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The Relationship Between 24-h Urinary Cortisol and Bone in Healthy Young Women

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Abstract

Background

Cortisol within the normal range has been associated with reduced bone density in the elderly, but little is known about this relationship in healthy young women.

Purpose

The purpose of this study is to assess whether 24-h urinary free cortisol excretion (UFC) is related to bone density in 132 healthy, non-obese, regularly menstruating women, aged 19–35.

Method

Participants completed questionnaires (food frequency, demographics, physical activity, dietary restraint, perceived stress, and daily stress) and a 24-h urine collection. UFC was determined by high-throughput liquid chromatography and tandem mass spectrometry. Anthropometrics were completed and a dual energy X-ray absorptiometry scan measured areal bone mineral density (aBMD, g/cm2) and bone mineral content (BMC, g) at the lumbar spine (L1–4), hip, and total body (TB) as well as total body lean (LBM) and fat mass.

Results

aBMD and BMC were significantly positively associated with height, LBM, physical activity, calcium intake, and duration of previous oral contraceptive use (except L1–4) and negatively with perceived stress. UFC was not correlated with any measured variables except urine volume (r = 0.17, p = 0.046). After adjusting for urine volume, height, LBM, ethnicity, and prior oral contraceptive use, UFC was significantly inversely associated with TB BMC (r = −0.30, p < 0.001) and aBMD (r = −0.27, p = 0.003), L1–4 aBMD (r = −0.19, p = 0.035) and BMC (r = −0.18, p = 0.049), and hip BMC (r = −0.23, p = 0.011). Further adjustment for sport activity, calcium intake and perceived stress did not change these relationships meaningfully except that L1–4 became nonsignificant (p < 0.07).

Conclusion

Cortisol within the normal range appears to have a minor negative influence on bone density in healthy young women.

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References

  1. McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583:174–85.

    Article  CAS  PubMed  Google Scholar 

  2. Chiodini I, Torlontano M, Carnevale V, Trischitta V, Scillitani A. Skeletal involvement in adult patients with endogenous hypercortisolism. J Endocrinol Invest. 2008;31:267–76.

    CAS  PubMed  Google Scholar 

  3. Cetin A, Gokce-Kutsal Y, Celiker R. Predictors of bone mineral density in healthy males. Rheumatol Int. 2001;21:85–8.

    Article  CAS  PubMed  Google Scholar 

  4. Dennison E, Hindmarsh P, Fall C, Kellingray S, Barker D, Phillips D, et al. Profiles of endogenous circulating cortisol and bone mineral density in healthy elderly men. J Clin Endocrinol Metab. 1999;84:3058–63.

    Article  CAS  PubMed  Google Scholar 

  5. Raff H, Raff JL, Duthie EH, Wilson CR, Sasse EA, Rudman I, et al. Elevated salivary cortisol in the evening in healthy elderly men and women: correlation with bone mineral density. J Gerontol A Biol Sci Med Sci. 1999;54:M479–83.

    CAS  PubMed  Google Scholar 

  6. Reynolds RM, Dennison EM, Walker BR, Syddall HE, Wood PJ, Andrew R, et al. Cortisol secretion and rate of bone loss in a population-based cohort of elderly men and women. Calcif Tissue Int. 2005;77:134–8.

    Article  CAS  PubMed  Google Scholar 

  7. Greendale GA, Unger JB, Rowe JW, Seeman TE. The relation between cortisol excretion and fractures in healthy older people: results from the MacArthur studies. J Am Geriatr Soc. 1999;47:799–803.

    CAS  PubMed  Google Scholar 

  8. Altindag O, Altindag A, Asoglu M, Gunes M, Soran N, Deveci Z. Relation of cortisol levels and bone mineral density among premenopausal women with major depression. Int J Clin Pract. 2007;61:416–20.

    Article  CAS  PubMed  Google Scholar 

  9. Biller BM, Saxe V, Herzog DB, Rosenthal DI, Holzman S, Klibanski A. Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. J Clin Endocrinol Metab. 1989;68:548–54.

    Article  CAS  PubMed  Google Scholar 

  10. Kahl KG, Rudolf S, Stoeckelhuber BM, Dibbelt L, Gehl HB, Markhof K, et al. Bone mineral density, markers of bone turnover, and cytokines in young women with borderline personality disorder with and without comorbid major depressive disorder. Am J Psychiatry. 2005;162:168–74.

