Chronic stress leads to elevated stress hormones, which may be linked to bone breakdown. Puerto Rican adults living on the US mainland have higher prevalence of stress than the general population, and higher and/or similar prevalence of osteoporosis compared with non-Hispanic Whites. The role of stress on bone remains unclear and may be modified by diet. A Dietary Approaches to Stop Hypertension (DASH) pattern, as a measure of dietary quality, was most protective for bone outcomes among Puerto Ricans.
In this cross-sectional study, 958 Boston Puerto Rican Health Study participants were included (aged: 59.9 ± 7.6 y). Stress markers (epinephrine, norepinephrine, cortisol) were collected via 12-hr urine samples and elevated concentrations were categorized using sex-specific cut-offs. Bone mineral density (BMD) was assessed via dual energy x-ray absorptiometry. Analysis of covariance models with least squares means were used to test differences in mean BMD between participants with elevated and non-elevated stress markers. Multivariable logistic regression examined associations between stress markers and osteoporosis in post-menopausal females and males. Models were adjusted for age, height, smoking, alcohol use, education, glucocorticoid use, and diabetes.
Higher urinary epinephrine was associated with lower BMD at the lumbar spine (P=.012), femoral neck (P=.005), trochanter (P<.001), and total hip (P.11), although higher urinary norepinephrine was associated with lower lumbar spine BMD in post-menopausal females not taking estrogen, with lower adherence to DASH (P=.03).
Higher urinary epinephrine and norepinephrine were associated with poorer bone outcomes in Puerto Rican adults, in a sex-specific manner, warranting future longitudinal studies to clarify associations. Dietary quality may moderate these associations.
© The Author(s) 2025. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.
