During the year, Poles buy over 4 million packages of steroid drugs. But only a third of patients found out from a doctor what the side effects of these preparations were and how to prevent them.
Glucocorticoids are the most effective anti-inflammatory drugs. They are used in the treatment of asthma, many skin diseases, chronic obstructive pulmonary disease, intestinal and eye diseases, diabetes, rheumatic and autoimmune diseases, as well as in patients after transplantation. They are administered intravenously to patients, in the form of inhalation, eye drops or ointments. Before these drugs were invented (which won the Nobel Prize in 1950), 90% of lupus erythematosus patients died within a year. Now 95% of them include thanks to these pharmaceuticals, he lives 10 years. Unfortunately, these drugs, like any other, have side effects. They cause, among others osteoporosis.
Drug-induced osteoporosis
– On the surface, the bone seems to be a dead part of the body – says prof. Piotr Głuszko from the Institute of Rheumatology in Warsaw. – Nothing could be more wrong. Life is booming there – he adds. Bone tissue is constantly rebuilding itself. Osteoblasts, i.e. building cells, bone-forming cells and osteoclasts, the so-called osteoclasts, take part in this process. osteoclast cells that dissolve and remove pieces of old bone. In the case of osteoporosis, the former stop working, and the ones that damage the bone continue to work. Therefore, the patient’s bone mass decreases, the bones become weak and break. – There is a belief that osteoporosis is a normal aging process. Meanwhile, this drug drug can attack young people. We do not take this disease lightly – says prof. Gałuszko. – At least once a year I see sick people who break their ribs coughing, and a broken rib pierces the lung, which can even lead to death – he adds.
Side effects of steroids
In people treated with steroids for more than 3 months, the risk of fracture of the hip and forearm neck doubles, and the risk of the spine even more. Therefore, any doctor who prescribes these drugs should warn the patient about their side effects and initiate preventive therapy. – Because steroids are used by specialists in many fields of medicine, not everyone knows about the need to start a therapy that will eliminate their side effects. Meanwhile, in order for it to be successful and prevent possible bone fractures, it must be implemented immediately when starting steroid treatment – says Prof. Gałuszko.
Patients treated with steroids should take prophylactically strengthening bones: calcium (about 1000 mg a day) and vitamin D (about 800 units a day) and drugs that prevent fractures of the so-called biophosphonates. Recently, one of such drugs has been reimbursed in the prevention of osteoporosis caused by glucocorticosteroids.
Unfortunately, biophosphonates are not effective in all patients. – If the patient has had five or six fractures, it is known that the biophosphonate is not working. The expensive parahormone is then used all over the world. Unfortunately, in Poland it is still not reimbursed – says prof. Gałuszko.
Prevention of osteoporosis
– The prevention of osteoporosis is primarily an adequate supply of vitamin D and calcium. The sun is an excellent source of vitamin D. That is why it is worth being in the sun – says prof. Witold Tłustochowicz, national consultant in the field of rheumatology. She adds that when she works in her garden in the summer, she always takes off her shirt to soak up the sun. The professor emphasizes that the risk of developing melanoma is small compared to the risk of developing osteoporosis. – Statistics show that as many as 40% of women in their 50s will experience bone fractures due to osteoporosis – says prof. Tłustochowicz.
In summer, half an hour of exposure to the sun is enough a day, even for the face and hands. In winter, vitamin D must be provided via the alimentary route – either in the form of an appropriate diet or as a tablet. Prof. Tłustochowicz emphasizes that vitamin D is also needed for the proper functioning of muscles and mind, and also increases resistance to infections.
– Our diet is deficient in calcium. Drinking seven glasses of milk is not advisable at all, so you need to enrich the diet with milk products or calcium tablets – says rheumatologist prof. Eugeniusz Kucharz from the Medical University of Silesia. Exercise is also extremely important in the prevention of osteoporosis. – Man has to move, because bone cells work best when they are loaded. If we do not move, osteoclast cells are activated – emphasizes prof. Gałuszko.
For people already suffering from osteoporosis, there are special sets of exercises, they are also taught how to prevent falls and conduct rehabilitation to heal fractures.
See also: New drugs for osteoporosis raise hopes for effective treatment