illustration of link between osteoporosis and mental health
Credit: Tatiana Ayazo

Along with physical health, mental health is an important component of your overall well-being. Though mental illness is prevalent — roughly one billion people worldwide are estimated to have some type of mental disorder, according to data from the United Nations.

When you think of mental health, bone health may not cross your mind — but it has been linked with osteoporosis, a bone condition thought to impact more than 200 million people around the world.

Learn more about the link between mental health and osteoporosis — and what you can do to best manage both conditions.  

The Link Between Mental Health and Osteoporosis

Mental health and physical health are known to have a two-way relationship. For example, depression is known to increase the risk of conditions like diabetes, heart disease, and stroke. Meanwhile, all that goes into managing a chronic health condition can take a toll on your mental well-being.

The same holds true for osteoporosis and mental health. “Evidence exists that mental health disorders (i.e., depressive disorders, anxiety disorders, and PTSD) and osteoporosis have a bidirectional relationship, meaning that depressive and anxiety disorders are associated with osteoporosis and osteoporosis is associated with depressive and anxiety symptoms,” says Traci Speed, MD, PhD, Assistant Professor of Psychiatry and Behavioral Sciences at the Johns Hopkins University School of Medicine.

While there’s still a lot that remains unknown about this link, a few factors are thought to play a role:

Stress hormones

Research has found that stress can contribute to the risk of developing osteoporosis.

“Mental health disorders and osteoporosis likely co-occur because of shared pathways in stress hormone signaling and the immune system,” says Dr. Speed. “The increased release of stress hormones and/or increased inflammatory response associated with mental health disorders may impact bone health.”

Having osteoporosis can also impact your mental health and quality of life, according to research. Not only can bone fractures related to osteoporosis have a negative impact on your physical, social, and financial well-being — they can also come with a psychological impact and lead to feelings of anxiety or depression.

“Osteoporosis may increase anxiety or depressive symptoms by increasing fears about movement and falls or reducing physical activity, which may lead to isolation and loneliness,” says Speed.

Medication

Some medications used to treat mental health conditions like depression may also be associated with an increased fracture risk, according to researchers. “Antidepressants such as SSRIs and mood stabilizers have a direct effect on bone health and can increase risk of osteoporosis and fractures,” says Speed. “There is some evidence that the anti-anxiety medications benzodiazepines may increase osteoporosis risk due to their increased fall risk.”

On the other hand, one study conducted in rats found that bisphosphonates, the gold-standard treatment for osteoporosis, helped improve mobility, which in turn, may help boost quality of life and even provide short-term benefits for anxiety and depression. That said, human studies are needed to fully understand the implication of bisphosphonate treatment on mental health.

Osteoporosis Risk Factors

“The risk factors for osteoporosis in someone living with a mental health disorder are similar to those without mental health disorders,” says Speed. These risk factors can be broken into two groups: uncontrollable and controllable.

Uncontrollable risk factors for osteoporosis include:

  • Gender: Osteoporosis is more common in menopausal women.
  • Ethnicity: Osteoporosis tends to affect more Caucasian and Asian women.
  • Age: As you age, your risk of developing osteoporosis increases.
  • Family history: Your risk of osteoporosis increases if an immediate family member, like a parent, has osteoporosis.

Controllable risk factors, or those you can modify, include:

  • Medications: Ask your doctor if any of the medications you take for your mental health or other conditions may increase your risk of osteoporosis.
  • Diet: Low calcium and vitamin D intake may increase your risk of osteoporosis.
  • Inactivity: Being sedentary can weaken your bones.
  • Weight: Being underweight (or having a small body frame) can affect bone health.
  • Smoking: Smoking cigarettes can contribute to weakened bones and increase fracture risk.
  • Alcohol: Excessive alcohol intake can decrease bone density, weaken bones, and increase osteoporosis risk.

Osteoporosis Symptoms

Osteoporosis is sometimes referred to as a “silent” condition. That’s because it often has no symptoms.

As it progresses, it can lead to symptoms like:

  • Back pain
  • Sudden back pain
  • Joint pain
  • Changes in posture
  • Stooping or loss of height

But most people don’t realize they have osteoporosis until they fracture or break a bone. That’s why it’s so important to learn about osteoporosis and take steps to protect your bones.

Tips to Manage Mental Health and Protect Your Bones

“The good news is that many healthy behaviors that are recommended for your mental health are preventative steps for osteoporosis,” notes Speed. Start by making these lifestyle changes to help stay on top of your mental well-being and keep bones healthy.

Stay active

“Exercise is extremely important for our mood: it can reduce stress, depressive, and anxiety symptoms,” notes Speed. “Also, the impact of physical activity on our bones and muscles helps strengthen them, which improves balance and stability and reduces fall risk.”

Aim for a mix of activities: Research shows that aerobic exercise, such as walking, cycling, and swimming can help improve anxiety and depression and manage stress. Meanwhile resistance exercises, such as lifting weights, can help strengthen bones. Talk to your doctor before starting a new exercise program.

Eat a nutritious diet

There’s also evidence that suggests eating a quality diet full of fruits, vegetables, fiber, fatty fish, legumes, and whole grains while limiting sugar and processed foods can help manage depression and promote mental well-being.

When it comes to osteoporosis, adequate calcium and vitamin D intake are necessary for bone health. Women ages 50 and under and men ages 70 and under should aim to get 1,000 mg of calcium each day and increase intake to 1,200 mg each day once women reach age 51 and men reach age 71. The recommended vitamin D intake is 400-800 IU a day for most adults under age 50, and 800-1,000 IU a day for those 50 and up.

Consider starting each day with a nutritious breakfast al-fresco: “Sunlight exposure in the morning can help set your circadian rhythm, boost mood, and increase vitamin D,” adds Speed.

Maintain a healthy weight

Being either overweight or underweight can impact your mental health and increase your risk of a bone break.

Research shows that obesity can come with a significant psychosocial burden, and can impact self-esteem, body image, self-esteem, mood, and quality of life. On the other hand, studies also show that being underweight can impair mental health and increase your risk of osteoporosis.

Aim for a BMI between 18.5–24.9 to lower your risk of osteoporosis.

Avoid smoking, alcohol, and substance use

Mood and anxiety disorders are a known risk factor for alcoholism and nicotine addiction. One Norwegian study found that adolescents who had a psychiatric disorder were more likely to smoke, drink alcohol, and use illicit drugs compared to the general adolescent population.

“Avoiding smoking, alcohol, and substances such as opioids can also protect bone health,” says Speed.

When to Talk to Your Doctor About Bone Health

“There are no specific guidelines about when to talk to your doctor about osteoporosis for individuals with mental health disorders,” notes Speed.

Routine screening for osteoporosis is generally done:

  • After age 65 for women, 70 for men, or sooner depending on your personal risk factors
  • Every one to two years, or more often depending on your health
  • After a bone fracture in those over age 50
  • When taking new medication

Osteoporosis screening is easy and only takes five to 10 minutes. Early detection can help you take proper steps to prevent fractures and keep bones healthy.

It’s never too early to initiate a conversation about bone health with your doctor. “There could be many benefits of discussing osteoporosis with your doctor even in early-to-mid adulthood,” says Speed. “Discussions about a healthy lifestyle including diet, exercise, sleep, and avoiding smoking and alcohol use may help reduce risk of osteoporosis later in life.”

Talk to your doctor at your next health exam about osteoporosis and whether or not you should get screened.

This article was made possible with support from Amgen.

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