    Article  PubMed  Google Scholar 

  11. Legroux-Gerot I, Vignau J, D'Herbomez M, Collier F, Marchandise X, Duquesnoy B, et al. Evaluation of bone loss and its mechanisms in anorexia nervosa. Calcif Tissue Int. 2007;81:174–82.

    Article  CAS  PubMed  Google Scholar 

  12. Misra M, Prabhakaran R, Miller KK, Goldstein MA, Mickley D, Clauss L, et al. Prognostic indicators of changes in bone density measures in adolescent girls with anorexia nervosa-II. J Clin Endocrinol Metab. 2008;93:1292–7.

    Article  CAS  PubMed  Google Scholar 

  13. Naessen S, Carlstrom K, Glant R, Jacobsson H, Hirschberg AL. Bone mineral density in bulimic women—influence of endocrine factors and previous anorexia. Eur J Endocrinol. 2006;155:245–51.

    Article  CAS  PubMed  Google Scholar 

  14. Eskandari F, Martinez PE, Torvik S, Phillips TM, Sternberg EM, Mistry S, et al. Low bone mass in premenopausal women with depression. Arch Intern Med. 2007;167:2329–36.

    Article  PubMed  Google Scholar 

  15. Petronijevic M, Petronijevic N, Ivkovic M, Stefanovic D, Radonjic N, Glisic B, et al. Low bone mineral density and high bone metabolism turnover in premenopausal women with unipolar depression. Bone. 2008;42:582–90.

    Article  CAS  PubMed  Google Scholar 

  16. Yazici AE, Bagis S, Tot S, Sahin G, Yazici K, Erdogan C. Bone mineral density in premenopausal women with major depression. Joint Bone Spine. 2005;72:540–3.

    Article  PubMed  Google Scholar 

  17. McLean JA, Barr SI, Prior JC. Dietary restraint, exercise, and bone density in young women: are they related? Med Sci Sports Exerc. 2001;33:1292–6.

    Article  CAS  PubMed  Google Scholar 

  18. Bacon L, Stern JS, Keim NL, Van Loan MD. Low bone mass in premenopausal chronic dieting obese women. Eur J Clin Nutr. 2004;58:966–71.

    Article  CAS  PubMed  Google Scholar 

  19. Nickols-Richardson SM, Beiseigel JM, Gwazdauskas FC. Eating restraint is negatively associated with biomarkers of bone turnover but not measurements of bone mineral density in young women. J Am Diet Assoc. 2006;106:1095–101.

    Article  PubMed  Google Scholar 

  20. Rideout CA, Linden W, Barr SI. High cognitive dietary restraint is associated with increased cortisol excretion in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2006;61:628–33.

    PubMed  Google Scholar 

  21. Putterman E, Linden W. Cognitive dietary restraint and cortisol: importance of pervasive concerns with appearance. Appetite. 2006;47:64–76.

    Article  CAS  PubMed  Google Scholar 

  22. Anderson DA, Shapiro JR, Lundgren JD, Spataro LE, Frye CA. Self-reported dietary restraint is associated with elevated levels of salivary cortisol. Appetite. 2002;38:13–7.

    Article  PubMed  Google Scholar 

  23. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36:936–42.

    CAS  PubMed  Google Scholar 

  24. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  PubMed  Google Scholar 

  25. Stunkard AJ, Messick S. The Three-Factor Eating Questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res. 1985;29:71–83.

    Article  CAS  PubMed  Google Scholar 

  26. Brantley PJ, Waggoner CD, Jones GN, Rappaport NB. A daily stress inventory: development, reliability, and validity. J Behav Med. 1987;10:61–74.

    Article  CAS  PubMed  Google Scholar 

  27. Csizmadi I, Kahle L, Ullman R, Dawe U, Zimmerman TP, Friedenreich CM, et al. Adaptation and evaluation of the National Cancer Institute's Diet History Questionnaire and nutrient database for Canadian populations. Public Health Nutr. 2007;10:88–96.

