The role of nutrition and physical exercise in promoting musculoskeletal health in individuals with rheumatic diseases undergoing glucocorticoid therapy

Author(s)

Gabriel Perri Esteves

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2025-05-21

Examining board members

Eimear Bernadette Dolan; Danieli Castro Oliveira de Andrade; Danilo Reis Coimbra; Erick Prado de Oliveira

• Advisor: Eimear Bernadette Dolan

Abstract

Glucocorticoids (GCs) are medications used in the treatment of rheumatic diseases due to their anti-inflammatory and immunosuppressive potential; however, they can lead to adverse effects, such as bone and muscle loss. Lifestyle interventions represent potential adjunct therapies capable of mitigating these adverse effects. This thesis comprises three studies, the primary objective of which is to investigate the role of nutritional and physical exercise interventions in promoting musculoskeletal health of individuals with rheumatic diseases using GCs. Study I is a narrative review summarizing the current level of evidence regarding nutritional interventions to counteract the adverse effects of GCs. Study II is an exploratory analysis of the National Health and Nutrition Examination Survey (NHANES) database, designed to assess potential associations between protein intake, lean mass, and bone mass in individuals with rheumatic diseases. Study III is a randomized parallel-group controlled trial, evaluating the effect of a six-month home-based training program on the bone health and metabolism of participants with Systemic Lupus Erythematosus (SLE) undergoing pulse therapy with GCs. Study I identified that adequate calcium, vitamin D and protein intake appears to be important recommendations for bone mass and muscle mass preservation, and the potential role of a diet based on minimally processed foods for aiding metabolic health in this population. However, it also noted that nutritional interventions are under-investigated, highlighting the need for future studies to address these gaps in the literature. Study II found significant non-linear positive associations between protein intake and femoral neck bone mass as well as lean mass, even after adjusting the models for confounding variables. Study III showed significant effects of the intervention on certain bone microarchitecture parameters in comparison to the control group. However, this outcome had a reduced sample size which reduces certainty in the finding. No significant effects of the intervention were observed on bone mineral density or bone metabolism biomarkers. In summary, the studies in this thesis reinforce that nutritional interventions based on adequate calcium, vitamin D, and protein intake may have relevant effects on preserving bone and muscle mass in individuals with rheumatic diseases undergoing GC therapy. Regarding exercise, results suggest a potential beneficial effect on microarchitecture parameters, but this finding needs to be confirmed by future studies. Collectively, this thesis highlights the promising role of diet and physical training in muscle mass and bone health in this population while also emphasizing the need for further studies to comprehensively understand their effects. (AU)

• FAPESP's process: 20/07860-9 - The influence of exercise training on bone health in patients taking high doses of glucocorticoids
• Grantee: Gabriel Perri Esteves
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)