Skip to main content

If you’re worried about bone loss, there are several preventive strategies you can take to maintain bone density, such as avoiding alcohol and tobacco, participating in weight-bearing exercise, and getting plenty of vitamin D and calcium. But there are two other, lesser-known, strategies that might be important, too: managing stress and getting plenty of sleep.

What do stress and sleep have to do with bone health? Chronic stress and sleep deprivation can lead to elevated cortisol levels, which have been associated with bone loss.

Architecture of Bones

We tend to think of bones as hard and durable, but in fact, they are comprised of living tissue that grows and changes throughout our lives. Bone formation is sort of like a never-ending remodel project taking place within the body. Old bone is constantly being removed and new bone formed. This process is regulated by two cell types: osteoblasts, which aid in depositing new bone tissue, and osteoclasts, which break down old bone tissue. Disruption to either of these cell types results in changes in bone density.

In childhood, adolescence, and early adulthood, new bone formation outpaces the removal of old bone. As we age, however, that process reverses—as a result of aging, as well as a variety of other lifestyle factors.

The Cortisol Connection

Cortisol is one of the body’s stress hormones. It is secreted by the adrenal glands and is supposed to regulate the body’s stress response. During the fight-or-flight response, the body releases a surge of adrenaline, followed by a surge of cortisol. The cortisol serves to replenish energy—energy that was theoretically “spent” during the adrenaline surge. When it comes to acute stress and fight-or-flight situations, cortisol is helpful; however, with long-term, chronic stress, cortisol levels in the body can remain elevated for long periods of time and this can have negative effects on your health.

Elevated cortisol levels interfere with osteoblast formation and dramatically decreases bone building—resulting in reduced bone density. Put simply—more bone tissue is broken down than deposited. As a result, patients with chronically elevated cortisol levels may be at an increased risk for osteoporosis.

Scroll to Continue


Stress, Sleep, and Bones

As long as your body remains in a state of chronic stress—with elevated cortisol levels—bone formation is disrupted. Without the opportunity for adequate rest and repair, the body simply cannot keep up with the bone-building process.

Bone loss is a silent condition—it has no symptoms and occurs slowly over many years. But, this silent condition has serious repercussions, namely fractures. If you want to take care of your bones—and your health—start by reducing your stress and making healthy sleep a priority.

If you want to reduce cortisol levels and improve bone health, here are a few simple lifestyle changes that go a long way:

  • Get approximately eight hours of sleep per night.
  • Prevent chronic stress by setting healthy boundaries, employing time management techniques, and maintaining a work-life balance.
  • Engage in stress management techniques, such as deep breathing, meditation, and guided imagery.
  • Optimize vitamin D levels
  • Participate in regular exercise. Cardiovascular exercise will help you to manage stress and maintain heart health; weight-bearing exercise helps build healthy bones.


Pereira RM, Delany AM, Canalis E. Cortisol inhibits the differentiation and apoptosis of osteoblasts in culture. Bone. 2001; 28(5):484-90.