PTSD and fractures: what the science really says (and what to do next)

If you've ever wondered whether PTSD can raise your risk of broken bones, you're not aloneand yes, there's a real, measurable link. When PTSD keeps the body's stress response stuck in high gear, stress hormones like cortisol can quietly chip away at bone strength. Over time, that can mean lower bone density and a higher chance of fractures.

But here's the hopeful part: bones are living tissue. They respond to what you dohow you move, what you eat, how you sleep, and even how you manage stress. PTSD and fractures are connected, but you have a lot more power than you might think. Let's walk through the science in plain language and map out simple, trauma-informed steps to protect your bone health without overwhelming your mental health.

Quick takeaways

Let's start with the headlines so you can get the big picture fast.

Is PTSD independently associated with fracture risk?

In large cohort studies, people with PTSD have a higher risk of fractures compared to those without PTSDeven after adjusting for smoking, BMI, and other health conditions. Effect sizes vary, but relative risk bumps of about 1.2 to 1.5 are commonly reported in observational research, with higher risks in older adults, postmenopausal women, and veterans. Some studies also link PTSD with lower bone mineral density (BMD), especially at the hip and spine, which helps explain why fractures are more likely.

What does "PTSD bone density" actually mean?

Bone mineral density (BMD) is a measure of how much mineral is packed into your bones. Osteopenia is lower-than-normal BMD; osteoporosis is more severe bone loss with a much higher fracture risk. PTSD can be associated with declines in BMD through stress-hormone effects, inflammation, sleep disruption, lifestyle changes, and certain medications. It's not inevitablebut it's something to be aware of and proactively manage.

Fast actions you can take today

Focus on bone-safe habits: Aim for 1,0001,200 mg of calcium and 8002,000 IU of vitamin D daily (food first; supplement if needed), build in weight-bearing and resistance exercise, keep alcohol moderate, avoid smoking, and prioritize consistent sleep. If you're at higher risk (past fractures, long-term steroid use, postmenopause, age over 50, or multiple risk factors), ask your clinician about getting a DEXA scan and using fracture-risk tools like FRAX.

The biology

Here's how PTSD and fractures connect under the hoodno medical degree required.

Stress hormones and fractures: the cortisol connection

PTSD often keeps the body's stress alarmthe HPA axison high alert. That means higher or dysregulated cortisol over time. Cortisol is useful in short bursts, but chronically elevated levels can:

1) Slow down osteoblasts, the cells that build bone. 2) Speed up osteoclasts, the cells that break bone down. 3) Disrupt calcium balance, making it harder for your body to maintain strong bones.

Think of it like this: your bones are constantly remodelingold bone out, new bone in. Chronic stress tips that balance in the wrong direction. This is part of why PTSD bone density can trend downward if nothing else changes. The good news is that lifestyle and care strategies can recalibrate the system.

Inflammation, cytokines, and bone turnover

Chronic stress can dial up systemic inflammationmore circulating cytokines like IL-6 and TNF-. These molecules can push bone toward resorption (breakdown) over formation. It's a subtle effect, not something you feel day to day, but over months and years it matters. Lowering inflammation through movement, sleep, nutrition, and mental health support doesn't just feel betterit supports trauma bone health too.

Sleep, nutrition, and movement patterns

PTSD can turn sleep into a battlefield. Nightmares, hyperarousal, or insomnia can leave you depleted. Poor sleep interferes with hormone rhythms (including cortisol and growth hormone) that help maintain bone. Nutrition may also take a hitlow appetite or stress eating can mean not enough protein, calcium, or vitamin D. And if you're avoiding activities or feeling too fatigued to move, bones lose the stimulus they need to stay strong. The combo of sleep loss, lower nutrient intake, and reduced activity creates a perfect storm for bone lossand it's reversible.

Medications and bone health

Certain medications used in PTSD or related conditions can affect bone. SSRIs and SNRIs have been linked in some studies to modest reductions in BMD and increased falls, especially at higher doses or long-term use. Benzodiazepines can contribute to fall risk due to sedation or dizziness. Glucocorticoids (steroids) are well-known to reduce bone density rapidly at higher doses. None of this means you should stop medicationthat can be dangerous. It means talk openly with your clinician about your risks, consider the lowest effective doses, and build in bone-protective habits and monitoring.

Who's at risk

Not everyone with PTSD will experience bone loss or fractures. But some profiles deserve extra attention.