    Article  PubMed  Google Scholar 

  28. Taylor RL, Machacek D, Singh RJ. Validation of a high-throughput liquid chromatography-tandem mass spectrometry method for urinary cortisol and cortisone. Clin Chem. 2002;48:1511–9.

    CAS  PubMed  Google Scholar 

  29. Parry BL, Javeed S, Laughlin GA, Hauger R, Clopton P. Cortisol circadian rhythms during the menstrual cycle and with sleep deprivation in premenstrual dysphoric disorder and normal control subjects. Biol Psychiatry. 2000;1(48):920–31.

    Article  Google Scholar 

  30. Abplanalp JM, Livingston L, Rose RM, Sandwisch D. Cortisol and growth hormone responses to psychological stress during the menstrual cycle. Psychosom Med. 1977;39:158–77.

    CAS  PubMed  Google Scholar 

  31. Bao AM, Ji YF, Van Someren EJ, Hofman MA, Liu RY, Zhou JN. Diurnal rhythms of free estradiol and cortisol during the normal menstrual cycle in women with major depression. Horm Behav. 2004;45:93–102.

    Article  CAS  PubMed  Google Scholar 

  32. Kudielka BM, Kirschbaum C. Awakening cortisol responses are influenced by health status and awakening time but not by menstrual cycle phase. Psychoneuroendocrinology. 2003;28:35–47.

    Article  CAS  PubMed  Google Scholar 

  33. Aedo AR, Landgren BM, Diczfalusy E. Studies on ovarian and adrenal steroids at different phases of the menstrual cycle: II. A comparative assessment of the circadian variation in steroid and lutropin levels during the follicular, periovulatory and luteal phases. Contraception. 1981;23:407–24.

    Article  CAS  PubMed  Google Scholar 

  34. Kneipp SM, Welch DP, Wood CE, Yucha CB, Yarandi H. Psychosocial and physiological stress among women leaving welfare. West J Nurs Res. 2007;29:864–95.

    Article  PubMed  Google Scholar 

  35. Knowles SR, Nelson EA, Palombo EA. Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: a possible mechanism underlying susceptibility to illness. Biol Psychol. 2008;77:132–7.

    Article  PubMed  Google Scholar 

  36. Ebrecht M, Hextall J, Kirtley LG, Taylor A, Dyson M, Weinman J. Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Psychoneuroendocrinology. 2004;29:798–809.

    Article  CAS  PubMed  Google Scholar 

  37. van Eck M, Berkhof H, Nicolson N, Sulon J. The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol. Psychosom Med. 1996;58:447–58.

    PubMed  Google Scholar 

  38. Lasikiewicz N, Hendrickx H, Talbot D, Dye L. Exploration of basal diurnal salivary cortisol profiles in middle-aged adults: associations with sleep quality and metabolic parameters. Psychoneuroendocrinology. 2008;33:143–51.

    Article  CAS  PubMed  Google Scholar 

  39. Simpson EE, McConville C, Rae G, O'Connor JM, Stewart-Knox BJ, Coudray C, et al. Salivary cortisol, stress and mood in healthy older adults: the Zenith study. Biol Psychol. 2008;78:1–9.

    Article  PubMed  Google Scholar 

  40. Waugh EJ, Polivy J, Ridout R, Hawker GA. A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women. Am J Clin Nutr. 2007;86:1791–801.

    CAS  PubMed  Google Scholar 

  41. Van Loan MD, Keim NL. Influence of cognitive eating restraint on total-body measurements of bone mineral density and bone mineral content in premenopausal women aged 18–45 y: a cross-sectional study. Am J Clin Nutr. 2000;72:837–43.

    PubMed  Google Scholar 

  42. Vescovi JD, Scheid JL, Hontscharuk R, De Souza MJ. Cognitive dietary restraint: impact on bone, menstrual and metabolic status in young women. Physiol Behav. 2008;95:48–55.

    Article  CAS  PubMed  Google Scholar 

  43. Barrack MT, Rauh MJ, Barkai HS, Nichols JF. Dietary restraint and low bone mass in female adolescent endurance runners. Am J Clin Nutr. 2008;87:36–43.

    CAS  PubMed  Google Scholar 

  44. Walker MD, Novotny R, Bilezikian JP, Weaver CM. Race and diet interactions in the acquisition, maintenance, and loss of bone. J Nutr. 2008;138:1256S–60.

