Abstract
Summary
Prior studies suggest an association between stressful life events and fractures that may be mediated by BMD. In the current study, risk of accelerated hip BMD loss was higher in older men with any type of stressful life event and increased with the number of types of stressful life events.
Introduction
Prior studies suggest that stressful life events may increase adverse health outcomes, including falls and possibly fractures. The current study builds on these findings and examines whether stressful life events are associated with increased bone loss.
Methods
Four thousand three hundred eighty-eight men aged ≥65 years in the Osteoporotic Fractures in Men study completed total hip bone mineral density (BMD) measures at baseline and visit 2, approximately 4.6 years later, and self-reported stressful life events data mid-way between baseline and visit 2, and at visit 2. We used linear regression to model the association of stressful life events with concurrent annualized total hip BMD loss, and log binomial regression or Poisson regression to model risk of concurrent accelerated BMD loss (>1 SD more than mean annualized change).
Results
Men (75.3 %) reported ≥1 type of stressful life event, including 43.3 % with ≥2 types of stressful life events. Mean annualized BMD loss was −0.36 % (SD 0.88), and 13.9 % of men were categorized with accelerated BMD loss (about 5.7 % or more total loss). Rate of annualized BMD loss increased with the number of types of stressful life events after adjustment for age (p < 0.001), but not after multivariable adjustment (p = 0.07). Multivariable-adjusted risk of accelerated BMD loss increased with the number of types of stressful life events (RR, 1.10 [95 % confidence interval (CI), 1.04–1.16]) per increase of one type of stressful life event). Fracture risk was not significantly different between stressful life event-accelerated bone loss subgroups (p = 0.08).
Conclusions
In these older men, stressful life events were associated with a small, dose-related increase in risk of concurrent accelerated hip bone loss. Low frequency of fractures limited assessment of whether rapid bone loss mediates any association of stressful life events with incident fractures. Future studies are needed to confirm these findings and to investigate the mechanism that may underlie this association.
References
Hatmi ZN, Nasiri LF, Sadegianmehr Z, Mirkia S, Darbooy S (2011) Association of myocardial infarction with stressful life events and psychiatric symptoms: a population-based survey. East Mediterr Health J 17:398–403
Roohafza H, Talaei M, Sadeghi M, Mackie M, Sarafzadegan N (2010) Association between acute and chronic life events on acute coronary syndrome: a case–control study. J Cardiovasc Nurs 25:E1–E7
Kriegbaum M, Christensen U, Lund R, Prescott E, Osler M (2008) Job loss and broken partnerships: do the number of stressful life events influence the risk of ischemic heart disease in men? Ann Epidemiol 18:743–745
Phillips AC, Der G, Carroll D (2008) Stressful life-events exposure is associated with 17-year mortality, but it is health-related events that prove predictive. Br J Health Psychol 13:647–657
Gallo WT, Teng HM, Falba TA, Kasl SV, Krumholz HM, Bradley EH (2006) The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey. Occup Environ Med 63:683–687
Maunsell E, Brisson J, Mondor M, Verreault R, Deschcnes L (2001) Stressful life events and survival after breast cancer. Psychosom Med 63:306–315
Martikainen P, Valkonen T (1996) Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health 50:264–268
Kornerup H, Osler M, Boysen G, Barefoot J, Schnohr P, Prescott E (2010) Major life events increase the risk of stroke but not of myocardial infarction: results from the Copenhagen City Heart Study. Eur J Cardiovasc Prev Rehabil 17:113–118
Fink HA, Kuskowski MA, Marshall LM (2013) Association of stressful life events with incident falls and fractures in older meN: the Osteoporotic Fractures in Men (MrOS) Study. Age & Ageing. doi:10.1093/ageing/aft117
Juster RP, McEwen BS, Lupien SJ (2010) Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 35:2–16
Polzer K, Joosten L, Gasser J et al (2010) Interleukin-1 is essential for systemic inflammatory bone loss. Ann Rheum Dis 69:284–290
McLean RR (2009) Proinflammatory cytokines and osteoporosis. Curr Osteoporos Rep 7:134–139
Ding C, Parameswaran V, Udayan R, Burgess J, Jones G (2008) Circulating levels of inflammatory markers predict change in bone mineral density and resorption in older adults: a longitudinal study. J Clin Endocrinol Metab 93:1952–1958
Gertz ER, Silverman NE, Wise KS, Hanson KB, Alekel DL, Stewart JW, Perry CD, Bhupathiraju SN, Kohut ML, Van Loan MD (2010) Contribution of serum inflammatory markers to changes in bone mineral content and density in postmenopausal women: a 1-year investigation. J Clin Densitom 13:277–282
Blank JB, Cawthon PM, Carrion-Petersen ML, Harper L, Johnson JP, Mitson E, Delay RR (2005) Overview of recruitment for the osteoporotic fractures in men study (MrOS). ContempClin Trials 26:557–568
Orwoll E, Blank JB, Barrett-Connor E et al (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. ContempClin Trials 26:569–585
Washburn RA, Smith KW, Jette AM, Janney CA (1993) The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol 46:153–162
Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. MedCare 34:220–233
Liang B, Feng Y (2012) The association of low bone mineral density with systemic inflammation in clinically stable COPD. Endocrine 42:190–195
Funding
The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. This material is also the result of work supported with resources and the use of facilities at the Minneapolis VA Medical Center. The views expressed herein do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Conflicts of interest
Howard A. Fink, Michael A. Kuskowski, Jane A. Cauley, Brent C. Taylor, John T. Schousboe, Peggy M. Cawthon, and Kristine E. Ensrud declare that they have no conflicts of interest.
Sponsor’s role
The funding agencies had no direct role in the conduct of the study; the collection, management, analyses and interpretation of the data; or preparation or approval of the manuscript.
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Fink, H.A., Kuskowski, M.A., Cauley, J.A. et al. Association of stressful life events with accelerated bone loss in older men: the osteoporotic fractures in men (MrOS) study. Osteoporos Int 25, 2833–2839 (2014). https://doi.org/10.1007/s00198-014-2853-8
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DOI: https://doi.org/10.1007/s00198-014-2853-8