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I am reading up on this article:

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Psychological stress causes bone fracture or the change of habits due to psychological stress cause bone fracture and remodeling?

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    $\begingroup$ Can you please provide a link to that article? It sounds like you're asking for medical advice rather than clarification/verification. Thanks! $\endgroup$ Commented Jan 24 at 21:18
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    $\begingroup$ Oops sorry will do! $\endgroup$ Commented Jan 25 at 14:50
  • $\begingroup$ What is your question? $\endgroup$
    – kmm
    Commented Jan 25 at 23:18

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The article you linked to is a review of the literature. Although your questions are related, I'll restate them as if they were independent questions. Please let me know if I'm not reading you correctly.

Can psychological stress cause bone fracture[s]?

The answer is "No." Psychological stress, which causes the release of hormones which may (over a long time) cause bone to weaken, cannot cause bone fractures. Fractures are caused by external stresses on bones obeying the laws of Physics. For example, any bone, healthy or not, will break if pressure of some kind bends or compresses it beyond it's limit to bend/compress. A very common example of this in people of all ages and bone health is a fracture of the distal radius from falling on an outstretched arm, or FOOSH (“fall on an outstretched hand"). We all reflexively stretch out our arm as we fall forwards to help break our fall. Depending on many factors, such as what surface we're falling onto, we may or may not sustain a fracture, but we've all been there. Little kids have less brittle bones, and such a fall commonly results in a "greenstick fracture", which is only partially broken, and on xray resembles the bend you see when a green twig is bent and straightened out again (hence the name). Older people don't get greenstick fractures; they have full fractures if the fall occurs on a hard surface, or under enough pressure (the FOOSH).

Does chronic psychological stress causing a change in habits cause bone fractures?

No. See above.

Does chronic psychological stress causing a change in habits contribute to bone strength and remodeling?

The answer according to the paper (and common sense) is, "In some people, most likely yes."

The paper gives a number of conditions which may well contribute to osteoporosis, a condition causing decreased bone strength. Such a decrease in bone strength means lesser external stresses can and often do cause fractures in those with the condition. Osteoporosis is most common in the elderly. Significantly decreased levels of activity over long periods of time (e.g. that may be present in depression) can contribute to the development of osteoporosis (again, multifactorial.)

I say, "...most likely, yes" because the article is not a study but a review, that is, the authors did not carry out any studies showing a direct cause and effect, but reviewed studies done by others which show a correlation between long term psychological stress (as well as the effects it has on physical behaviors) and osteporosis, which in turn predisposes people to sustain fractures which those with normal bones may not sustain. ("In some people" because it's multifactorial, e.g. sex, activity levels, genetics, and other factors contribute.)

I say "common sense" because there is much evidence in the literature about osteoporosis and fractures, but much less evidence about the effects of psychological stress causing osteoporosis, which is the subject of the review article. But common sense is not evidence.

Evidence informs us that prolonged immobilization (say, someone is in a wheelchair for a year and never uses their legs) leads to osteoporosis in those leg bones.

Evidence informs us that the incidence of fractures increases with osteoporosis.

Evidence informs us that prolonged use of glucocorticoid steroids causes osteoporosis in a percentage of those people (but not which people exactly).

Evidence informs us that psychological stress causes increased levels of glucocorticoids in people.

What evidence does not inform us of is that prolonged psychological stress causes osteoporosis.

We can infer (that is, hypothesize/make an informed guess which requires studies to obtain evidence for causation) that chronic stress may well cause ostoeoporosis in a percentage of sufferers. But a hypothesis requires "proof", through controlled studies, that our guess is correct.

That's why the paper concludes that further study is warranted. Common sense, informed guesses and hypotheses are not evidence.

I answered this question because the OP was kind enough to provide a good link, which is wonderful and fully deserves my respect. I hope that with this answer, people will understand the respective values of "common sense" and "evidence" in science, because so many of us human beings mistakenly think they are one and the same. Stepping down from the soap box now, requesting your grace for this very long... answer. Thanks.

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  • $\begingroup$ Great answer!Thank you! $\endgroup$ Commented Jan 27 at 20:25
  • $\begingroup$ You're very welcome! $\endgroup$ Commented Jan 27 at 23:04

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