You’re probably familiar with the symptoms of polymyalgia rheumatica (PMR), including stiffness and pain in your upper arms, neck, lower back, and thighs. But here’s what you might not know. People with PMR are more likely to have weak bones.
“We know that PMR classically affects older adults who may already have certain diseases such as cardiovascular disease, kidney disease, osteoporosis, and diabetes,” says Northwestern University. says Anisha Dua, MD, MPH, associate professor of rheumatology and rheumatologist.
“Of course, when you add steroids to that, you increase the risk of a lot of those things. You want to do everything you can to protect your bones and reduce the side effects of taking the medication.”
That said, bone health in PMR patients can be managed through bone-friendly exercise, nutrition, and overall health. Here’s what you need to know to protect your bones, especially if he has PMR and is taking steroids.
Understanding PMR and bone health
PMR tends to occur more frequently in women than in men, and virtually never occurs before the age of 50 (for unknown reasons, it may be related to the aging of the immune system).
According to a research paper in the same journal, this is the population most affected by osteoporosis, and moreover, PMR is usually treated long-term with glucocorticoids such as prednisone. women’s health.
According to the American College of Rheumatology, glucocorticoids are a powerful treatment for people with conditions such as PMR, but they can have some negative effects on bone health. These can lead to glucocorticoid-induced osteoporosis, where patients rapidly lose bone and fracture rates are very high.
Some studies have shown that exercise can help maintain bone density even when taking glucocorticoids. In a 2023 review published in , patients taking the drug who exercised had better spinal bone density compared to those who did not exercise. Advances in Rheumatology Practice. (However, the same results were not seen for hip bone density.)
“More well-designed exercise studies are needed to address the issue of exercise effects on GC-induced osteoporosis in more detail, but future guidelines will pay more attention to aspects of exercise for bone strengthening. “There is a need,” the authors wrote in their review.
The American College of Rheumatology’s guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis include recommendations for regular weight-bearing or resistance training.
“Regular activity is very important for bone health,” says rheumatologist Carol Langford, M.D., director of the Vasculitis Treatment and Research Center at the Cleveland Clinic. “If we have a patient who needs prednisone for a period of time, we look at their current bone density and proactively think about bone protection, including what they do for exercise. .”
Bone-friendly exercises for PMR
According to Harvard Medical School, several studies have shown that, in general, weight-bearing exercise (even weight-bearing aerobic exercise such as walking or running) can support bone health.
Activities that place some stress on bones cause extra calcium deposition and activate bone-forming cells, slowing bone loss or promoting bone formation.
“The exercise you choose will depend on your basic activity, but simple exercises like a brisk walk or yoga-like stretches can be effective,” says Dr. Dua. “Doing bone-strengthening activities, such as lifting weights with low weights and high reps, can also help. Even if it’s sedentary exercise, it may help.”
According to Harvard Medical School, a bone-strengthening exercise program should include four main components.
- weight-bearing exercise Encourage your body to work against gravity by walking, climbing stairs, playing tennis, and dancing (which helps strengthen your bones).
- muscle strengthening exercise Free weights, weight machines, resistance bands, and exercises using your own body weight.
- balance exercise Tai Chi and yoga to prevent falls.
- flexibility exercises Like yoga and stretching, it helps soften your muscles and make your joints more mobile.
If possible, swimming or water aerobics can be effective since they are less stressful on the joints. “It also helps with joint flexibility,” says Dr. Dua.
Health tips for PMR patients
As part of PMR management, your doctor may also look at your diet and any supplements you may need to protect your bones.
“Work with your doctor to find out what your calcium and vitamin D intake is,” says Dr. Langford. “It’s important to know each patient’s usual diet and what they can consume. But in general, we recommend a diet rich in calcium and vitamin D, such as the Mediterranean diet.”
Mediterranean diet is associated with lower risk of hip fractures, according to a 2023 review in the same journal nutrients.
“The Mediterranean diet (MD), a popular alternative dietary pattern, has recently been shown to positively impact musculoskeletal health and reduce the incidence of hip fractures,” the authors write in their review. states. “Higher adherence to MD is also associated with increased calcium intake in perimenopausal women.”
