Correction of bone remodeling disorders in long-term corticosteroid therapy

Abstract

Background. In severe dermatoses, corticosteroid drugs are usually prescribed for a long period of time, and even for life; therefore, the detection of side effects caused by prolonged use of systemic glucocorticosteroids, in particular bone metabolism disorders, and their prevention are important components of comprehensive therapy for severe dermatoses. Consequently, the development of methods for early diagnosis, treatment and prevention of bone remodeling disorders under the influence of prolonged corticosteroid therapy in patients with severe dermatosis is extremely relevant for modern dermatology. The purpose of the study is to increase the efficiency and safety of treating patients with severe dermatosis by preventing or minimizing the development of side effects in the treatment with glucocorticosteroid hormones. Materials and methods. The study involved 134 patients with severe dermatosis (acantholytic pemphigus, bullous pemphigoid, Dühring disease, erythroderma, etc.). Clinical anamnestic, biochemical, cytological, immunoenzyme, instrumental and statistical methods of research were used. Results. Patients receiving prolonged systemic corticosteroid therapy showed a significant decrease in the bone fraction of alkaline phosphatase — by 2.1 times, in osteocalcin level — by 6.6 times, and 2.2­fold increase in the C­terminal telopeptide. According to ultrasonic densitometry, osteopenia was detected in 35.5 %, osteoporosis — in 64.5 % of patients. Calcium supplements with vitamin D3 and anti­resorptive agent were prescribed to correct bone remodeling. As a result, an increase in these parameters was noted, indicating the restoration of osteosynthesis and normalization of bone tissue resorption processes that was confirmed by 1.8­fold increase in the bone mineral density. To prevent the development of bone remodeling disorders, antiresorptive drugs, calcium and vitamin D3 were administered as a part of comprehensive treatment, in combination with systemic corticosteroids throughout the whole course of therapy. Conclusions. The conducted research has allowed increasing efficiency and safety of treatment of patients with severe dermatosis by preventing or minimizing the development of side effects of glucocorticosteroid treatment.

Keywords

• glucocorticosteroids
• remodeling
• bone tissue
• side effects
• chronic dermatosis
• therapy
• prevention