Why Chronic Stress Can Lead to Osteoporosis and How to Reverse the Process
Every living person experiences some form of stress. It is practically impossible to escape it completely because stressors are often typical everyday activities like going to work, commuting in traffic, making dinner, caring for children, or paying the bills. However, when stress levels are chronically elevated over long periods of time, this can weigh heavily on the body and the mind.
This type of stress raises cortisol levels which, if left unchecked, can do an abundance of harm. Among the negative impacts of long-term elevated cortisol is that bone density may be diminished, and osteoporosis can result.
What Is Osteoporosis?
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break.
Inside normally functioning bones, osteoclasts break down old bone. Under typical circumstances, this would be followed by new bone formation. Osteoblasts are responsible for re-building the bone matrix, resulting in sustained bone mass. However, when osteoclasts outweigh and outnumber osteoblasts, bone density diminishes greatly. As a result, osteoporosis can occur.
Risk Factors for Osteoporosis
There are numerous risk factors in the development of this disease. They include unchangeable things like gender, age, race, family history, body frame size, and hormonal changes. For example, post-menopausal women have a greater likelihood than men in developing osteoporosis. Being of smaller statue is a factor as well since less bone mass exists. Also, low estrogen and low testosterone may decrease bone density, as may elevated thyroid hormone.
Other risk factors may be preventable like inadequate or improper dietary intake of key nutrients, low activity levels, certain medications (especially corticosteroids), excessive alcohol and/or tobacco use. Medical conditions like cancer or some autoimmune diseases also play a role. And as we shall see, stress can play a big part in osteoporosis development as well.
What Is Cortisol?
Cortisol is one of the body's stress hormones produced by the adrenal glands. When we think of acute stress as one might feel in a car accident or other emergency situation, we think of that "fight or flight" response. This is largely the result of adrenaline and epinephrine, and to an extent, cortisol. It is good to have these stress responses so that we can act quickly and logically when needed.
However, when stress becomes chronic, cortisol really kicks in. Cortisol is not inherently bad. In fact, we absolutely need it—in the right doses. Cortisol plays a role in circadian rhythms, glucose metabolism, blood pressure, and reduction of inflammation.
The problem is, when cortisol levels are high for prolonged periods of time, they can have deleterious effects on weight, immune function, and chronic disease risk. Those with cortisol dysregulation may experience insulin-resistance, high blood sugars, weight gain, gastrointestinal issues, high blood pressure, insomnia, fertility problems, and a decreased immune system which makes them susceptible to infections and disease.
The Connection Between Cortisol and Osteoporosis
There are three primary ways elevated cortisol can weaken bones.
1. Abnormal Functioning of Bone-Building Cells
Cortisol slows the production of new bones and the ability of osteoblasts to do their job. At the same time, higher levels of cortisol mean that osteoclasts break down bone more quickly. In similar fashion, studies have shown that people taking glucocorticoids, a synthetic form of cortisol used to treat inflammation, may experience bone loss due to decreased bone formation and to increased bone breakdown, both which lead to a high risk of fracture.
2. Decreased Absorption of Key Nutrients
Stress can decrease nutrient absorption, increase nutrient excretion, as well as enhance nutrient requirements. Elevated cortisol creates an acidic environment in the body. In this state, bones are less likely to be able to absorb calcium, magnesium, and vitamin D. All three of these are necessary for bone growth and strength. Bones may also begin to release minerals to decrease acidity, thereby further depleting the mineral stores and weakening bones.
3. Increased Sugar Cravings
When someone is stressed, they likely turn to carbohydrates and simple sugars for quick fuel. More scientifically, elevated cortisol creates an insulin-resistant state in the body. This increases blood sugars, but the cells are starved for energy since insulin isn't functioning properly to bring sugar into them. Hunger signals are then sent out by the brain in search of energy and sugar, thus creating powerful sugar cravings. Sugar is inherently bad for bone health because it, too, is acidic. Bones may begin to leach out important minerals, like calcium and magnesium, to counterbalance this acidic state. This becomes a cycle of deteriorating bone health.
How Can We Stop This Cycle?
Osteoporosis formation is multi-factorial. There is not just one cause. However, decreasing stress and adding helpful supplements are key ways to try to stop and possibly reverse the stress/bone-weakening process.
Decreasing chronically elevated cortisol levels is of utmost importance. Being gentle with oneself and implementing self-care are necessary components to both cortisol and daily stress reduction. Some ways to reduce stress:
1. Exercise Daily
Gentle and restorative exercise is best when a person has elevated cortisol. So going for long walks, doing yoga, or swimming are great forms of exercise.
2. Get Adequate Sleep
Sleeping seven to nine hours is optimal. Less sleep further elevates cortisol levels.
3. Make Time for Relationships
Socializing and prioritizing relationships are important for stress relief. Physical touch like hugging or sex helps to boost oxytocin, and activities like laughter release feel-good chemicals that reduce stress and positively affect our moods.