The anti-inflammatory Mediterranean diet emphasizes vegetables, fruits, beans, lentils, nuts, extra virgin olive oil, and fish rich in omega-3 fatty acids, according to the Cleveland Clinic. It also contains a moderate amount of natural cheese and yogurt.
Olive oil is rich in polyphenols, which are known to reduce inflammation and can also prevent bone loss, the authors added. nutrients study. In general, studies have found an association between inflammatory foods (such as red and processed meats, or foods high in sugar) and decreased bone mineral density and content in overweight and obese people. Masu. Orthopedics and Research Journal.
Bone-strengthening nutrients are available through your diet, but if you don’t get enough through your diet, your doctor may recommend calcium and vitamin D supplements. In fact, it may have been a conversation she had with her doctor before her PMR diagnosis.
“Bone mass typically begins to decline earlier in life than in patients affected by PMR, so many patients will already be receiving calcium and vitamin D supplements,” Dr. Dua says. says.
Ask your doctor if you are a candidate for supplements and how steroids affect your bone health, based on your baseline bone mineral density and ongoing scans.
“As a rheumatology society, we always remember to give people calcium and vitamin D prophylaxis. [preventively]They are related but not the same, especially if you are taking high doses of prednisone for something like giant cell arteritis,” says Dr. Dua. “I think that may be a little bit overlooked in patients who are on these chronic low-dose steroids.” [like low-dose prednisone for PMR]”
stress management techniques
Chronic stress can affect the entire body, including the skeleton.
Stress is thought to be a risk factor for osteoporosis, although further research is needed to clarify the exact mechanism (hypotheses range from mild inflammation to the effects of stress on the genetic regulation of skeletal development). Masu. Stress coping techniques should therefore be part of an osteoporosis prevention strategy, says a 2021 review. international medical journal.
“We all have stressors in our lives on a regular basis, and being diagnosed with a new illness can also be stressful,” says Dr. Dua. “Stress is definitely something I talk about with patients, especially since steroids can increase hunger, irritability, and anxiety, making basic problems like increased stress from treatment even more likely. Masu.”
Dr. Dua recommends apps like Headspace and Calm for guided meditation, breathing techniques, and light yoga with an emphasis on stress reduction.
“Some patients are very interested in other treatments such as massage therapy or acupuncture,” says Dr. Dua. “We don’t have a wide enough knowledge of other integrative therapies, but we are working with integrative therapy experts to find out what specific tips might be helpful for patients who are interested. Masu.”
Sleep hygiene practices
If you have pain or are taking medications for PMR, getting quality sleep can be difficult to manage.
“Prednisone and other glucocorticoids can interfere with sleep and can cause problems such as a decreased sense of well-being,” Dr. Langford says. “Sleep cycles are very important for pain management, so we want to encourage good sleep habits.”
Even if you feel tired during the day, Dr. Langford recommends trying to maintain your daytime activity to help you sleep better at night.
Steroids can especially affect sleep when taken in the evening, so your doctor may recommend that you take your entire daily dose in the morning (but before changing it yourself, check with your doctor please). According to the Hospital for Special Surgery, this will help you sleep better at night.
Dr. Dua recommends making further lifestyle changes to improve sleep quality, such as limiting caffeine later in the day and avoiding stimulating activities such as checking your phone right before bed. I am proposing it.
“If you don’t sleep well, your body doesn’t heal when it should throughout the night,” says Dr. Dua. “Sleep hygiene is so important because you wake up in the morning more sore and tired, and then end the day feeling even more exhausted.”
According to Harvard Medical School, if pain wakes you up in the middle of the night, try “relaxing distractions,” such as breathing meditation or guided imagery, in which you imagine yourself in a quiet place. If that doesn’t work, you can also stand up and read in a quiet room with little light, but avoid anything with bright light, such as a TV, smartphone, or computer.
Also, try to maintain a regular schedule, such as going to bed and waking up at the same time every day. This supports your natural sleep drive by setting your body clock. If the pain persists and keeps you up at night, see your doctor.
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This article was created with support from Sanofi.