High-risk groups for PTSD and fractures

Veterans and first responders carry higher PTSD prevalence and physical risks. Survivors of violence or disasters may also face overlapping health and socioeconomic stressors. Older adults and postmenopausal women have naturally higher fracture risk due to age and estrogen changesPTSD can add another layer. If you're in these groups, early screening and prevention can pay off.

Red flags that suggest lower bone density

Have you had a low-trauma fracture (like a wrist or vertebra from a fall at standing height)? Noticed height loss or a stooped posture? Used steroids for months? Do you have a low BMI, smoke, drink heavily, or struggle with chronic insomnia? These flags don't guarantee low BMD, but they're solid reasons to assess your bone health soon rather than later.

Screening smarter: when to get a bone density test

Ask about a DEXA scan if you're a woman 65+ or a man 70+, or earlier if you have risk factors (previous fractures, long-term steroids, high FRAX score, or multiple red flags). The FRAX calculator estimates 10-year fracture risk using age, sex, weight, height, and risk factors; it's commonly used in clinics and can guide treatment decisions. If DEXA shows osteopenia or osteoporosis, you and your clinician can tailor a planfrom lifestyle to medications.

Care strategies

Let's talk about what actually helpspractical steps you can start today and build on over time.

Lifestyle interventions that actually move the needle

Movement: Bones respond to load. Aim for weight-bearing exercise (brisk walking, hiking, stair climbing, dancing) most days, plus resistance training 23 times weekly for major muscle groups. Balance work (single-leg stands, heel-to-toe walking, tai chi) cuts fall risk. Start small: 10-minute "movement snacks" count. If anxiety or pain is a barrier, try gentle, consistent routinesthink resistance bands, short walks with music, or beginner-friendly strength videos.

Nutrition: Target 1.01.2 g of protein per kilogram of body weight daily, especially if you're 50+. For calcium, aim for 1,0001,200 mg/day from foods like yogurt, tofu, sardines, leafy greens, and fortified milks. Vitamin D often needs a supplement (common ranges 8002,000 IU/day), but get a level checked if possible.

Home safety: Fall-proof your spaceclear clutter, use non-slip mats, add nightlights, and keep frequently used items within easy reach. Small upgrades can prevent big injuries.

Mental health care that supports bones

Trauma-focused therapies like TF-CBT or EMDR can improve sleep, reduce hyperarousal, and make it easier to stick with exercise and nutrition. Skills like paced breathing, mindfulness, or grounding techniques help dial down stress-hormone surges. Consider pairing therapy sessions with a short walk afterwardhabit-stacking strengthens both mind and body.

For clinical guidance, you'll find consistent recommendations on trauma care in resources from reputable bodies such as the American Psychiatric Association and the National Center for PTSD. For osteoporosis management, the Endocrine Society and National Osteoporosis Foundation offer frameworks for screening and treatmentthese can help you and your clinician decide on timing for DEXA, labs, and potential medications, according to evidence-based guidelines.

Medication decisions with bone health in mind

If you use SSRIs/SNRIs, benzodiazepines, or glucocorticoids, ask about bone-sparing strategies: baseline DEXA, vitamin D and calcium optimization, fall-prevention plans, and dose minimization where clinically appropriate. If you're a candidate for bone medications (like bisphosphonates), your clinician can weigh benefits vs risks based on DEXA and FRAX. The key is collaborative, not either/oryour mental health and bone health both matter.

Building a care team

Your team might include primary care, psychiatry/psychology, endocrinology, physical therapy, and dietetics. Think of it as a relay: your therapist helps with sleep and stress, your PT builds balance and strength, your clinician coordinates labs and scans, and your dietitian nails down protein, calcium, and vitamin D. A simple shared plan (even a one-page summary) helps everyone pull in the same direction.

Real stories

Sometimes the science clicks best when you see it in motion.

Case snapshots that feel real

Example 1: A veteran in his early 50s with long-standing PTSD discovered early osteopenia on a DEXA scan. He started with resistance bands three times a week, added daily vitamin D, and worked with his therapist on sleep and hypervigilance. Six months later, he was walking hills with a buddy twice a week. At one year, his follow-up DEXA showed stable BMDno further loss. He felt steadier, slept better, and said, "I didn't fix everything. I just kept doing the good stuff long enough for it to work."

Example 2: A survivor coping with severe insomnia kept tripping on the way to the bathroom at night. She completed brief behavioral therapy for insomnia, added morning daylight walks, and put nightlights in the hallway. The falls stopped. Energy crept back. She began short strength sessions on weekends. "I thought I needed to overhaul my life," she said. "Turns out I needed three lights and a ten-minute walk."

