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VZP spustila 1. dubna 2023 tzv. Popula\u010dn\u00ed program \u010dasn\u00e9ho z\u00e1chytu osteopor\u00f3zy v\u00a0\u010cR<\/b>. Hlavn\u00edm c\u00edlem programu je v\u010dasn\u00e1 l\u00e9\u010dba tohoto z\u00e1va\u017en\u00e9ho onemocn\u011bn\u00ed a sn\u00ed\u017een\u00ed po\u010dtu osteoporotick\u00fdch zlomenin.\u00a0Nechat se vy\u0161et\u0159it v\u00a0r\u00e1mci plo\u0161n\u00e9ho z\u00e1chytu osteopor\u00f3zy mohou v\u0161ichni poji\u0161t\u011bnci spl\u0148uj\u00edc\u00ed indika\u010dn\u00ed krit\u00e9ria<\/b>\u00a0(viz d\u00e1le). Programu se nemohou z\u00fa\u010dastnit pacienti, kte\u0159\u00ed jsou diagnostikov\u00e1ni a l\u00e9\u010deni s\u00a0osteopor\u00f3zou nebo osteopeni\u00ed (p\u0159edstupe\u0148 osteopor\u00f3zy).<\/p>\n
Co je to osteopor\u00f3za?<\/b><\/p>\n
Osteopor\u00f3za je metabolick\u00e9 onemocn\u011bn\u00ed kostn\u00ed tk\u00e1n\u011b. Projevuje se jej\u00edm \u00fabytkem (\u0159\u00eddnut\u00edm kost\u00ed), co\u017e vede ke zv\u00fd\u0161en\u00e9 k\u0159ehkosti kost\u00ed a vy\u0161\u0161\u00edmu riziku zlomenin i po mal\u00e9m \u00farazu nebo spont\u00e1nn\u011b. Nemoc zpravidla prob\u00edh\u00e1 bez jak\u00fdchkoli p\u0159\u00edznak\u016f \u010di bolesti, tzn. pacient o n\u00ed nemus\u00ed dlouhou dobu v\u011bd\u011bt. Odhalena b\u00fdv\u00e1 velmi \u010dasto a\u017e po \u00farazu \u2013 mezi nej\u010dast\u011bj\u0161\u00ed pat\u0159\u00ed nap\u0159. zlomenina kr\u010dku (horn\u00edho konce) stehenn\u00ed kosti, obratle nebo z\u00e1p\u011bst\u00ed. Ve vy\u0161\u0161\u00edm v\u011bku s\u00a0sebou tyto \u00farazy nesou \u0159adu komplikac\u00ed a jejich n\u00e1sledky mohou b\u00fdt fat\u00e1ln\u00ed. Kl\u00ed\u010dov\u00e1 by proto m\u011bla b\u00fdt prevence osteopor\u00f3zy, kter\u00e1 spo\u010d\u00edv\u00e1 ve zdrav\u00e9m \u017eivotn\u00edm stylu a \u017eivotospr\u00e1v\u011b, dostatku pohybu a zdrav\u00e9 v\u00fd\u017eiv\u011b bohat\u00e9 na\u00a0v\u00e1pn\u00edk a vitamin D.<\/p>\n
Kdo se m\u016f\u017ee nechat vy\u0161et\u0159it?<\/b><\/p>\n
\u017deny do roku po menopauze do 59 let, mu\u017ei od 65 do 69 let<\/u><\/p>\n
V\u0161eobecn\u00fd praktick\u00fd l\u00e9ka\u0159 nebo gynekolog s\u00a0pacientem v\u00a0r\u00e1mci preventivn\u00ed prohl\u00eddky<\/b>\u00a0(ve\u00a0dvoulet\u00fdch intervalech)\u00a0projde anamn\u00e9zu a vypln\u00ed jednoduch\u00fd dotazn\u00edk FRAX.<\/b>\u00a0Ten slou\u017e\u00ed k odhadu rizika zlomeniny v n\u00e1sleduj\u00edc\u00edch 10 letech.\u00a0V\u00a0p\u0159\u00edpad\u011b, \u017ee\u00a0vznikne podez\u0159en\u00ed na\u00a0onemocn\u011bn\u00ed osteopor\u00f3zou, je\u00a0u\u00a0pacienta provedeno m\u011b\u0159en\u00ed kostn\u00ed hustoty denzitometrem.<\/b><\/p>\n
