfng, khong Iam giam nguy

ctf gay xUong do dung corticoid.

• Biphosphonat: Trong ctf the

luon luon co qua trinh tang, hiiy

xUtfng. Biphosphonat Iam giam

stf hiiy xUtfng nen gian tie'p lam

tang ma t do xUtfng. Sd dung

biphosphonat trong 12 thangy

mdt dp xUtfng tdng 2,8% so v(

nhom khong diing. Thudng dflni

biphosphonat lOmg/ngay hay'

70mg/tuan.

• Chdt dieu hda chgn lgc thu

the estrogen (raloxiphen): Cacch^

nay doi khang vdi estrogen dfloj

cho'ng ung thu vij, nhUng dong v^i

vdi estrogen tai xUOng nen dUOc

dung chong loang xUOng. Diing

Ioai thuo'c nay gifl dUtfc mat dS

XUtfng cot sd'ng thdt lUng vd hi

d phu nfl man kinh bi loang xUi

do dimg cortiocid (khi diing li(

tha'p tri viem khdp dang thdj _

Raloxifen Iam tang mgt dp xUtfn^'

len 2,3 - 2,5% d tat ca cac vi trf'

XUtfng, dac biet d xUtfng song th^t

lung, hong; lam giam 30 - 50% ty

le gay xUOng cot song. Raloxifen

it dpc, cac tac dung phu gom btfc

hoa do mo hoi, chupt rut bap chan,

phii mach ngoai bien chi thoang

qua; khdng gay ung thU npi mac tiJ

cung, rat hiem khi gay huyet khoi

thuyen tdc tinh mach.

* Hormon can gidp: Ne'u diing

biphosphonat, cha't dc che chgn

loc thu the estrogen ma dap dng

khong to't thi diing hormon cgn

giap. Ci ngUdng sinh ly, hormon

can giap giup hap thu calci, cung

vdi vitamin D giiJ cho ty

le calci tren phosphor

on dinh, chuyen chiing

thanh tricalciphosphat

ciia xUtfng, tSng sU

tao xUtfng, do dd Iam

tang dang ktf mat dO

XUtfng thdt lung, duy

tri mat do xUtfng hang

d phu nU man kinh bi

loang xUtfng do diing

corticoid. O My cho

luu hanh tepiratamid.

Tren dgng vdt, nd gfiy

THUOC & sifc KHOE so'498 (15.4.2014)