How Mental & Emotional Stress Can Increase Fracture Risk — Especially for Someone with O.I.
When you live with Osteogenesis Imperfecta (O.I.), you already know how careful you must be to protect your bones. But there’s an invisible factor that many don’t talk about enough: stress — mental, emotional, psychological. It doesn’t directly “snap” bones, but over time, it can make your bones more vulnerable and your recovery slower. In this post, I’ll walk you through how stress affects bone biology, how it interacts with daily mechanics and behavior, and how using safe, adaptive movement can be a powerful counterbalance. I’ll also link to key research for those who want the science behind it.
The Biology: Stress Hormones, Inflammation, & Bone Remodeling
Cortisol, Glucocorticoids & Bone Cell Activity
When you experience chronic stress, your hypothalamic-pituitary-adrenal (HPA) axis is activated, and your body produces more cortisol (a glucocorticoid). Over time, elevated cortisol has several negative effects on bone:
- It suppresses osteoblast activity (the cells that build bone)
- It can promote osteoclast activity (the cells that resorb bone)
- It reduces calcium absorption from the gut and increases urinary calcium excretion
- It interferes with sex hormones (estrogen, testosterone), which are crucial for bone maintenance
These combined effects tilt the balance toward bone loss. In fact, a review on psychological stress and osteoporosis describes how dysregulated glucocorticoid signaling is one of the overlapping pathways between stress and bone fragility. (Frontiers)
One more recent study showed that psychological stress disturbed bone metabolism via molecular regulation (miR-335-3p / Fos pathway) in animals, adding mechanistic evidence to what we suspect in humans. (eLife)
Chronic Stress, Inflammation & Immune Effects
Long-term stress also prompts inflammatory signaling (through cytokines like IL-6, TNF-α, etc.) that can further disrupt bone remodeling. (Frontiers)
Moreover, chronic stress can lead to glucocorticoid receptor (GR) resistance, making immune cells less responsive to cortisol’s “off switch,” which can exacerbate inflammation. (Frontiers)
In a pilot histologic study, both acute and chronic stress were shown to negatively affect bone remodeling and maturation. (MDPI)
So from a biological standpoint, stress creates an environment less conducive to strong, healthy bone.
Behavior, Movement & Risk — The Indirect Pathways
Biology is just part of the story. Stress also changes how we move, think, and care for ourselves — and for someone with O.I., those changes can raise fracture risk.
Muscle Tension, Posture & Neurocontrol
Stress often causes tension in muscles (neck, shoulders, back), rigid postures, shallow breathing, and less fluid movement. Over time:
- This can throw off your balance and proprioception
- It can create micro-imbalances that put unexpected torque on bones
- You may become more susceptible to slips, missteps, or catching yourself awkwardly
A striking example of how emotional stress can trigger falls comes from a case-crossover study of older adults: feelings like anger, sadness, stress — within about an hour — were linked to an increased risk of falls that led to hip or pelvic fractures. (BioMed Central)
This suggests that stress doesn’t just degrade bone; it also can trigger a vulnerable moment in balance or coordination.
Changes in Activity, Motivation & Fatigue
When you’re emotionally taxed:
- You may move less (avoiding activity out of fatigue, fear, or low motivation)
- You may skip exercise that supports bone and muscle
- Sleep often suffers, which impairs recovery, hormone balance, and repair
- You may make poorer choices in diet, nutrition, or adherence to care routines
Reduced mechanical loading (less movement) is itself a risk for bone thinning (bones weaken when they’re “unloaded”). Wolff’s Law states that bone adapts to the loads placed on it — use it or lose it. (Wikipedia)
Mental Health & Comorbid Risk
Many large clinical studies show links between psychiatric conditions and fracture risk. For instance, patients with depression, anxiety, or stress-related disorders had a higher relative risk of fracture and worse surgical outcomes after fractures. (PubMed)
Another study of older adults residing after disasters found that those with high psychological stress had increased fracture rates—likely via cortisol and behavioral pathways. (BioMed Central)
In short: stress can amplify both the biological vulnerability of bones and the mechanical/behavioral risks of falling or overloading.
Why People with O.I. Are Especially Vulnerable To Stress
All of the above is relevant to everyone. But for those with O.I., the margin is narrower:
- Collagen defects already compromise bone microarchitecture and strength
- Healing is often slower; microdamage may accumulate more easily
- There may already be issues in muscle, ligament, and joint integrity
- The fracture “threshold” (how much force causes a break) is much lower
So even small decreases in bone strength or small mistakes in movement have greater consequences. That’s why stress — which imposes a hidden load on the system — becomes far more significant in O.I.
