VERTEBRALNI PRELOMI U OSTEOPOROZI: OD DIJAGNOSTIKE DO REHABILITACIJE
Sažetak
Vertebralni prelomi u osteoporozi predstavljaju značajan sociomedicinski problem koji narušava kvalitet života starije populacije. Klinički pregled, dopunske dijagnostičke metode (redgenski snimak (RTG), kompjuterizovana tomografija (egnl. Computed Tomography – CT), osteodezintomerija (engl. Dual-Energy X-ray Absorptiometry – DXA), dezintometrija lumbalnog dela kičme (engl. Lateral Vertebral Assessment – LVA) i procena rizika od nastanka preloma (engl. Fracture Risk Assessment Tool – FRAX)) ključni su za efikasnu procenu težine preloma, pravovremenu odluku o načinu lečenja, kao i započinjanje rehabilitacije. Od velikog praktičnog značaja jeste efekat antiresorptivne terapije na formiranje kalusa. Preporučljivo je da se kod osoba koje boluju od osteoporoze, a uprkos lečenju imaju prelom, ne prekida terapija bisfosfonatima, započeta nekoliko meseci pre dijagnostikovanog preloma. Bisfosfonate treba uvoditi u lečenje od dva do četiri meseca po nastanku preloma, u zavisnosti od lokacije preloma, odnosno vremena potrebnog za formiranje kalusa. Rekombinantni paratireoidni hormon predstavlja efikasnu anaboličku terapiju koja ubrzava regeneraciju kostiju tokom preloma, povećava zapreminu kalusa i omogućava brže postizanje čvrstoće kostiju. Terapiju osteoporoze ne treba započeti bez provere ukupnog i jonizovanog Ca, P, 25(OH)D, PTH, kao i opštih biohemijskih analiza; tek nakon toga treba uvesti antiresorptivnu ili anaboličku terapiju. Rehabilitacioni tretman koncipira se individualno i obuhvata vežbe ravnoteže, vežbe snage, vežbe obima pokreta i posturalni trening, koji dovode do poboljšanja pokretljivosti kičme, snage mišića i ukupne funkcionalnosti. Cilj ovog pregleda bio je da se ukaže na pravovremenu dijagnostiku, evaluaciju, kao i na lečenje preloma pršljenova u osteoporozi.
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