I find what is missing in information on osteoporosis is the effect of stress on bone health.
Maintaining strong and healthy bones is a complex process.
And there are many factors at play: genetics, nutritional deficiencies (Vitamin D, phosphorus, calcium), medications (glucocorticoids like cortisone and prednisone), positive or negative stresses on the bones, our immune system, and hormones that are in disarray (thyroid, human growth hormone (IGF-1), estrogen, testosterone, cortisol, insulin).
Osteoporosis, meaning, "porous bone," is a skeletal disorder characterized by compromised bone strength, predisposing one to an increased risk of fracture." (Surgeon General Report 2004).
It's a constant changing in the make-up, or physiology, of the bone. Constant remodeling takes place via cells called osteoblasts (building) and cells called osteoclasts (breaking down/resorption). The rate of building and resorption is dependent on all of the above listed factors. There is subtle balance between losing too much bone and making too little bone, or both.
The most common fracture sites are the femur (hip), wrist and the vertebrae of the spine (compression).
Risk Factors of Osteoporosis:
- Over age of 50
- Being female (50% percent of women over the age of 65 will have osteoporosis, compared to 25% of men over age 65)
- Menopause (estrogen is a bone protecting hormone)
- Family history
- Low body weight/thin frame (increased weight bearing exercise is bone protective, so with a thin frame, you have less weight to bear down. Also, men and women with anorexia experience bone loss not only due to a thin frame, but also due to drops in sex hormones.)
- Reduced calcium/Vitamin D (or ability to absorb it)
- Smoking (not clearly understood)
- Excessive alcohol (more than 2 drinks/day--alcohol interferes with the ability of the pancreas to absorb calcium and Vitamin D. It also affects the liver, which is important for activating Vitamin D, which by the way, is itself important in the absorption of calcium. Chronic alcohol consumption also increases parathyroid hormone, which leaches calcium from the bone).
- Sedentary lifestyle (again, weight bearing exercise is bone protective--sitting does not count)
- Cancer treatments (disrupts hormone levels)
- Long term steroid use (Cushing's disease, chronic asthmatics. Glucocorticoids disrupt the division of bone precursor cells at the ends of the bones. They reduce calcium supply to the bone by blocking the calcium in the intestines, increasing the excretion of calcium by the kidneys and accelerate resorption of bone.)
Which brings us to stress and it's possible affect on bone health.
Yes, cortisol, the so-called stress hormone, is a glucocorticoid. And cortisol is an important hormone involved in metabolism of carbohydrates, fats, and proteins and is also important in the body's ability to respond to stress. Small amounts are actually necessary for bone development. However, as noted above, long term presence of glucocorticoids (ie cortisol) are detrimental to bone health.
It has been found that in depressed individuals that there is an increased presence of decreased bone mineral density that may be associated with increased levels of cortisol.
Stress induced inflammation has been implicated in disease states such as osteoporosis. More-over, cortisol is a potent anti-inflammatory and its failure to function results in an unmodulated inflammatory response to physical pathogens, unrecognized proteins, or psychological stressors. Inflammation induces oxidative stress, free radical damage, cellular death, aging, and systemic tissue degeneration. Accumulation of free-radicals over time accelerates the aging process, not only of tissue but of bone.
Signs and symptoms of stress-induced cortisol dysfunction include bone and muscle breakdown, fatigue, depression, pain, and memory impairments.
Hmmm, this is sounding a bit like like symptoms of peri-menopause and menopause too, right? A little bit of stress (those ups and downs) is normal and our body knows how to adjust. And as noted above, cortisol can have anti-inflammatory effects too. But on overload, cortisol is not so beneficial.
So what can you do about stress-induced inflammation that may alter your bone health?
Yoga for Bone Health
You might have heard that yoga can be helpful in reducing stress. And that even the physical practice of yoga can help improve bone density. In fact, Dr Loren Fishman studied the effects of yoga on bone health in, "Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss." They looked at 741 people from 2005 to 2015. Forty three were assessed in the end with actual pre/post tests done. Partcipants were provided a DVD with 12 poses done for 30 seconds each on a daily basis. They measured Bone Mineral Density (BMD) of spine, hip and femur before the study and after 2 years of daily yoga. They found increased BMD of spine, hip and femur. However, no mention of stress resilience was included in this study. Yet we know that Yoga can be useful for stress resilience by way of practicing mindfulness and conscious breath practices. Here is a link to a Handout for Abdominal Breathing and a Handout for Alternate Nostril Breath. These practices can help you with not only the physical bone building practice benefits of yoga but also with building stress resilience.