What You Can Do: Using Safe Movement & Stress Management Together
If stress can weaken bone and up risk, then a powerful countermeasure is intentional, safe movement + stress management. Below are practices and strategies that many in the O.I. community (and beyond) have found useful.
Mind-Body Practices & Regulation
- Breathwork / diaphragmatic breathing — slows the sympathetic stress response
- Mindfulness / meditation — helps regulate emotional reactivity and lower cortisol
- Gentle yoga / stretching / mobility work — helps release chronic tension
- Guided imagery, journaling, or creative practices — for expressing and processing emotional load
These practices help “turn down the background stress,” giving your body more capacity to repair.
Adaptive & Safe Movement Routines
- Slow, controlled movement (e.g. Pilates, adaptive resistance with bands, aquatic work)
- Isometric work (gentle muscle activation without risky joint excursions)
- Balance, proprioception drills (within your safe zone)
- Functional “micro-movements” throughout the day (frequent gentle movement breaks)
- Progressive loading, carefully and gradually, to maintain bone stimulus — done under guidance
Over time, safe movement not only helps maintain bone, muscle, and joint health — it also acts as a buffer against stress and anxiety.
Sleep, Nutrition & Self-Care
- Prioritize sleep hygiene — consistent schedules, low screen time before bed, calming bedtime routines
- Ensure nutrient support — calcium, vitamin D, magnesium, protein, and other bone-supporting nutrients
- Practice stress hygiene — setting boundaries, pacing, breaks, social support
- Seek mental health support when needed — therapy, peer groups, coaching
All of these make it easier for your body to resist the cascading negative effects of stress.
Sample Framework: A Weekly “Stress & Bone Care” Cycle
Here’s a simple structure you could follow or encourage others to adapt:
| Day | Mind-Body | Movement Focus | Recovery / Self-Care |
|---|---|---|---|
| Monday | 10 min breathing / mindfulness | Adaptive strength (low load) | Nutrition check, restful evening |
| Tuesday | Journaling / reflection | Balance / proprioceptive work | Stretching, evening wind-down |
| Wednesday | Breathwork + visualization | Gentle mobility + functional movement | Sleep priority |
| Thursday | Guided meditation or gratitude | Isometric hold work | Social connection or creativity |
| Friday | Progressive muscle relaxation | Light “flow” movement (e.g. aquatic, gentle yoga) | Nature walk, self-check |
| Saturday | Mindful pause | Favorite safe activity (within limits) | Relaxed recovery mode |
| Sunday | Rest / reflection | Micro-movements only | Prepare week ahead, self-care focus |
You don’t have to be perfect. Even small, consistent doses of mind + movement go a long way.
Don’t Take The Blame
This isn’t about blaming yourself for feeling stress — it’s about empowering your body and mind to work together. O.I. already challenges your system; stress is an added load—often hidden but real. The good news is: you can do things to reduce the impact rather than resign yourself to it.
The relationship between stress and fracture is not deterministic — it’s conditional. You’re not doomed, but awareness and consistent habits can shift that condition in your favor.
Let Me Help You Move Safely
If you’d like personalized guidance to design a movement plan that’s safe, stress-sensitive, and tailored to your body with O.I., I invite you to check out my coaching for safe movement. Together, we can build resilience, ease tension, and protect your precious bones.
Click here to learn more about my coaching programs → https://www.tonyjacobsen.com/coaching
Evidence
- “Psychological stress disturbs bone metabolism via miR-335-3p / Fos” — mechanistic animal study showing how psychological stress impacts bone. (eLife)
- “Stress and Alterations in Bones: An Interdisciplinary Perspective” — looks at GR resistance, immune interactions, and systemic effects. (Frontiers)
- Emotional stress as a trigger of falls leading to hip or pelvic fracture (ToFa study) — human epidemiologic evidence of stress triggering falls. (BioMed Central)
- Clinical study linking psychiatric comorbidity and fracture risk — showing mental health conditions map to higher fracture and complication rates. (PubMed)
- Frontiers: Impacts of Psychological Stress on Osteoporosis — excellent overview of stress + bone intersection. (Frontiers)
- “Potential mechanisms linking psychological stress to bone health” — review article exploring cortisol, inflammation pathways, and bone remodeling. (PMC)