    CAS  PubMed  Google Scholar 

  45. Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr. 2000;19:83S–99.

    CAS  PubMed  Google Scholar 

  46. Liu SL, Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. Br J Sports Med. 2006;40:11–24.

    Article  CAS  PubMed  Google Scholar 

  47. Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. American college of sports medicine. American college of sports medicine position stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36:1985–96.

    Article  PubMed  Google Scholar 

  48. Nichols DL, Sanborn CF, Essery EV. Bone density and young athletic women. An update. Sports Med. 2007;37:1001–14.

    Article  PubMed  Google Scholar 

  49. Aldana SG, Sutton LD, Jacobson BH, Quirk MG. Relationships between leisure time physical activity and perceived stress. Percept Mot Skills. 1996;82:315–21.

    CAS  PubMed  Google Scholar 

  50. Brown JD. Staying fit and staying well: physical fitness as a moderator of life stress. J Pers Soc Psychol. 1991;60:555–61.

    Article  CAS  PubMed  Google Scholar 

  51. Iwasaki Y, Zuzanek J, Mannell RC. The effects of physically active leisure on stress-health relationships. Can J Public Health. 2001;92:214–8.

    CAS  PubMed  Google Scholar 

  52. Starkweather AR. The effects of exercise on perceived stress and IL-6 levels among older adults. Biol Res Nurs. 2007;8:186–94.

    Article  CAS  PubMed  Google Scholar 

  53. Taylor-Piliae RE, Haskell WL, Waters CM, Froelicher ES. Change in perceived psychosocial status following a 12-week Tai Chi exercise programme. J Adv Nurs. 2006;54:313–29.

    Article  PubMed  Google Scholar 

  54. Mastorakos G, Pavlatou M, Diamanti-Kandarakis E, Chrousos GP. Exercise and the stress system. Hormones (Athens). 2005;4:73–89.

    PubMed  Google Scholar 

  55. Nabkasorn C, Miyai N, Sootmongkol A, Junprasert S, Yamamoto H, Arita M, et al. Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. Eur J Public Health. 2006;16:179–84.

    Article  PubMed  Google Scholar 

  56. Esch T, Duckstein J, Welke J, Braun V. Mind/body techniques for physiological and psychological stress reduction: stress management via Tai Chi training—a pilot study. Med Sci Monit. 2007;13:CR488–97.

    PubMed  Google Scholar 

  57. British Columbia (BC) Stats. Summary of smoking rates for BC: September 2006 to August 2007 [Internet]. Victoria (BC): Provincial Government, BC Stats; 2007 Oct 23 [cited 2009 July 1]. Available from: http://www.bcstats.gov.bc.ca/data/ssa/reports/tobacco/smoke07060707.pdf

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Acknowledgements

We are extremely grateful to our participants who enthusiastically committed their time to this study. We extend our gratitude to Amandeep Ghuman for her assistance in data entry. We thank Romy Chan and her staff at VGH for the urinalysis and the VGH Nuclear Medicine technologists for the DXA measurements.

Disclosure Statement

The authors have nothing to disclose.

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Authors and Affiliations

  1. Human Nutrition, The University of British Columbia, 2205 East Mall, Vancouver, BC, V6T 1Z4, Canada

    Jennifer L. Bedford & Susan I. Barr

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  1. Jennifer L. Bedford
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  2. Susan I. Barr
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Corresponding author

Correspondence to Susan I. Barr.

Additional information

This study was funded by the Canadian Institute for Health Research (CIHR) operating grant 79563. JB was supported by a CIHR Doctoral Award and was a Michael Smith Foundation for Health Research Trainee.

Ethical Approval

The procedures of this study received ethics approval from the University of British Columbia’s Clinical Research Ethics Board on May 11, 2006 (reference number: C05-0257) and approval was renewed annually.

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Bedford, J.L., Barr, S.I. The Relationship Between 24-h Urinary Cortisol and Bone in Healthy Young Women. Int.J. Behav. Med. 17, 207–215 (2010). https://doi.org/10.1007/s12529-009-9064-2

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  • DOI: https://doi.org/10.1007/s12529-009-9064-2

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