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J Epidemiol Community Health. 2019 Sep;73(9):888-892. doi: 10.1136/jech-2019-212516. Epub 2019 Jul 9.

Psychosocial stress and bone loss among postmenopausal women: results from the Women's Health Initiative.

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Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA.
Cancer Center, University of Arizona, Tucson, Arizona, USA.
Nutritional Sciences, University of Arizona, Tucson, Arizona, USA.
BIO5 Institute, University of Arizona, Tucson, Arizona, USA.
Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA.
Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
Department of Pathology, School of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.



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.


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.


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.


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.


BMD; WHI; ageing; fractures; psychosocial stress


Conflict of interest statement

Competing interests: None declared.

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