4. Keep a Gratitude Journal
Reflecting daily on the things in life we are grateful for helps provide focus on the positive and releases some of the negativity in our minds.
5. Take an Epsom Salt Bath
Soaking in a warm tub is quite relaxing, but when Epsom salts are added, the magnesium in the salts help to further provide a calming effect.
6. Practice Spirituality
Going to church, meditating, prayer, and listening to music all help to center the mind and provide comfort.
7. Reduce Caffeine Intake
A cup of coffee in the morning likely won't harm you, but if you frequently consume multiple cups of caffeinated beverages throughout the day, this creates a stress response in the body. Circadian rhythms and hormones and be affected as well.
8. Say "No"
Our modern day lives are stressful. Taking on more responsibilities than you are able to handle doesn't benefit anyone. Only say yes to the things that bring you joy. If too much is on your plate, graciously decline offers or requests in favor of some downtime.
9. Get a Pet
Cuddling with a pet produces oxytocin much like hugging a loved one does. Having a furry friend can bring comfort and a sense of purpose. Plus, it may get you out the door on some long walks, too.
We'll look at two areas of supplementation. There are a number of supplements known to help reduce and combat stress. As for bone health, some supplements have been studied and shown to slow the deterioration of bones and may even help to remineralize lost bone density.
Supplements for Stress Reduction
This is an adaptogenic herb, meaning that it provides the body with what it needs to bring it into homeostasis. Ashwaghanda has a calming effect and can reduce elevated cortisol. In addition, it may help prevent bone loss by boosting osteoblastic activity and suppressing inflammation that weakens bones.
In studies, Rhodiola was shown to reduce stress and help with fatigue. Anything that reduces fatigue can help in the battle against stress.
3. Valerian Root
Valerian has been used to help with nervousness, anxiety, and sleep disturbances for centuries.
This mineral is known as the relaxation mineral. Magnesium helps with sleep. It increases GABA, which encourages relaxation as well. Magnesium also plays a key role in regulating the body's stress-response system.
Low GABA levels in the body can make it difficult to relax. Taking a GABA supplement helps boost the brain's GABA levels and, in turn, treats anxiety, stress, depression, and sleep problems.
If you struggle with sleep, melatonin is a safe sleep aid. Because sleep and mood are closely connected, supplementing with melatonin can alleviate stress.
7. B Complex Vitamin
B vitamins are fairly easy to get from a good diet. However, any deficiencies can be related to mood disturbances. B complex vitamins are linked to improved mood and can specifically help lower stress levels. Look for ones with methylated folate and methylated B12 to ensure maximum absorption.
Supplements for Bone Density
There is some controversy over calcium supplementation. Some doctors fear that calcium supplementation can actually contribute to coronary artery disease. However, getting a high quality, absorbable calcium (like calcium citrate) and combining it with the next supplements listed may benefit you.
2. Vitamin D
Vitamin D, the sunshine vitamin, is best taken in the form of D3. Vitamin D maintains adequate calcium levels in the blood. It also enhances the absorption of calcium from the food you eat.
3. Vitamin K2
Vitamin K2, preferably in the MK-7 form, is absolutely necessary for the body to properly absorb both calcium and vitamin D. Without K2, calcium can end up in the wrong places like the heart and arterial walls instead of in the bones. Vitamin K2 activates osteocalcin, a protein that promotes the accumulation of calcium in your bones and teeth.
Although we mentioned magnesium above as a relaxation mineral, it plays a role in bone health as well. Magnesium is necessary to convert vitamin D into its active form so that it can turn on calcium absorption. Magnesium stimulates the hormone calcitonin, which helps to preserve bone structure by drawing calcium out of the blood and soft tissues back into the bones. As you can see, these above vitamins and minerals all work synergistically together to ensure that calcium is absorbed into the bones.
5. Collagen Hydrolysate
New research shows that collagen peptides are responsible for increasing bone mineral density. In studies, supplementing with a powdered form of collagen showed a favorable shift in bone markers, indicating increased bone formation and reduced bone degradation.
Although stress is inevitable, decreasing long-term stress as much as possible is important in the preservation of bone health. Implementing stress reduction techniques and taking some key supplements may help stop the decline of bone density and may improve overall health as well.
"The Role of Cortisol in the Body," April 2018, Health Direct, https://www.healthdirect.gov.au/the-role-of-cortisol-in-the-body.
Aronson, Dina. "Cortisol -- It's Role in Stress, Inflammation, and Indications for Diet Therapy," November 2009, Today's Dietitian, http://www.todaysdietitian.com/newarchives/111609p38.shtml.
Pradelli, Carl. "The Hidden Bone Destroyer Most Doctors Never Check For," Summer 2018, Journal of Women's Health.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.