Understanding Anxiety and Osteoporosis

Though anxiety and osteoporosis are two different diseases, having both conditions is common. This article reviews each disease, how they impact each other, complications, diagnosis, treatment, and coping.

The Connection Between Anxiety and Osteoporosis

The connection between anxiety and osteoporosis may seem unlikely, but they affect each other. The following is an overview of each disease and the relationship between the two.

Anxiety

"Fight or flight" is the body's natural response to danger or stressors. It activates the nervous system, telling it to make extra epinephrine (adrenaline). This prepares the body by increasing the heart rate, breathing rate, blood pressure, and blood sugar. Extra adrenaline can cause worry, dread, and physical symptoms such as nausea or shakiness.

Anxiety disorder (AD) occurs when this stress reaction lingers or is out of proportion. AD is one of the most prevalent mental disorders and is frequently linked to depression, phobias, and panic attacks.

Osteoporosis

Osteoporosis causes bone thinning and deterioration. Bones have a honeycomb-type structure that allows bones to be strong yet lightweight. Osteoporosis decreases bone mass, leaving larger structural gaps and making bones more fragile. 

Symptoms of osteoporosis include:

• Losing height
• Stooping forward 
• Back pain
• Shortness of breath 
• Bone fractures (from minor force)

Though this is not a complete list, risk factors for osteoporosis include the following: 

• Aging
• Smoking
• Female sex 
• Inactivity 
• Certain medications and medical conditions

How Anxiety Affects Osteoporosis

Chronic anxiety produces long-term physical, emotional, and behavioral changes. It can worsen chronic health conditions and disrupt the endocrine, nervous, and immune systems, leading to poor bone health. 

How Osteoporosis Affects Anxiety

Osteoporosis causes physical limitations. This may force someone to make unwanted lifestyle changes and can cause anxiety due to:

• Less physical activity
• Fear of falling and fractures
• Depression
• Self-esteem issues
• Financial problems

Complications of Anxiety and Osteoporosis

Complications of anxiety involve depression, substance abuse, insomnia, and isolation. Osteoporosis can lead to fractures and increased difficulty in healing from fractures. 

Shared Risk Factors

Anxiety and osteoporosis share risk factors that increase the risk of complications, including:

• Altered nutrition
• Cigarette smoking 
• Excessive alcohol use
• Physical inactivity
• Substance abuse 
• Obesity
• Social isolation

Feelings of hopelessness, fear, and uncertainty are common effects of anxiety and osteoporosis. These feelings can cause a person to avoid following their treatment for either condition.

When to See a Healthcare Provider

When anxiety is excessive or ongoing, talking with your healthcare provider is best. This is especially true when it keeps you from your normal activities or causes work, school, physical health, and relationship problems.

Diagnosis of Anxiety and Osteoporosis

Mental health providers typically treat severe anxiety, but all healthcare providers may detect and manage anxiety. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) helps providers diagnose mental disorders.

Anxiety is diagnosed based on the duration and severity of symptoms, such as: 

• Uneasiness or agitation
• Headaches, muscle aches, dry mouth, or nausea
• Panic attacks 
• Problems sleeping 
• Fatigue
• Difficulty concentrating
• Not enjoying things you previously enjoyed
• Avoiding work, school, or social events
• Inability to perform daily activities
• Problems managing emotions
• Frequent illness
• Decreased physical activity

Healthcare providers use bone density tests to screen for and diagnose osteoporosis. This non-invasive, painless test uses a low dose of radiation to determine bone density and measure the amount of calcium and minerals in your bones. 

Self-Test for Anxiety

Mental Health America (MHA) offers an online anxiety self-test based on the GAD-7 anxiety screening questionnaire from the American Psychiatric Association (APA).

If your screening results indicate anxiety, reach out to a healthcare provider. A healthcare professional can make an accurate diagnosis.

Treatment of Anxiety and Osteoporosis

Anxiety treatment involves lifestyle modifications, medications, and psychotherapy (talk therapy). Osteoporosis treatment includes lifestyle changes, medications, and supplements.

Medications

Though this is not an exhaustive list, examples of common medications that treat anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs increase serotonin levels which regulate mood, appetite, and the sleep-wake cycle. Examples include Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs regulate serotonin and norepinephrine. Examples include Cymbalta (duloxetine) and Effexor (venlafaxine)
• Tricyclic antidepressants: These prevent the reabsorption of serotonin and epinephrine. Common examples include Elavil (amitriptyline) and Anafranil (clomipramine). 
• Benzodiazepines: Benzodiazepines (benzos) slow down the central nervous system. They include Rivotril (clonazepam), Xanax (alprazolam), and Ativan (lorazepam). Benzos are typically a short-term solution reserved for severe anxiety. 

