The PTSD-Bone Axis: Evidence, Mechanisms, and Management

PURPOSE OF REVIEW: This review explores the relationship between post-traumatic stress disorder (PTSD) and bone health, focusing on how chronic psychological stress influences skeletal integrity through neuroendocrine, immune, and behavioral pathways. RECENT FINDINGS: Clinical and preclinical studies demonstrate PTSD is associated with reduced bone mineral density, impaired healing, and fracture risk. Mechanistic insights implicate hypothalamic-pituitary-adrenal (HPA) axis dysregulation, sympathetic nervous system (SNS) overactivation, and chronic inflammation in disrupting bone remodeling. Additional risk modifiers include sex-specific biology, early-life adversity, and glucocorticoid sensitivity. However, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), anti-inflammatory agents, and emerging tools like exosomal profiling and microbiome modulation show promise in mitigating stress-related bone loss. PTSD contributes to skeletal fragility through complex, multisystem mechanisms. Trauma-informed care integrating bone health screening and personalized interventions may improve psychological and musculoskeletal outcomes. Future research should prioritize longitudinal, mechanistic studies to guide holistic management of trauma-related disease.