Blood Sugar Balance for Bone Health
Sugar and caffeine (I know all the good stuff!) will cause a rapid rise in blood glucose. The elevated blood glucose stimulates a rapid rise in insulin, which in turn rapidly lowers your blood glucose. It's a balancing act and thank goodness this is all going on behind the scenes so we don't have to worry too much. But it becomes a problem, because this rapid rise and then subsequent fall in blood glucose registers hypoglycemia and cravings and hunger increase. Result: ingesting more sugar and caffeine that starts the spike and fall roller coaster all over again, and again, and again. Excess sugar and caffeine also spike levels of adrenaline and cortisol---the amounts you would need to be able to escape from danger. But you are doing this to yourself willingly, over and over each time you have your coffee and pastry in the morning.
- I believe that if we are getting enough nutrients that our body needs, then we crave these things less. Eat protein with every meal---helps to sustain your energy over the long haul.
- Good sleep also helps. See my post on tips for improving sleep here.
- Start to wean yourself off caffeine. Start with half-caff coffee and add a teaspoon of coconut oil in to slow down the spike). Progress to green tea (great for it's anti-inflammatory properties, as well). Try capomo, a nut based bean that is caffeine free, has protein and nutrients and tastes like coffee (this might be part of your half-caff transition. Find capomo here.
Social Connections: Oxytocin for Bone Health
Oxytocin, the so-called, "love and bonding" hormone reduces the release of cortisol in humans in response to stressful stimuli. In primates, research has shown that social grooming activities increases plasma levels of oxytocin. And those primates with closer social bonds to their grooming partner, actually have larger increases in oxytocin compared to partners they are not as close with. Social isolation studies demonstrate decreased levels of oxytocin versus the levels of those with more social engagement. Lowered cortisol levels and increased oxytocin has also been found in dogs after hearing and seeing their owners, and more so when they are stroked and caressed. And in humans, couples that were instructed to perform 30 minutes of reciprocal, "warm-sensual," touch on their partners neck, shoulders and hands for 3x/week for 4 weeks demonstrated increased levels of salivary oxytocin and decreased stress markers such as blood pressure and cortisol levels.
- So, really engage in reciprocal touch with your friends and family---without distraction and with true intentions. I think technology these days lends itself to long-distance relationships, without much actual physical connection. For instance today, I gave my almost-90 year old client a hug. I don't think he gets those too often these days without family around as much. And the best thing is that it works both ways!
- Caress your pets--I'm sure the hormone producing effect is mutual
So, does stress lead to osteoporosis?
No, I don't think stress in and of itself causes osteoporosis, given all the above risk factors. But we do have evidence to support that an excess of glucocorticoids, and thus stress is a risk factor.
If you would like more help in your bone health conquest, please contact Tianna to see how we can work on your prevention goals.
Bone Health and Osteoporosis; a report of the Surgeon General: U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General; (pp. 1-437, Rep). (2004). Rockville, MD. http://www.surgeongeneral.gov/library
Hannibal, K. E., & Bishop, M. D. (2014). Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. Physical Therapy, 94(12), 1816-1825. doi:10.2522/ptj.20130597
Epel, E., Daubenmier, J., Moskowitz, J. T., Folkman, S., & Blackburn, E. (2009). Can Meditation Slow Rate of Cellular Aging? Cognitive Stress, Mindfulness, and Telomeres. Annals of the New York Academy of Sciences, 1172(1), 34-53. doi:10.1111/j.1749-6632.2009.04414.x
Lu, Y., Rosner, B., Chang, G., & Fishman, L. M. (2016). Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Topics in Geriatric Rehabilitation, 32(2), 81-87. doi:10.1097/tgr.0000000000000085
Ellingsen, D., Leknes, S., Løseth, G., Wessberg, J., & Olausson, H. (2016). The Neurobiology Shaping Affective Touch: Expectation, Motivation, and Meaning in the Multisensory Context. Frontiers in Psychology Front. Psychol., 6. doi:10.3389/fpsyg.2015.01986
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