Osteoporosis treatment begins with lifestyle changes and supplements, such as calcium, vitamin D, magnesium, and omega-3 fatty acids. Post-menopausal women may receive hormone (estrogen) therapy to decrease osteoporosis risk. It may also involve the following medications:

• Biphosphonates: These increase bone density and include Fosamax (alendronate), Actonel (risedronate), and Boniva (ibandronate).
• Selective estrogen receptor modulators (SERMs): SERMs, such as Evista (raloxifene), mimic estrogen's effects to increase bone density (thickness). 
• RANKL inhibitor: RANKL inhibitors, such as Prolia (denosumab), block a specific receptor in the body, which helps decrease bone breakdown.

Many anxiety and osteoporosis medications can be taken together safely. This includes Prozac (fluoxetine) and Fosamax (alendronate), two of the most commonly prescribed medications for each. However, some anti-anxiety medications can increase the risk of falls and osteoporotic fractures.

Osteoporosis medications, such as Fosamax (alendronate) and Actonel (risedronate), could increase the risk for depression and anxiety. This does not mean your healthcare provider won't prescribe these medications. But they may want to monitor you for unwanted side effects and interactions. 

Psychotherapy

Psychotherapy helps treat mental health disorders or disease-related stress. Types of therapy include:

• Cognitive behavioral therapy (CBT)
• Psychodynamic therapy
• Interpersonal therapy
• Exposure therapy
• Couples therapy (if relationship distress contributes to anxiety)

Coping With Anxiety and Osteoporosis

Treating anxiety and osteoporosis requires professional help. However, there are lifestyle changes you can adpot during treatment to help with anxiety symptoms, bone health, and your overall health.  

Lifestyle Changes 

Healthy lifestyle changes that may increase your sense of well-being and bone health include:

• Exercise: Exercise releases serotonin and endorphins (mood-elevating chemicals). Weight-bearing activities like walking, hiking, or dancing can increase bone health.
• Eat a well-balanced diet: Incorporate fresh foods and healthy fats. Limit sugars, highly processed foods, tobacco, alcohol, and caffeine. 
• Reduce stress: Stress reduction may include breathing exercises, massage, yoga, music, hobbies, aromatherapy, and mindfulness.
• Get enough sleep: If you have problems sleeping, it may help to evaluate your sleep hygiene. This might include beginning a nighttime routine, blocking out light, and creating a comfortable bedroom. 
• A positive support system: Supportive relationships are beneficial for mental health and typically cause you to be more active.
• Fresh air: Incorporate more fresh air (less pollution) and green space into your days. 
• Consider a pet: Interacting with an animal provides unconditional love and a sense of purpose. 

If you have osteoporosis, preventing falls is also very important. Though this is not an exhaustive list, here are some fall prevention tips: 

• Clear clutter on the floor
• Anchor loose cords
• Secure throw rugs
• Keep kitchen drawers closed
• Install grab bars in the bathroom
• Take care around liquid spills or slippery bathtubs
• Use assistive devices, such as canes or walkers, if you are unsteady
• Don’t rush to move around (e.g., to answer the phone)

Support Groups

Support groups are beneficial because you can interact with those in similar situations. Ask your healthcare provider about local groups or explore one of the following online mental health support groups:

• Mental Health Strong
• Anxiety Anonymous
• DailyStrength
• Support Groups
• Support Groups Central

Online osteoporosis support groups include:

• Inspire
• American Bone Health

Summary

Anxiety is normal for short, brief periods. It becomes concerning when these symptoms linger or are out of proportion. Osteoporosis is a bone disease that thins your bones and increases the risk of fractures. 

Anxiety and osteoporosis share risk factors and have an impact on each other. Those with anxiety and depression are more susceptible to osteoporosis, and those with osteoporosis often experience anxiety.

Treatment for each disease is multifaceted and includes a combination of lifestyle changes, medications, supplements, and psychotherapy. Exercise, proper nutrition, and getting more fresh air are lifestyle changes that can decrease anxiety and increase bone health.

A Word From Verywell

Anxiety disorders (ADs) and osteoporosis are not normal parts of aging. If you are coping with either, it’s best to seek treatment from a healthcare provider while incorporating lifestyle changes that are within your control.