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Research report
Psychosocial stress and bone loss among postmenopausal women: results from the Women’s Health Initiative
  1. Shawna L Follis1,
  2. Jennifer Bea2,3,
  3. Yann Klimentidis1,4,
  4. Chengcheng Hu1,
  5. C J Crandall5,
  6. David O Garcia6,
  7. Aladdin H Shadyab7,
  8. Rami Nassir8,
  9. Zhao Chen1
  1. 1 Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
  2. 2 Cancer Center, University of Arizona, Tucson, Arizona, USA
  3. 3 Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
  4. 4 BIO5 Institute, University of Arizona, Tucson, Arizona, USA
  5. 5 Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
  6. 6 Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
  7. 7 Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
  8. 8 Department of Pathology, School of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
  1. Correspondence to Shawna L Follis, Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85721, USA; shawnafollis{at}email.arizona.edu

Abstract

Background Bone loss is a major public health concern with large proportions of older women experiencing osteoporotic fractures. Previous research has established a relationship between psychosocial stressors and fractures. However, few studies have investigated bone loss as an intermediary in this relationship. This study investigates whether social stress is associated with bone loss during a 6-year period in postmenopausal women.

Methods Data from 11 020 postmenopausal women from the USA was used to examine self-reported psychosocial stress in relation to change in bone mineral density (BMD) measured at the femoral neck, lumbar spine and total hip. Linear regression models were used to examine associations between social measures of psychosocial stress (social strain, social functioning and social support) and per cent change in BMD over 6 years.

Results High social stress was associated with decreased BMD over 6 years. After adjustment for confounders, each point higher in social strain was associated with 0.082% greater loss of femoral neck BMD, 0.108% greater loss of total hip BMD and 0.069% greater loss of lumbar spine BMD (p<0.05). Low social functioning and low social support were associated with greater decreases in femoral neck BMD, and low social functioning was associated with greater decreases in total hip BMD.

Conclusion The findings provide evidence for an association between high social stress and greater bone loss over 6 years of follow-up. In agreement with the prior literature, the findings for social strain and social functioning suggest that poor quality of social relationships may be associated with bone loss in postmenopausal women.

  • WHI
  • psychosocial stress
  • fractures
  • BMD
  • ageing

https://doi.org/10.1136/jech-2019-212516

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    Footnotes

    • Contributors SLF: study concept and design, acquisition of data, analysis and interpretation of data, preparation of the manuscript and the final approval of the manuscript. The author agrees to be accountable for all aspects of the work. JB, AHS, YK, CH, CJC, DOG and RN: study design, interpretation of data, preparation of the manuscript and the final approval of the manuscript. All the authors agree to be accountable for all aspects of the work. ZC: study design and concept, data collection, interpretation of data and the final approval of the manuscript. The author agrees to be accountable for all aspects of the work.

    • Funding This work was supported by the Women's Health Initiative (WHI), which is funded by the National Heart, Lung, and Blood Institute through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C and HHSN271201100004C.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The institutional review board at each clinic site approved the study, and the study was conducted in accordance with the ethical standards set forth in the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from the Women’s Health Initiative (www.whi.org) and are not publicly available.