\u017deny od 60 let a mu\u017ei od 70 let<\/u><\/p>\n
U t\u00e9to v\u011bkov\u00e9 skupiny poji\u0161t\u011bnc\u016f je<\/b>\u00a0stejn\u00e9 vy\u0161et\u0159en\u00ed<\/b>\u00a0<\/b>(m\u011b\u0159en\u00ed kostn\u00ed hustoty denzitometrem)\u00a0automaticky sou\u010d\u00e1st\u00ed preventivn\u00ed prohl\u00eddky<\/b>\u00a0(ve dvoulet\u00fdch intervalech)\u00a0u v\u0161eobecn\u00e9ho praktick\u00e9ho l\u00e9ka\u0159e nebo u\u00a0gynekologa,\u00a0<\/b>jen bez vypl\u0148ov\u00e1n\u00ed dotazn\u00edku FRAX.<\/b><\/p>\n
Jak vy\u0161et\u0159en\u00ed prob\u00edh\u00e1?<\/b><\/p>\n
M\u011b\u0159en\u00ed kostn\u00ed miner\u00e1ln\u00ed hustoty<\/b>\u00a0(BMD)\u00a0se prov\u00e1d\u00ed celot\u011blov\u00fdm kostn\u00edm denzitometrem<\/b>\u00a0(DXA),\u00a0a to v\u00a0ordinaci praktick\u00e9ho l\u00e9ka\u0159e nebo gynekologa nebo m\u016f\u017ee b\u00fdt pacient odesl\u00e1n na\u00a0pracovi\u0161t\u011b vybaven\u00e9 denzitometrem.<\/b>\u00a0Vy\u0161et\u0159en\u00ed nen\u00ed bolestiv\u00e9 ani invazivn\u00ed, radia\u010dn\u00ed d\u00e1vka je ni\u017e\u0161\u00ed ne\u017e u klasick\u00e9ho rentgenu (RTG). Pacient b\u011bhem vy\u0161et\u0159en\u00ed le\u017e\u00ed oble\u010den\u00fd na speci\u00e1ln\u00edm l\u016f\u017eku a scanner denzitometru zachycuje jednu nebo v\u00edce oblast\u00ed kost\u00ed. M\u011b\u0159en\u00ed obvykle prob\u00edh\u00e1 na dvou a\u017e t\u0159ech m\u00edstech \u2013 v\u00a0oblasti bedern\u00ed p\u00e1te\u0159e, horn\u00ed \u010d\u00e1sti stehenn\u00ed kosti a na p\u0159edlokt\u00ed.\u00a0Dle v\u00fdsledku denzitometrick\u00e9ho vy\u0161et\u0159en\u00ed l\u00e9ka\u0159 zvol\u00ed dal\u0161\u00ed postup\u00a0<\/b>(pravideln\u00e9 sledov\u00e1n\u00ed pacienta, zah\u00e1jen\u00ed l\u00e9\u010dby nebo odesl\u00e1n\u00ed ke klinick\u00e9mu osteologovi).<\/p>\n
Vy\u0161et\u0159en\u00ed na specializovan\u00e9m pracovi\u0161ti<\/b><\/p>\n
P\u0159i podez\u0159en\u00ed na onemocn\u011bn\u00ed osteopor\u00f3zou m\u016f\u017ee praktick\u00fd l\u00e9ka\u0159 nebo gynekolog doporu\u010dit pacienta ke specializovan\u00e9mu vy\u0161et\u0159en\u00ed v osteologick\u00e9 ambulanci<\/b>\u00a0u klinick\u00e9ho osteologa.<\/b><\/p>\n
Pro\u010d mus\u00edm vypl\u0148ovat dotazn\u00edk FRAX?<\/b><\/p>\n
