Anxiety levels may affect bone health in postmenopausal women
Among postmenopausal women, anxiety levels are associated with the bone mineral density (BMD) in the lumbar spine and femoral neck, a study reports.
The study included 192 women (mean age 67.5 years), grouped into three according to their anxiety levels, which were assessed using the Hamilton Anxiety Rating Scale (HAMA). Other assessments performed included the Fracture Risk Assessment Tool score, Beck Depression Inventory scores and the 36-Item Short Form Health Survey (SF-36) scores for evaluation of the quality of life. X-ray vertebral morphometry was carried out in postmenopausal women referred for osteoporosis.
Women allocated to the lowest tertile of HAMA scores (HAMA-1) had a lower probability of fracture compared with those in the highest tertile (HAMA-3; 20.44 percent vs 24.94 percent; p=0.01). The same trend was observed when comparing the HAMA-2 and HAMA-3 tertiles.
Compared with the HAMA-1 group, the HAMA-3 group exhibited lower T-score vales in the lumbar spine (−2.84 vs −2.06; p<0.001) and in the femoral neck (−2.21 vs −1.93; p<0.05). Lower T-score values were likewise observed in HAMA-3 than in HAMA-2. The prevalence rate of vertebral fractures was higher in HAMA-3 than in HAMA-1, although the difference was not significant.
Multiple regression analysis showed that anxiety levels were predictive of reduced BMD in the lumbar spine (p=0.0002), and were significantly related to age, menopausal age, years since menopause and depressive symptoms.
Researchers postulated that both immunological and endocrinological aspects could expedite the association of anxiety with bone metabolism and osteoporosis. This is because individuals affected by anxiety show higher inflammatory markers. Through activation of bone turnover, inflammation may induce bone loss and contribute to osteoporosis. [Brain Behav Immun 2017;62:212-218; Rheum Dis Clin North Am 2006;32:631-658; Arch Immunol Ther Exp 2016;64:111-126]
Moreover, anxious individuals exhibit high plasma cortisol levels, with cortisol shown to contribute to bone loss by increasing bone resorption and reducing bone formation. [J Affect Disord 2008;106:307-313; Eur Rev Med Pharmacol Sci 2014;18:352-358]