title: Association of stressful life events with accelerated bone loss in older men: the osteoporotic fractures in men (MrOS) study.
abstract: 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.
  
  
  BACKGROUND
  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.
authors.affiliation: Geriatric Research Education & Clinical Center, Veterans Affairs Health Center, Minneapolis, MN, USA, howard.fink@va.gov.
authors.forename: H A
authors.initials: HA
authors.lastname: Fink
authors.forename: M A
authors.initials: MA
authors.lastname: Kuskowski
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.forename: B C
authors.initials: BC
authors.lastname: Taylor
authors.forename: J T
authors.initials: JT
authors.lastname: Schousboe
authors.forename: P M
authors.initials: PM
authors.lastname: Cawthon
authors.forename: K E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D015519:Bone Density / Q000502:physiology; D018450:Disease Progression; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008016:Life Change Events; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology