Osteoporozda Stresin Psikososyal Boyutlarının İncelenmesi: Sistematik Bir Derleme

Öz

Osteoporoz, çoğu zaman yaşlanmanın kaçınılmaz bir sonucu olarak görülerek göz ardı edilen ve sessizce ilerleyen bir hastalıktır. Ancak hastalığın kemiklerde oluşturduğu hasar ve bununla ilişkili karşılaşılan sorunlar sebebiyle stres bu süreçteki kritik bileşenlerden birisidir. Stresin osteoporoz ile ilişkisini irdeleyen çalışmalarda genellikle stresin biyolojik perspektiften ele alındığı dikkat çeker. Ancak az da olsa stresin psikososyal yönüne değinenlerin de olduğu görülmektedir. Mevcut çalışma bu az sayıdaki araştırmayı yöntemsel ve bulgusal olarak ele almayı amaçlamaktadır. Bu çalışmada PRISMA ilkeleri izlenerek sistematik derleme yöntemi benimsenmiştir. Osteoporoz hastalarının stres yaşantılarını psikososyal açıdan ve orijinal bir araştırma deseniyle ele alan çalışmalar derlemeye dahil edilirken bunu subjektif ölçeklerle ölçmeyen, hastalık grubuna değil farklı örneklemlere odaklanan çalışmaların ise dışlanmasının ardından yedi çalışma derlemede yer almıştır. Bu çalışmaların büyük bir kısmı kadınlarda algılanan yüksek düzeyde stres, düşük sosyal destek ve uzun süreli psikolojik sıkıntının kemik mineral yoğunluğu kaybı ve kırık riskinde anlamlı artışla ilişkili olduğunu bulgulamıştır. Ayrıca araştırmalarda stres osteoporozu doğrudan biyolojik sistemlerde yarattığı disfonksiyonla ve dolaylı olarak riskli davranışlara sebep olmasıyla etkileyebildiği ortaya konmaktadır. Sonuç olarak, osteoporozun yalnızca biyomedikal değil, aynı zamanda psikososyal bir hastalık olarak ele alınması gerektiği gözden kaçmamalıdır. Psikososyal stresin osteoporoz hastalarında değerlendirilmesi ve müdahale stratejilerine entegre edilmesi hem önleyici sağlık hizmetleri hem de hasta yaşam kalitesi açısından büyük önem taşıdığı düşünülmektedir.

Anahtar Kelimeler

• Osteoporoz
• psikososyal stres
• biyopsikososyal kuram.

Examining the Psychosocial Dimensions of Stress in Osteoporosis: A Systematic Review

Abstract

Osteoporosis is a silently progressing disease that is often disregarded as an inevitable consequence of ageing. Stress is critical for osteoporosis as it inflicts damage on bones and related issues. Studies exploring the link between stress and osteoporosis mostly focus on the biological, but a few studies have touched on the psychosocial perspective. The study aimed to examine these studies in terms of methodology and outcomes. A systematic review was conducted following the PRISMA guidelines. Studies that addressed the stress of osteoporosis patients from a psychosocial perspective and with an original research design were included, while did not measure with subjective scales and focused on different samples rather than the clinical group were excluded; finally, seven studies were analysed. Most of these indicated high perceived stress, low social support, and prolonged psychological distress in women were related to a significant increase in bone mineral density loss and fracture risk. Also, studies showed that stress can influence osteoporosis directly, through causing dysfunctional biological systems, and indirectly, by prompting risky behaviours. Hence, these results underline the need to conceptualise osteoporosis not only as a biomedical but also as a psychosocial issue. Assessing the psychosocial stress for osteoporosis patients and integrating it into intervention strategies is considered crucial for preventive healthcare and patients' quality of life.

Keywords

• Osteoporosis
• psychosocial stress
• silent disease
• biopsychosocial model

References

1. Aloumanis K, Mavroudis K (2013) The “depressive” face of osteoporosis and the “osteoporotic” face of depression. Hormones (Athens), 12:350 362.
2. American Psychological Association (2015) APA Dictionary of Psychology. Washington, DC, American Psychological Association.
3. Besser SJ (2014) The psychological factors in adherence to osteoporosis medication: an exploration and intervention development (Doctoral thesis) London, King’s College University.
4. Catalano A, Martino G, Bellone F, Gaudio A, Lasco C, Langher V et al. (2018) Anxiety levels predict fracture risk in postmenopausal women assessed for osteoporosis. Menopause, 25:1110 1115.
5. Cohen S, Janicki Deverts D, Turner RB, Doyle WJ (2015) Does hugging provide stress buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychol Sci, 26:135 147.
6. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al. (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int, 251:2359 2381.
7. Crosswel AD, Lockwood KG (2020) Best practices for stress measurement: how to measure psychological stress in health research. Health Psychol Open, 7:2055102920933072.
8. Ditzen B, Heinrichs M (2014) Psychobiology of social support: the social dimension of stress buffering. Restor Neurol Neurosci, 32:149 162.

9. El Gabalawy R, Blaney C, Tsai J, Sumner JA, Pietrzak RH (2018) Physical health conditions associated with full and subthreshold PTSD in US military veterans: results from the National Health and Resilience in Veterans Study. J Affect Disord, 227:849 853.
10. Fink HA, Kuskowski MA, Cauley JA, Taylor BC, Schousboe JT, Cawthon PM et al. (2014). Osteoporotic Fractures in Men (MrOS) Study Group. Association of stressful life events with accelerated bone loss in older men: the osteoporotic fractures in men (MrOS) study. Osteoporos Int, 25:2833 2839.
11. Follis SL, Bea J, Klimentidis Y, Hu C, Crandall CJ, Garcia DO et al. (2019) Psychosocial stress and bone loss among postmenopausal women: results from the Women’s Health Initiative. J Epidemiol Community Health, 73:888 892.
12. Hansell N, Strike L, De Zubicaray G, Thompson P, McMahon K, Wright M (2022) Persistence of anxiety/depression symptoms in early adolescence: a prospective study of daily life stress, rumination, and daytime sleepiness in a genetically informative cohort. Twin Res Hum Genet, 25:115 128.
13. Hao Kun X, Jie Xi L, Ze Kai Z, Chen Xi Z, Bing Dong S, Yuan Y, et al. (2024) Osteoporosis under psychological stress: mechanisms and therapeutics. Life Med, 3:lnae009.
14. He Y, Wuertz Kozak K, Kuehl LK, Wippert PM (2021) Extracellular vesicles: potential mediators of psychosocial stress contribution to osteoporosis? Int J Mol Sci, 22:5846.
15. Herath M, Cohen A, Ebeling PR, Milat F (2022) Dilemmas in the management of osteoporosis in younger adults. JBMR Plus, 6:e10594.
16. Hiligsmann M, Cornelissen D, Vrijens B, Abrahamsen B, Al Daghri N, Biver E et al. (2019) Determinants, consequences and potential solutions to poor adherence to anti osteoporosis treatment: results of an expert group meeting organized by the European Society. Osteoporos Int, 30:2155 2165.
17. Hillen MA, Gutheil CM, Strout TD, Smets EM, Han PK (2017) Tolerance of uncertainty: conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med, 180:62 75.
18. Huang C, Liao L, Tong K, Lai H, Chen W, Chen C, et al. (2015) Mediating effects on health related quality of life in adults with osteoporosis: a structural equation modeling. Osteoporos Int, 26:875 883.
19. Huang WS, Hsu JW, Huang KL, Bai YM, Su TP, Li CT et al. (2018) Post traumatic stress disorder and risk of osteoporosis: a nationwide longitudinal study. Stress Health, 34:440 445.
20. Ji ZW, Fan CY, Yu ZL, Wu XX, Mao HQ (2023) Enhanced recovery after surgery (ERAS) relieves psychological stress in patients with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty: an observational retrospective cohort study. J Orthop Surg Res, 18:218.
21. Jiang T, Veres K, Körmendiné-Farkas D, Lash TL, Sørensen HT, Gradus JL (2018) Post traumatic stress disorder and incident fractures in the Danish population. Osteoporos Int, 29:2487 2493.
22. Kanis JA, WHO Scientific Group (2007) WHO Technical Report: Assessment of Osteoporosis at the Primary Health Care Level. Sheffield, UK, University of Sheffield.
23. Kelly RR, McDonald LT, Jensen NR, Sidles SJ, LaRue AC (2019) Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front Psychiatry, 10:443946.
24. Kirazlı Y, Atamaz Çalış F, El Ö, Gökçe Kutsal Y, Peker Ö, Sindel D et al. (2020) Updated approach for the management of osteoporosis in Turkey: a consensus report. Arch Osteoporos, 15:e10799 0.
25. Lems WF, Raterman HG (2017) Critical issues and current challenges in osteoporosis and fracture prevention: an overview of unmet needs. Ther Adv Musculoskelet Dis, 9:299 316.
26. McClung MR, Pinkerton J, Blake J, Cosman F, Lewiecki E, Shapiro M (2021) Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society (NAMS). Menopause, 28:973 997.
27. Mezuk B, Eaton WW, Golden SH, Wand G, Lee HB (2008) Depression, antidepressants, and bone mineral density in a population based cohort. J Gerontol A Biol Sci Med Sci, 63:1410 1415.
28. O’Connor DB, Thayer JF, Vedhara K (2021) Stress and health: a review of psychobiological processes. Annu Rev Psychol, 72:663 688.
29. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev, 10:89.
30. Paratz E, Katz B. (2011) Ageing Holocaust survivors in Australia. Med J Aust, 194:194-197.
31. Park Lee E, Fredman L, Hochberg M, Faulkner K (2009) Positive affect and incidence of frailty in elderly women caregivers and noncaregivers: results of Caregiver Study of Osteoporotic Fractures. J Am Geriatr Soc, 57:627 633.
32. Pedersen AB, Ehrenstein V, Szepligeti SK, Lunde A, Sørensen HT (2016) Perceived stress and risk of any osteoporotic fracture. Osteoporos Int, 27:3615 3623.
33. Ryder AL, Azcarate PM, Cohen BE (2018) PTSD and physical health. Curr Psychiatry Rep, 20:116.
34. Silverman SL, Shen W, Minshall ME, Xie S, Moses KH (2007) Prevalence of depressive symptoms in postmenopausal women with low bone mineral density and/or prevalent vertebral fracture: results from the Multiple Outcomes of Raloxifene Evaluation (MORE) study. J Rheumatol, 34:140 144.
35. Sindel, D (2023) Osteoporosis: spotlight on current approaches to pharmacological treatment. Turk J Phys Med Rehabil, 69:140 152.
36. Søgaard AJ, Joakimsen RM, Tverdal A, Fønnebø V, Magnus JH, Berntsen GKR (2005) Long term mental distress, bone mineral density and non vertebral fractures: the Tromsø Study. Osteoporos Int, 16:887 897.
37. Steppe L, Megafu M, Tschaffon Müller ME, Ignatius A, Haffner Luntzer M (2023) Fracture healing research: recent insights. Bone Rep, 19:101686.
38. Tan H, Agarthesh T, Tan C, Sultana R, Chen H, Chua T et al. (2021) Perceived stress during labor and its association with depressive symptomatology, anxiety, and pain catastrophizing. Sci Rep, 11:17005.
39. Trimpou P, Landin Wilhelmsen K, Odén A, Rosengren A, Wilhelmsen L (2010) Male risk factors for hip fracture a 30 year follow up study in 7,495 men. Osteoporos Int, 21:409 416.
40. Trimpou P, Odén A, Simonsson T, Wilhelmsen L, Landin Wilhelmsen K (2011) High serum total cholesterol is a long term cause of osteoporotic fracture. Osteoporos Int, 22:1615 1620.
41. Wang X, Kattan MW (2020) Cohort studies: design, analysis, and reporting. Chest, 158:72 78.
42. Yehuda R, LeDoux J (2007) Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron, 56:19 32.