Psychological factors may impacton postmenopausal women fracture risk

Federica Bellone, Antonino Catalano, Gabriella Martino, Carmen Lasco, Annamaria Pugliese, Nunziata Morabito


Anxiety and osteoporosis are common diseases and major public health problems. The association between  anxiety levels and bone loss was poorly investigated, thus we aimed to explore whether anxiety severity could be considered as an independent fracture risk. In a setting of postmenopausal women we measured anxiety levels by Hamilton Anxiety Rating Scale (HAMA), depressive symptoms by Beck Depression Inventory and evaluated quality of life by the 36-Item Short Form Health Survey (SF-36) questionnaire. Women with higher anxiety levels showed lower BMD at lumbar spine and femoral neck, and exhibited a poorer quality of life after grouping our population in tertiles of HAMA score. Anxiety levels were predictive of reduced BMD after correcting for other known clinical risk of fractures.


postmenopausal; osteoporosis; anxiety; depression; quality of life

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Svedbom, A., Hernlund, E., Ivergård, M., Compston, J., Cooper, C., Stenmark, J., McCloskey, E.V., Jönsson, B., Kanis, J.A.,EU Review Panel of IOF (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137.

Catalano, A., Morabito, N., Basile, G., Fusco, S., Castagna, G., Reitano, F., Albanese, R.C., Lasco, A. (2013) Fracture risk assessment in postmenopausal women referred to an Italian center for osteoporosis: a single day experience in Messina. Clin Cases Miner Bone Metab 10(3):191-194.

Williams, L.J., Bjerkeset, O., Langhammer, A., Berk, M., Pasco, J.A., Henry, M.J., Schei, B., Forsmo, S. (2011) The association between depressive and anxiety symptoms and bone mineral density in the general population: the HUNT Study. J Affect Disord 131(1-3):164-171.

Baxter, A.J., Scott, K.M., Vos, T., Whiteford, H.A. (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43(5):897-910

Kanis, J.A., Johnell, O., Oden, A., Johansson, H., McCloskey, E. (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 19(4):385-397.

Hamilton, M. (1959) The assessment of anxiety states by rating. Br J Med Psychol 32(1):50-55.

Beck, A.T., Steer, R.A., Brown, G.K. (1996) Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation.

Ware, J.E. Jr, Sherbourne, C.D.(1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473-483.

Celano, C.M., Millstein, R.A., Bedoya, C.A., Healy, B.C., Roest, A.M., Huffman, J.C. (2015) Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. Am Heart J.; 170(6):1105-15. doi: 10.1016/j.ahj.2015.09.013.

Messina, G., Lissoni, P., Rovelli, F. (2012) Psychoimmunological analysis of cancer patients: correlation with the prognosis. Curr Aging Sci.;5(3):263-272.

Catalano, A., Morabito, N., Agostino, R.M., Basile, G., Gaudio, A., Atteritano, M., Natale, G., Xourafa, A., Morini, E., Adamo, V., Lasco, A. (2017) Bone health assessment by quantitative ultrasound and dual-energy x-ray absorptiometry in postmenopausal women with breast cancer receiving aromatase inhibitors. Menopause 24(1):85-91.

Atteritano, M., Lasco, A., Mazzaferro, S., Macrì, I., Catalano, A., Santangelo, A., Bagnato, G., Bagnato, G., Frisina, N. (2013) Bone mineraldensity, quantitative ultrasoundparameters and bone metabolism in postmenopausalwomen with depression. Intern Emerg Med 8(6):485-491.

Williams, L.J., Pasco, J.A., Jacka, F.N., Hodge, J.M., Kotowicz, M.A., Berk, M. (2013) Quantitative Heel Ultrasound (QUS) measures of bone quality in association with mood and anxiety disorders. J Affect Disord 146(3):395-400.

Catalano, A., Morabito, N., Di Vieste, G., Pintaudi, B., Cucinotta, D., Lasco, A., Di Benedetto, A. (2013) Phalangeal quantitative ultrasound and metabolic control in pre-menopausalwomen with type 1 diabetesmellitus. J EndocrinolInvest 36(5):347-251.

Hou, R., Garner, M., Holmes, C., Osmond, C., Teeling, J., Lau, L., Baldwin, D.S. (2017) Peripheral inflammatory cytokines and immune balance in Generalised Anxiety Disorder: Case-controlled study. Brain BehavImmun 62:212-218.

Minciullo, P.L., Catalano, A., Mandraffino, G., Casciaro, M., Crucitti, A., Maltese, G., Morabito, N., Lasco, A., Gangemi, S., Basile, G. (2016) Inflammaging and Anti-Inflammaging: The Role of Cytokines in Extreme Longevity. Arch ImmunolTherExp (Warsz). 64(2):111-126.

Chaudieu, I., Beluche, I., Norton, J., Boulenger, J.P., Ritchie, K., Ancelin, M.L. (2008) Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes. J Affect Disord 106(3):307-313.

Lasco, A., Catalano, A., Pilato, A., Basile, G., Mallamace, A., Atteritano, M. (2014) Subclinical hypercortisol-assessment of bone fragility: experience of single osteoporosis center in Sicily. Eur Rev Med Pharmacol Sci. 18(3):352-358.

Salim, S. (2017) Oxidative Stress and the Central Nervous System. J PharmacolExpTher 360(1):201205.

Gennero, I., Laurencin-Dalicieux, S., Conte-Auriol, F. et al (2011) Absence of the lysophosphatidic acid receptor LPA1 results in abnormal bone development and decreased bone mass. Bone 49(3):395-403.

Rauma, P.H., Koivumaa-Honkanen, H., Williams, L.J., Tuppurainen, M.T., Kröger, H.P., Honkanen, R.J. (2014) Life satisfaction and bone mineral density among postmenopausal women: cross-sectional and longitudinal associations. Psychosom Med 76(9):709-715.

Catalano, A., Vita, G.L., Russo, M., Vita, G., Lasco, A., Morabito, N., Messina, S. (2016) Effects of teriparatide on bone mineral density and quality of life in Duchenne muscular dystrophy related osteoporosis: a case report. OsteoporosInt 27(12):3655-3659.

Catalano, A., Martino, G., Morabito, N., Scarcella, C., Gaudio, A., Basile, G., Lasco, A. (2017) Pain in osteoporosis: from pathophysiology to therapeutic approach. Drugs Aging. doi: 10.1007/s40266-0170492-4.



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