Perceived stress and risk of any osteoporotic fracture

Comprehensive health assessment of retired martial arts athletes: bone density, dietary intake, physical activity, and wellbeing

Regular physical activity offers benefits like enhanced bone density, which often persists post-retirement. However, retirement can lead to weight gain and changes in quality of life due to reduced physical activity. Therefore, this study investigates the long-term effects of elite athletic experience by comparing retired Jordanian male elite athletes (ages 40-50) with non-athletes of the same age. The differences were explored in weight changes, bone density, quality of life, happiness, stress, insomnia, physical activity, and dietary intake to understand how martial arts impact these health dimensions.

Methods

A descriptive case-control study was conducted among 30 retired male elite athletes and 20 age-matched non-athletes. Bone density and body composition were measured using dual-energy X-ray absorptiometry (DEXA) scans. Additional assessments included anthropometric measurements, a 3-day dietary recall, physical activity (International Physical Activity Questionnaire), quality of life (WHOQOL), happiness (Subjective Happiness Scale), stress (Perceived Stress Scale), and insomnia (Insomnia Severity Index).

Results

Retired athletes showed significantly higher Z-scores for the left femur (neck and total) and the AP spine, with p-values <0.05. Among non-athletes, 65% had normal bone density with a Z-score ≥ -1.9 and a T-score > -1.1, 20% had abnormal bone density with a Z-score < -1.9, and 15% had osteopenia with a T-score between -1.1 and -2.4. In contrast, 100% of retired athletes had normal bone density with a Z-score ≥ -1.9 and a T-score > -1.1. Retired athletes exhibited greater weight changes than non-athletes, with a p-value <0.05; the average weight gain among retired athletes was 18.548 kg, and the mean weight gain among non-athletes was 4.3 kg. There were statistically significant mean differences in perceived stress levels between retired athletes and non-athletes with a p-value <0.05. In contrast, there were no statistically significant mean differences between the groups in quality of life, subjective happiness, and the Insomnia Severity Index.

Conclusion

The study reveals that retired elite athletes maintain better bone density but face greater weight gain and stress than their non-athlete counterparts. Both groups enjoy a high quality of life and low levels of insomnia. These findings underscore the importance of continued physical activity for health and suggest that both retired athletes and non-athletes should adopt a balanced lifestyle to manage weight and stress effectively.

Perceived stress across population segments characterized by differing stressor profiles-A latent class analysis

OBJECTIVE

We aimed to 1) identify distinct segments within the general population characterized by various combinations of stressors (stressor profiles) and to 2) examine the socio-demographic composition of these segments and their associations with perceived stress levels.

METHODS

Segmentation was carried out by latent class analysis of nine self-reported stressors in a representative sample of Danish adults (N = 32,417) aged 16+ years. Perceived stress level was measured by the Perceived Stress Scale (PSS).

RESULTS

Seven classes were identified: Class 1 was labeled Low Stressor Burden (64% of the population) and the remaining six classes, which had different stressor combinations, were labeled: 2) Burdened by Financial, Work, and Housing Stressors (10%); 3) Burdened by Disease and Death among Close Relatives (9%); 4) Burdened by Poor Social Support and Strained Relationships (8%); 5) Burdened by Own Disease (6%); 6) Complex Stressor Burden Involving Financial, Work, and Housing Stressors (2%); and 7) Complex Stressor Burden Involving Own Disease and Disease and Death among Close Relatives (2%). Being female notably increased the likelihood of belonging to Classes 2, 3, 5, and 7. Higher age increased the likelihood of belonging to Class 3. Low educational attainment increased the likelihood of belonging to Classes 5 and 6. A significant difference was observed in perceived stress levels between the seven latent classes. Average PSS varied from 9.0 in Class 1 to 24.2 in Class 7 and 25.0 in Class 6.

CONCLUSION

Latent class analysis allowed us to identify seven population segments with various stressor combinations. Six of the segments had elevated perceived stress levels but differed in terms of socioeconomic composition and stressor combinations. These insights may inform a strategy aimed at improving mental health in the general population by targeting efforts to particular population segments, notably segments experiencing challenging life situations.

Osteoporosis under psychological stress: mechanisms and therapeutics

Psychological stress has been associated with the onset of several diseases, including osteoporosis. However, the underlying pathogenic mechanism remains unknown, and effective therapeutic strategies are still unavailable. Growing evidence suggests that the sympathetic nervous system regulates bone homeostasis and vascular function under psychological stress, as well as the coupling of osteogenesis and angiogenesis in bone development, remodeling, and regeneration. Furthermore, extracellular vesicles (EVs), particularly mesenchymal stem cell extracellular vesicles (MSC-EVs), have emerged as prospecting therapies for stimulating angiogenesis and bone regeneration. We summarize the role of sympathetic regulation in bone homeostasis and vascular function in response to psychological stress and emphasize the relationship between vessels and bone. Finally, we suggest using MSC-EVs as a promising therapeutic method for treating osteoporosis in psychological stress.

Physical Activity and Psychosocial Factors Associated With Risk of Future Fractures in Middle-Aged Men and Women

Identification of risk factors for fractures is important for improving public health. We aimed to identify which factors related to physical activity and psychosocial situation were associated with incident fractures among 30,446 middle-aged women and men, followed from 1991-1996 to 2016, in a prospective population-based cohort study. The association between the baseline variables and first incident fracture was assessed by Cox regression models, and significant risk factors were summed into fracture risk scores. Any first incident fracture affecting spine, thoracic cage, arms, shoulders, hands, pelvis, hips, or legs was obtained from the National Patient Register, using the unique personal identity number of each citizen. A total of 8240 subjects (27%) had at least one fracture during the follow-up of median 20.7 years. Age, female sex, body mass index, previous fracture, reported family history of fracture >50 years (all p < .001), low leisure-time physical activity (p = .018), heavy work (p = .024), living alone (p = .002), smoking (p < .001), and no or high alcohol consumption (p = .005) were factors independently associated with incident fracture. The fracture risk score (0-9 points) was strongly associated with incident fracture (p for trend <.001). Among men without risk factors, the incidence rate was 5.3/1000 person-years compared with 23.2 in men with six or more risk factors (hazard ratio [HR] = 5.5; 95% confidence interval [CI] 3.7-8.2). Among women with no risk factors, the incidence rate was 10.7 compared with 28.4 in women with six or more risk factors (HR = 3.1; 95% CI 2.4-4.0). Even moderate levels of leisure-time physical activity in middle age are associated with lower risk of future fractures. In contrast, heavy work, living alone, smoking, and no or high alcohol consumption increase the risk of fracture. Our results emphasize the importance of these factors in public health initiatives for fracture prevention. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The relative importance of work-related and non-work-related stressors and perceived social support on global perceived stress in a cross-sectional population-based sample

Background

High levels of perceived stress have a negative bearing on health and well-being, and stress is a major public health issue. According to the Stress Process Model, stressors are socially patterned and combine to produce strain. Despite this, most studies on stress have focused on work-related stressors leaving non-work determinants under-investigated. The aim of the present study was to determine the relative importance of work-related and non-work-related stressors and perceived social support for the overall perceived stress level.

Methods

Self-reported data were drawn from the 2017 population-based health survey “How are you?” conducted in the Central Denmark Region (N = 32,417). Data were linked with data drawn from national administrative registers. Work- and non-work-related stressors assessed included major life events, chronic stressors and daily hassles. Perceived social support was assessed using a single question. Overall perceived stress was assessed by the 10-item Perceived Stress Scale. We conducted dominance analyses based on a multiple linear regression model to determine the most important explanatory variables of overall perceived stress. Analyses were weighted and adjusted.

Results

Work- and non-work-related stressors along with perceived social support explained 42.5% of the total variance (R²) in overall perceived stress. The most important explanatory variables were disease, perceived social support and work situation. The stratified analyses produced slightly varying results (“dominance profiles”) of perceived stress between subgroups. Work situation was the most important explanatory variable in the employed group. However, adding non-work-related explanatory variables to the analysis tripled the explained variance.

Conclusions

The overall level of perceived stress can be statistically explained by a combination of work- and non-work-related stressors and perceived social support both at population level and in subgroups. The most important explanatory variables of overall perceived stress are disease, perceived social support and work situation. Results indicate that public health strategies aiming to reduce stress should take a comprehensive approach and address a variety of stressor domains rather than focus on a single domain.

Trial registration

The study was approved by the Danish Data Protection Agency (r. no. 2012-58-0006) and registered in the Central Denmark Region (r. no. 1-16-02-593-16).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10594-2.

Intersectionality and trauma analysis in bioarchaeology

Intersectionality, the theory named by Kimberlé Crenshaw, outlines how multiple elements of an individual's social identity overlap to create and preserve societal inequalities and discrimination. Recently bioarchaeology's engagement with intersectionality has become increasingly explicit, as the field recognizes the lived experience of multiple axes of an individual's identity. Evidence of trauma can remain observable in an individual's skeleton for years, making it an ideal subject of study for intersectional analyses in bioarchaeology. Using contrasting case studies of two individuals who died in hospitals and were unclaimed after death, we explore the theoretical and methodological application of intersectionality to investigations of accidental and interpersonal trauma. Differences in identities and structural inequalities affect bone quality and health outcomes. As we demonstrate, a broken bone is the intersecting result of biological, histomorphological, sociocultural, and behavioral factors. This approach allows for a better acknowledgement of the inherent complexity of past lives, elevating and amplifying previously silenced voices. In this way, intersectionality in bioarchaeology demands social justice.

Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey

Background

It has been reported that psychological stress affects bone metabolism and increases the risk of fracture. However, the relationship between bone fractures and post-traumatic stress disorder (PTSD) is unclear. This study aimed to evaluate the effects of disaster-induced PTSD symptoms on fracture risk in older adults.

Methods

This study evaluated responses from 17,474 individuals aged ≥ 65 years without a history of fractures during the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. The obtained data could determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between the fractures and each factor. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors.

Results

In total, 2,097 (12.0%) fractures were observed throughout the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex.

Conclusions

The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within the Fukushima Prefecture.

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.

Is there association between stress and periodontitis?

OBJECTIVE

This study estimated the association between stress and periodontitis.

MATERIALS AND METHODS

A cross-sectional study was conducted with a sample of 621 individuals. Information about individuals was obtained through a questionnaire. Stress was evaluated using the Perceived Stress Scale. The diagnosis of periodontitis was based on a complete periodontal examination including clinical attachment level, probing depth, and bleeding on probing. Prevalence ratios (PR), crude and adjusted, and their respective 95% confidence intervals (95%CI) were estimated by Poisson regression analysis.

RESULTS

In the final sample, 48.47% (301) of the individuals were classified as having stress, of which, 23.92% (72) had the diagnosis of periodontitis. Association measurements between stress and probing depth ≥ 4 mm (PR_adjusted = 1.28, 95%CI [1.04 to 1.58]), stress and clinical attachment level ≥ 5 mm (PR_adjusted = 1.15, 95%CI [1.01 to 1.31]), and stress and periodontitis (PR_adjusted = 1.36, 95%CI [1.01 to 1.83]) showed that the frequency of these outcomes among those exposed to stress was 15-36% higher than those without the condition of stress, after adjustment for age, sex, schooling level, current smoking habit, pulmonary disease, and body mass index.

CONCLUSIONS

The findings showed positive association between exposure to stress and the presence of periodontitis, reaffirming the need to prevent and control stress.

CLINICAL RELEVANCE

Although there are limitations in this study, the results showed that an association exists between stress and periodontitis, signaling the necessity of a multidisciplinary attention when considering the psychological status in the management of oral and general health conditions of the individual.

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.

The Use of Antidepressive Agents and Bone Mineral Density in Women: A Meta-Analysis

Antidepressive agents are one of the fastest-growing classes of prescribed drugs. However, the effects of antidepressive agents on bone density are controversial. The aim of this meta-analysis is to evaluate the state of research on the relationship between the use of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) and bone mineral density (BMD) in women. The database searched was Pubmed. The meta-analysis included human studies in women fulfilling the following criteria: (i) an assessment of bone mineral density in the lumbar spine, the femoral neck or the total hip; (ii) a comparison of the BMD of depressed individuals using antidepressive agents (SSRIs or TCAs), and a control group that did not use antidepressive agents; (iii) measurement of BMD using dual-energy X-ray absorptiometry (DXA); and (iv) calculations of the mean BMD and standard deviation or standard error. Four studies were identified, which, in total, included 934 women using antidepressive agents and 5767 non-using individuals. The results showed that no significant negative composite weighted mean effect sizes were identified for the comparisons between SSRI users and non-users. Similarly, no significant negative composite weighted mean effect sizes were identified for the comparisons between TCA users and non-users, indicating similar BMD in SSRI or TCA users and non-users. The meta-analysis shows that the association between antidepressant medication and bone mineral density has not been extensively researched. Only four studies fulfilled the inclusion criteria. The global result of the literature review and meta-analysis was that the use of antidepressive agents was not associated with lower or higher BMD. This result applies to both SSRIs and TCAs and to all measurement locations (lumbar spine, femoral neck and total hip).

Missing data and multiple imputation in clinical epidemiological research

Missing data are ubiquitous in clinical epidemiological research. Individuals with missing data may differ from those with no missing data in terms of the outcome of interest and prognosis in general. Missing data are often categorized into the following three types: missing completely at random (MCAR), missing at random (MAR), and missing not at random (MNAR). In clinical epidemiological research, missing data are seldom MCAR. Missing data can constitute considerable challenges in the analyses and interpretation of results and can potentially weaken the validity of results and conclusions. A number of methods have been developed for dealing with missing data. These include complete-case analyses, missing indicator method, single value imputation, and sensitivity analyses incorporating worst-case and best-case scenarios. If applied under the MCAR assumption, some of these methods can provide unbiased but often less precise estimates. Multiple imputation is an alternative method to deal with missing data, which accounts for the uncertainty associated with missing data. Multiple imputation is implemented in most statistical software under the MAR assumption and provides unbiased and valid estimates of associations based on information from the available data. The method affects not only the coefficient estimates for variables with missing data but also the estimates for other variables with no missing data.