Fouhy Liam E, Mangano Kelsey M, Zhang Xiyuan, Dawson-Hughes Bess, Cornell David J, Tucker Katherine L, Noel Sabrina E
Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA 01854, United States.
Center for Population Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854, United States.
J Bone Miner Res. 2025 Apr 21;40(4):500-510. doi: 10.1093/jbmr/zjaf016.
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 yr). Stress markers (epinephrine, norepinephrine, cortisol) were collected via 12-h urine samples and elevated concentrations were categorized using sex-specific cutoffs. BMD was assessed via DXA. 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 postmenopausal 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 LS (p = .012), FN (p = .005), trochanter (p < .001), and TH (p < .001) in Puerto Rican adults, and with higher odds of osteoporosis among males (odds ratio = 4.01 [95%CI: 1.11, 14.5], p = .03). An interaction between DASH and norepinephrine was noted for postmenopausal females at the LS. No associations were noted for norepinephrine or cortisol (p > .11), although higher urinary norepinephrine was associated with lower LS BMD in postmenopausal 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.
慢性应激会导致应激激素升高，这可能与骨质破坏有关。生活在美国大陆的波多黎各成年人的应激发生率高于普通人群，与非西班牙裔白人相比，骨质疏松症的发生率更高和/或相似。应激对骨骼的作用尚不清楚，可能会受到饮食的影响。作为衡量饮食质量的一种方法，终止高血压膳食方法（DASH）模式对波多黎各人的骨骼健康结局最具保护作用。在这项横断面研究中，纳入了958名波士顿波多黎各健康研究参与者（年龄：59.9±7.6岁）。通过12小时尿液样本收集应激标志物（肾上腺素、去甲肾上腺素、皮质醇），并使用性别特异性临界值对升高的浓度进行分类。通过双能X线吸收法（DXA）评估骨密度。使用最小二乘均值的协方差分析模型来测试应激标志物升高和未升高的参与者之间骨密度均值的差异。多变量逻辑回归分析绝经后女性和男性应激标志物与骨质疏松症之间的关联。模型对年龄、身高、吸烟、饮酒、教育程度、糖皮质激素使用和糖尿病进行了调整。较高的尿肾上腺素与波多黎各成年人腰椎（p = 0.012）、股骨颈（p = 0.005）、大转子（p < 0.001）和全髋（p < 0.001）骨密度较低有关，与男性骨质疏松症的较高几率有关（比值比 = 4.01 [95%CI：1.11，14.5]，p = 0.03）。在绝经后女性的腰椎处，观察到DASH与去甲肾上腺素之间存在相互作用。未观察到去甲肾上腺素或皮质醇有相关性（p > 0.11），尽管较高的尿去甲肾上腺素与未服用雌激素的绝经后女性较低的腰椎骨密度有关，与较低的DASH依从性有关（p = 0.03）。较高的尿肾上腺素和去甲肾上腺素与波多黎各成年人较差的骨骼健康结局有关，且存在性别特异性，需要未来进行纵向研究以阐明其中的关联。饮食质量可能会调节这些关联。
