Post‐traumatic stress disorder and risk of osteoporosis: A nationwide longitudinal study

Abstract

Several studies suggested a relationship between stress and related mental illnesses, such as depression and osteoporosis. However, it was unclear whether patients with post-traumatic stress disorder (PTSD) were at risk of developing osteoporosis in later life. In this study, 6,041 patients with PTSD and 24,164 age- or sex-matched controls were enrolled between 2002 and 2009 in our study and followed up to the end of 2011. Cases of osteoporosis were identified during the follow-up. Patients with PTSD had an elevated likelihood of developing osteoporosis (HR: 2.66, 95% CI [1.91, 3.71]) in later life compared with the controls. Sensitivity tests after excluding the first year observation (HR: 2.46, 95% CI [1.72, 3.53]) and the first 3-year observation (HR: 1.88, 95% CI [1.18, 3.01]) were consistent. Patients with PTSD had a higher risk of developing osteoporosis at an earlier age compared with those without PTSD. Further studies would be necessary to clarify the pathophysiology between PTSD and osteoporosis.

Crosstalk of Brain and Bone—Clinical Observations and Their Molecular Bases

“…Bone mineral density (BMD) is assessed through dual-energy x-ray absorptiometry (DXA) in which osteoporosis is defined at T-score −2.5 or less standard deviations below the average of young and healthy adults [ 10 ]. Osteoporosis has been associated with a great variety of brain dysfunctions such as epilepsy [ 11 ], schizophrenia [ 12 ], shift work [ 13 ], post-traumatic stress disorder [ 14 ], depression [ 15 ] as well as major neurodegenerative diseases including stroke [ 16 ], Alzheimer’s [ 17 ] and Parkinson’s disease [ 18 ]. Interestingly, trauma to the central nervous system such as traumatic brain [ 19 ] and spinal cord injury positively affect bone regeneration (for a detailed review please see Reference [ 20 ]).…”

“…Post-traumatic stress disorder represents another chronic psychological stress condition associated with bone loss, which poses an elevated risk for osteoporosis in civilian [ 14 ] as well as military patients [ 41 ]. Although malnutrition could not be excluded, the negative effect on bone mass was proposed to be mediated by elevated serum levels of proinflammatory cytokines such as tumor necrosis factor α (TNFα), interleukin 1 (IL1) and interleukin 6 (IL6) [ 42 ] known to stimulate bone resorption [ 43 ], as well as through hormones released in response to chronic psychological stress [ 44 ].…”

Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions

“…Chronic stress has been associated with obesity, atherosclerosis, lung pathologies, and diabetes (26, 27). In regard to osteoporosis, U.S. military veterans diagnosed with PTSD have a higher risk of developing osteoporosis (28), as do civilians with PTSD diagnosis (29). Likewise, it was found that among 73 female Holocaust survivors there was a 3.47-fold increase in prevalence of osteoporosis compared to controls (30), suggesting psychological stress may be a risk factor for osteoporotic disease.…”

Effects of Early Life Stress on Bone Homeostasis in Mice and Humans

“…Stress alters their expression, and they can also act as direct and indirect growth factors for osteoblasts [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Latest studies indicate that psychosocial stress can lead to structural and functional changes in neuronal plasticity, neuronal marker expression, mitochondria and inflammation [ 4 , 27 , 28 ], possibly resulting in downstream alterations of bone homeostasis [ 29 , 30 , 31 , 32 , 33 ].…”