By Nancy A. Alexander, PT, CSCS
The end of the year brings the holiday season. What is intended as a time of joy and hope, often becomes one of sadness and stress for many. The impact and effect of stress now, or anytime, has been well documented. But did you know that psychological stress can cause bone loss? Today we will explore this relationship and discuss ways to minimize its impact on you.
As we head toward the year’s end, Americans’ stress levels are rising. In fact, we are more anxious about the holidays than last year, according to the latest APA Healthy Minds Poll. Among U.S. adults, 41% say they anticipate more stress related to the holidays this year than last year, a notable increase over 2024 (28%) and 2023 (29%). (American Psychiatric Association)
Bone density loss and stress are directly and indirectly connected. The mechanism involves a complex interplay of hormonal and physiological changes in your body. We will not go into detail here about the science behind it all. Please consult the resources at the end of this article for that. What we will do here is arm you with the tools you need understand this relationship and to improve your bone density at any age.
Bone Health
Bone health relies on the constant remodeling of bone. This is a lifelong cycle where old bone is removed (resorption by osteoclasts) and new bone is formed (osteoblasts). Together, this process maintains your bone strength, repairs micro-damage, and regulates minerals like calcium.
Osteoporosis happens because the body loses too much bone, makes too little new bone, or both, leading to porous, and less dense bones. It is often called a “silent disease” because there are usually no symptoms until a break occurs, commonly in your hip, spine, or wrist. When bone mineral density and bone mass decreases, or when the structure and strength of bone changes, this can lead to a decrease in bone strength that can increase your risk of fractures (broken bones).
You have likely heard of the following risk factors as they relate to bone loss and osteoporosis:
- Aging (65 and older)
- Hormonal changes like menopause in women or low testosterone in men
- Lifestyle factors including poor diet, excessive alcohol use, smoking, and inactivity
- Certain medications such as steroids
- Medical conditions including rheumatoid arthritis, celiac disease, and thyroid issues
Though not frequently mentioned, evidence suggests that psychological or emotional stress is also a risk factor for bone loss.
Psychological Stress
Psychological stress, especially chronic stress (over a long period of time), negatively impacts your bone density by several factors. Here we briefly explore each one:
- Increases the stress hormone cortisol
- Chronic stress floods your body with cortisol, which signals the body to release calcium from bones to neutralize acid, depleting bone stores.
- Disrupts bone-building hormones
- Stress disrupts your growth hormones and sex hormones, reducing bone formation.
- Causes inflammation
- Mental stress can trigger low-grade inflammation, which damages your bone-building cells.
- Activates nervous system
- Stress activates your sympathetic nervous system, releasing neurotransmitters (like norepinephrine) that stimulate bone breakdown.
- Leads to unhealthy behaviors
- Stress often leads to poor diet (lacking calcium/Vit D), less exercise, poor sleep, smoking, or drinking excessive alcohol.
Not only do these factors individually impact your bone loss, but collectively they promote increased bone breakdown and heightened osteoporosis risk. Certain stress-related medical conditions can also increase your chance for bone loss. Depression is linked to lower bone mineral density (BMD) and higher fracture risk. Also, if you have PTSD (Post-traumatic stress disorder) you are more likely to develop osteoporosis. What all of this demands is stress management and lifestyle changes that you can make for your optimal bone health.
Act Now
Your first step should be in knowing your bone status. If you don’t know your bone density, get tested by asking for a DEXA scan. A DEXA scan is the gold standard for diagnosing osteoporosis and measures bone mineral density (BMD) is areas like the spine, hip, and wrist. This information is vital to assess fracture risk, monitor treatment, and detect early bone loss.
A DEXA scan provides you the following diagnoses with the key result being your T-score:
- Normal bone: Above -1.0.
- Osteoporosis: A condition where your bones become brittle and weak. -2.5 or lower (each full point below -2.5 indicates significantly weaker bones).
- Osteopenia: Lower than normal bone density, but not to the level of osteoporosis. Between -1.0 and -2.5.
Your T-score and other risk factors are combined in this report to determine your fracture risk. This predicts the likelihood of breaking a bone. DEXA screening guidelines from the Bone Health & Osteoporosis Foundation (BHOF) recommend bone density scans for women 65+, men 70+, and younger adults with risk factors like low trauma fractures, certain medications (steroids), smoking, heavy alcohol use, or family history. Repeat screens are usually recommended every two years but may be different depending on your T-score and risk factors. (Bone Health & Osteoporosis Foundation)
Knowing your numbers is critical to medical and lifestyle management. Ask your physician if you qualify for a DEXA scan either by age, medical history, or a combination of risk factors. Know your numbers.
Once you know your bone health status, consider these next steps to help you decrease stress and lessen your risk of bone loss:
- Manage Stress: Practice mindfulness, meditation, yoga, or tai chi to lower cortisol levels and improve your balance.
- Exercise: Participate in regular physical activity including weight-bearing exercises, strength training, and activities that involve impact (walking, jogging, paddle sports, dancing). These help you strengthen your bones and reduces stress. Don’t forget to add balance training to help prevent falls. Specialized classes like Buff Bones® here at the Living Well Academy combine all these activities in each class. (Check out our new session starting in January 2026)
- Eat Well: Consume adequate calcium and Vitamin D through your diet or supplements. Eat a well-balanced diet and avoid foods with excess salt that contributes to inflammation.
- Seek Help: Address underlying mental health issues like depression or anxiety with a qualified and trusted provider.
Chronic emotional stress disrupts your body’s delicate balance by directly and indirectly eroding bone mass and increasing fracture risk, making stress management crucial for strong bones. Concerned about your bone health? Consult with your physician to discuss your status and together you can formulate a plan to address your specific needs.
Move and keep moving. Any exercise or movement you can do will help lower your stress. It can be as simple as taking a walk. This holiday season, find joy and hope in the knowledge that tools are available for you to improve your bone health, at any age.
Sources:
American Psychiatric Association: https://www.psychiatry.org/news-room/news-releases/americans-more-anxious-about-the-holidays#:~:text=Washington%2C%20D.C.%20%E2%80%94%20As%20we%20head,those%20aged%2018%20to%2034)
Bone Health & Osteoporosis Foundation: https://www.bonehealthandosteoporosis.org/patients/what-is-osteoporosis/
Google AI with subsequent fact checking.
Impacts of Psychological Stress on Osteoporosis: Clinical Implications and Treatment Interactions: https://pmc.ncbi.nlm.nih.gov/articles/PMC6465575/
Physiology, Bone Remodeling (NIH): https://www.ncbi.nlm.nih.gov/books/NBK499863/#:~:text=This%20process%20of%20skeletal%20change%20is%20known,by%20the%20deposition%20of%20new%20bone%20material.
Potential mechanisms linking psychological stress to bone health: https://pmc.ncbi.nlm.nih.gov/articles/PMC7797546/
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