Dotazn\u00edk FRAX umo\u017e\u0148uje ur\u010dit riziko osteoporotick\u00e9 zlomeniny v\u00a0n\u00e1sleduj\u00edc\u00edch 10 letech. Je tedy vod\u00edtkem, zda je t\u0159eba u pacienta prov\u00e9st denzitometrick\u00e9 vy\u0161et\u0159en\u00ed.<\/b>\u00a0Pou\u017e\u00edv\u00e1 se\u00a0standardizovan\u00fd dotazn\u00edk<\/a><\/strong>, jeho\u017e vypln\u011bn\u00ed zabere zhruba 10 minut. Dotazn\u00edk zji\u0161\u0165uje z\u00e1kladn\u00ed informace o pacientovi (v\u011bk, v\u00e1ha, v\u00fd\u0161ka atd.), \u017eivotospr\u00e1vu (konzumace alkoholu, kou\u0159en\u00ed), pacientovu a rodinnou anamn\u00e9zu (se\u00a0zam\u011b\u0159en\u00edm na zlomeniny).<\/p>\n L\u00e9\u010dba osteopor\u00f3zy<\/b><\/p>\n Na z\u00e1klad\u011b v\u00fdsledku proveden\u00fdch vy\u0161et\u0159en\u00ed l\u00e9ka\u0159 stanov\u00ed diagn\u00f3zu.<\/b>\u00a0L\u00e9\u010dba osteopor\u00f3zy vy\u017eaduje individu\u00e1ln\u00ed p\u0159\u00edstup\u00a0<\/b>\u2013 l\u00e9ka\u0159 po zhodnocen\u00ed v\u0161ech dostupn\u00fdch informac\u00ed (v\u011bk pacienta, v\u00fdskyt zlomenin, stupe\u0148 \u00fabytku kostn\u00ed hmoty \u2013 BMD, v\u00fdsledky vy\u0161et\u0159en\u00ed atd.) doporu\u010d\u00ed pacientovi vhodnou l\u00e9\u010dbu.\u00a0Ta\u00a0prob\u00edh\u00e1 farmakologicky, tzn. p\u0159edeps\u00e1n\u00edm l\u00e9\u010div\u00fdch p\u0159\u00edpravk\u016f.\u00a0<\/b>Z\u00e1kladem je u\u017e\u00edv\u00e1n\u00ed v\u00e1pn\u00edku a\u00a0vitam\u00ednu D.\u00a0L\u00e9ka\u0159 pacientovi m\u016f\u017ee tak\u00e9 p\u0159edepsat hormon\u00e1ln\u00ed substitu\u010dn\u00ed l\u00e9\u010dbu<\/b>\u00a0(nahrazuje nedostatek hormon\u016f v\u00a0t\u011ble),\u00a0l\u00e9ky, kter\u00e9 zabra\u0148uj\u00ed ztr\u00e1t\u011b hustoty kostn\u00ed hmoty<\/b>\u00a0(tzv.\u00a0bisfosfon\u00e1ty),\u00a0nebo biologickou l\u00e9\u010dbu.<\/b><\/p>\n \u00dahrada z\u00a0ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed<\/b><\/p>\n Ve\u0161ker\u00e1 indikovan\u00e1 vy\u0161et\u0159en\u00ed jsou hrazena z ve\u0159ejn\u00e9ho zdravotn\u00edho poji\u0161t\u011bn\u00ed. V\u0161echna je nutn\u00e9 prov\u00e9st ve\u00a0smluvn\u00edch zdravotnick\u00fdch za\u0159\u00edzen\u00edch<\/b>\u00a0(tzn.\u00a0u\u00a0poskytovatele zdravotn\u00edch slu\u017eeb, kter\u00fd m\u00e1 smlouvu se\u00a0zdravotn\u00ed poji\u0161\u0165ovnou pacienta).<\/p>\n Seznam pracovi\u0161\u0165 zapojen\u00fdch do popula\u010dn\u00edho programu \u010dasn\u00e9ho z\u00e1chytu osteopor\u00f3zy<\/b><\/p>\n