Association of stressful life events with accelerated bone loss in older men: the osteoporotic fractures in men (MrOS) study

Potential mechanisms linking psychological stress to bone health

Chronic psychological stress affects many body systems, including the skeleton, through various mechanisms. This review aims to provide an overview of the factors mediating the relationship between psychological stress and bone health. These factors can be divided into physiological and behavioural changes induced by psychological stress. The physiological factors involve endocrinological changes, such as increased glucocorticoids, prolactin, leptin and parathyroid hormone levels and reduced gonadal hormones. Low-grade inflammation and hyperactivation of the sympathetic nervous system during psychological stress are also physiological changes detrimental to bone health. The behavioural changes during mental stress, such as altered dietary pattern, cigarette smoking, alcoholism and physical inactivity, also threaten the skeletal system. Psychological stress may be partly responsible for epigenetic regulation of skeletal development. It may also mediate the relationship between socioeconomic status and bone health. However, more direct evidence is required to prove these hypotheses. In conclusion, chronic psychological stress should be recognised as a risk factor of osteoporosis and stress-coping methods should be incorporated as part of the comprehensive osteoporosis-preventing strategy.

Increased risk for hip fracture after death of a spouse-further support for bereavement frailty?

Death of a spouse is associated with poorer physical and mental health. We followed all married individuals, born from 1902 to 1942, during the period from 1987 to 2002, and found that widows and widowers had higher risk for hip fracture, compared with still married women and men.

INTRODUCTION

Spousal bereavement can lead to poorer physical and mental health. We aimed to determine whether married women and men had an elevated risk of hip fracture after death of a spouse.

METHODS

In a retrospective cohort study, we followed all Swedish married individuals aged 60 to 100 years (n = 1,783,035), from 1987 to 2002. Data are presented as mean with 95% confidence interval (CI).

RESULTS

During the follow-up period, 21,305 hip fractures among widows and 6538 hip fractures among widowers were noted. The hazard ratio (HR) for hip fracture in widows compared with married women was 1.34 (95% CI 1.31 to 1.37) and for widowers compared with married men 1.32 (95% CI 1.29 to 1.35). The HR for hip fracture in the first 6 months after death of a spouse was in widows compared with married women 1.62 (95% CI 1.53 to 1.71) and in widowers compared with married men 1.84 (95% CI 1.68 to 2.03). The elevated risk was especially prominent in young widowers in the age range 60-69 years. During the first 6 months they showed a HR of 2.76 (95% CI 1.66 to 4.58) for a hip fractvure compared with age matched married men. Widows aged 60-69 years showed a HR of 1.59 (95% CI 1.26 to 1.99) compared with age matched married women.

CONCLUSION

Our observation of a higher hip fracture risk in both genders in connection with the death of a spouse indicates a possible effect of bereavement on frailty.

Increased risk of osteoporosis in patients with peptic ulcer: a follow-up study using a national sample cohort

We performed a nationwide, population-based cohort study to investigate the risk of osteoporosis in patients with peptic ulcer disease in South Korea and concluded that peptic ulcer disease is associated with an increased risk of osteoporosis.

PURPOSE

This study aimed to evaluate the association between peptic ulcer disease (PUD) and the occurrence of osteoporosis using a national sample cohort from South Korea.

METHODS

Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with PUD (n = 50,002) and for 1:1 matched control participants (n = 50,002); we then analyzed the occurrence of osteoporosis from 2002 to 2013. The patients were matched according to age, sex, income, region of residence, and past medical history. A stratified Cox proportional hazards model was used to analyze the hazard ratios (HRs) and the 95% confidence intervals (CIs). Subgroup analyses were performed based on age and sex.

RESULTS

The adjusted HR for osteoporosis was 1.36 (95% CI = 1.33-1.40, P < 0.001) in the PUD group. In the subgroup analysis based on age and sex, the respective adjusted HRs of PUD for osteoporosis were 1.33 (95% CI = 1.21-1.47) in the < 65-year-old group of men and 1.42 (95% CI = 1.30-1.56) in the ≥ 65-year-old group of men (each P < 0.001). The respective adjusted HRs of PUD for osteoporosis were 1.34 (95% CI = 1.29-1.39) in the < 65-year-old group of women and 1.38 (95% CI = 1.33-1.47) in the ≥ 65-year-old group of women (each P < 0.001).

CONCLUSION

In the current nationwide cohort study, we found that PUD is associated with an increased risk of osteoporosis regardless of sex.

Post-traumatic stress disorder and incident fractures in the Danish population

Psychological stress may be associated with increased risk of fractures. It is unknown whether post-traumatic stress disorder (PTSD), a marker of chronic severe psychological stress occurring in response to a traumatic event, influences fracture risk. In this nationwide cohort study, persons with PTSD had an increased risk of fractures compared to the general population.