Common setbacks and how to recover

Missed workouts? Start with five minutes todayone song's worth of squats, wall push-ups, and marching in place. Medication side effects? Bring them up; small dose changes or timing tweaks can help. Flare-ups of anxiety or pain? Switch to gentler movement until symptoms easestretching, breathing drills, or a stroll while listening to a comforting podcast. Progress isn't linear. It's like climbing a hill with switchbacksyou still gain altitude.

For clinicians

If you're a clinician or researcher, here's the distilled signal.

What the strongest studies show on PTSD and fractures

Observational cohort data associate PTSD with increased incident fractures and lower BMD, persisting after adjustments for age, BMI, smoking, alcohol, and comorbidities. Absolute risk varies by age and sex; relative risk tends to be modest but clinically relevant, particularly in older adults and postmenopausal women, and in populations with high PTSD prevalence (e.g., veterans). Confounding from medications (SSRIs, benzodiazepines, glucocorticoids) and lifestyle factors is common and should be explicitly modeled.

Gaps and what to watch next

We need longitudinal interventional trials integrating trauma therapy with bone-health protocols, SSRI class/dose effects on fracture and BMD, sex- and age-specific risk stratification, and biomarker panels beyond cortisol (e.g., inflammatory signatures). Fall-risk mechanisms in PTSD (hyperarousal, sleep fragmentation, psychomotor effects of meds) deserve targeted study.

Translating evidence to practice

Embed brief PTSD screens where fracture risk is high and vice versa. Add fall-risk assessments to PTSD care plans. Consider early DEXA in symptomatic or high-risk patients. Standardize counseling on calcium/vitamin D, resistance/balance training, sleep interventions, and home safety. Coordinate with mental health services; shared care improves adherence and outcomes.

Talk to your doctor

Starting the conversation can feel awkward. Here's a simple way in.

A simple script to start the conversation

"I have PTSD and I'm concerned about fractures. I've read that stress hormones and sleep problems can affect bone density. Could we review my risk and see if a DEXA scan or vitamin D test makes sense? Also, I'm on [medication], and I want to make sure my bone health is protected." That's itclear, respectful, and actionable.

What labs and tests might be ordered

Common options include DEXA for BMD; 25OH vitamin D; calcium and basic metabolic panel; thyroid function; and sex hormones if indicated (estrogen in women with early menopause, testosterone in men with symptoms). Results guide whether lifestyle alone is enough or if medications are warranted.

Tracking progress without obsessing

Create a simple checklist: weekly resistance sessions (23), daily protein targets, vitamin D/calcium intake, sleep routine, and a monthly home-safety check. Review every 36 months. Celebrate what's working, tweak what isn't, and keep it kindperfection is not required for strong bones.

Myths vs facts

Let's clear up a few common misconceptions so you can focus on what helps.

"Only older people with PTSD get fractures"

Age increases risk, but younger adults with PTSD can have lower BMD, especially with added risks like low BMI, smoking, heavy alcohol, poor sleep, or long-term steroids. Prevention is worth it at any age.

"If I take antidepressants, my bones will definitely get worse"

Not necessarily. Some antidepressants are associated with small changes in BMD and fall risk, but the benefits for mental health may outweigh risks. Monitoring, dose optimization, and bone-protective habits reduce potential downsides. Never stop a medication without medical guidance.

"Supplements alone will fix this"

Calcium and vitamin D are important, but they're not magic. Resistance and balance training, sleep, alcohol/smoking limits, and fall-proofing are equally critical. Think team effort, not a single hero.

Before we wrap up, a quick note on trustworthy sources: guidance from organizations like the Endocrine Society and National Osteoporosis Foundation can help you and your clinician tailor screening and treatment. For example, recommendations on DEXA timing and treatment thresholds are outlined in their clinical guidance and reviews, according to patient-friendly resources on osteoporosis treatment.

So where does this leave you? If PTSD has been part of your story, your bones deserve some attentionbut not fear. Start where you are. Add one helpful habit. Then another. Keep going. Your future selfsteadier on your feet, stronger in your bodywill thank you.

Conclusion
PTSD and fractures are connected through a web of biology and behaviorstress hormones, inflammation, sleep, movement, and medications all play a role. The risk is real, but it's also manageable. Solid habitsstrength and balance training, enough protein and vitamin D, better sleepcombined with trauma-informed care can stabilize bone density and reduce falls. If you recognize risk factors in yourself or someone you love, talk with a clinician about screening (DEXA, FRAX) and a coordinated plan. Small, steady steps truly matter. You don't have to choose between mental health and bone healthyou can protect both. What's one change you feel ready to try this week?

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.