INTRODUCTION

We conducted a population-based national cohort study in Denmark to examine the association between PTSD and incident fractures.

METHODS

We examined the incidence rate of overall and specific fractures among patients with clinician-diagnosed PTSD (n = 4114), compared with the incidence rate in the general population from 1995 to 2013, using Danish medical registry data. We further examined differences in associations by gender, age, psychiatric and somatic comorbidity, and follow-up time. We calculated absolute risks, standardized incidence ratios (SIRs), and 95% confidence intervals (95% CIs).

RESULTS

Risk of any fracture among persons with PTSD was 24% (95% CI 20%, 28%) over the study period. The SIR for any fracture was 1.7 (95% CI 1.6, 1.9). We found little evidence of effect measure modification of the association between PTSD and fractures in our stratified analyses.

CONCLUSIONS

Our findings suggest that PTSD is associated with increased fracture risk.

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

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.

Predictors of change of trabecular bone score (TBS) in older men: results from the Osteoporotic Fractures in Men (MrOS) Study

Among older men, characteristics that predict longitudinal changes in trabecular bone score (TBS) are different from characteristics that predict changes in bone mineral density (BMD). Most notably, weight loss is strongly associated with concomitant loss in BMD but with concomitant increases in TBS, when measured on Hologic densitometers.

INTRODUCTION

Our objective was to compare and contrast predictors of changes in TBS, total hip BMD, and lumbar spine BMD.

METHODS

Our study population was 3969 Osteoporotic Fractures in Men (MrOS) cohort participants (mean age 72.8 years) with repeat measures of TBS, lumbar spine and total hip BMD, body mass index (BMI) less than 37 kg/m2, and no use of bisphosphonate or glucocorticoid medications. TBS was scored (Med-Imaps Software version 2.1) and BMD measured on Hologic densitometers.

RESULTS

One thousand four hundred forty-four men had a TBS decrease > 0.04 units (estimated least significant change for TBS), 795 men had a TBS increase > 0.04 units, and 1730 men had TBS change ≤ 0.04 units over mean follow-up of 4.6 years. Older age was not associated with TBS change, but was associated with greater decline in lumbar spine and total hip BMD. Compared to stable weight, > 10% weight loss was strongly associated with an increase in TBS [effect size = 1.24 (95% CI 1.12, 1.36)] and strongly associated with a decrease in total hip BMD [- 1.16 (95% CI - 1.19, - 1.03)]. Other predictors discordant for longitudinal changes of TBS and BMD included baseline BMI, walk speed, and ACE inhibitor use.

CONCLUSIONS

Predictors of changes in TBS are different from predictors of changes in lumbar spine and total hip BMD. At least when assessed on Hologic densitometers, weight loss is associated with subsequent declines in spine and total hip BMD but subsequent increase in TBS. Faster walk speed may protect against loss of hip BMD, but is not associated with longitudinal changes of TBS.

Contingent association between the size of the social support network and osteoporosis among Korean elderly women

OBJECTIVE

To investigate the association between the number of personal ties (or the size of the social support network) and the incidence of osteoporosis among older women in Korea.

METHODS

Data from the Korean Urban Rural Elderly Study were used. Bone density was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femur neck. T-score, the standardized bone density compared with what is normally expected in a healthy young adult, was measured and the presence of osteoporosis was determined, if the T-score was < -2.5. The social support network size was measured by self-responses (number of confidants and spouse).

RESULTS

Of the 1,846 participants, 44.9% were diagnosed with osteoporosis. The association between the social support network size and the incidence of osteoporosis was curvilinear in both bivariate and multivariate analyses. Having more people in one's social support network size was associated with lower risk of osteoporosis until it reached around four. Increasing the social support network size beyond four, in contrast, was associated with a higher risk of osteoporosis. This association was contingent on the average intimacy level of the social network. At the highest average intimacy level ("extremely close"), increasing the number of social support network members from one to six was associated with linear decrease in the predicted probability of osteoporosis from 45% to 30%. However, at the lowest average intimacy level ("not very close"), the predicted probability of osteoporosis dramatically increased from 48% to 80% as the size of the social network increased from one to six.

CONCLUSION

Our results show that maintaining a large and intimate social support network is associated with a lower risk of osteoporosis among elderly Korean women, while a large but less-intimate social relationship is associated with a higher risk.

Osteoporosis in men: findings from the Osteoporotic Fractures in Men Study (MrOS)

The lifespan of men is increasing and this is associated with an increased prevalence of osteoporosis in men. Osteoporosis increases the risk of bone fracture. Fractures are associated with increased disability and mortality, and public health problems. We review here the study of osteoporosis in men as obtained from a longitudinal cohort of community-based older men, the Osteoporotic Fractures in Men Study (MrOS).