Cortisol and bone loss

Cortisol is your body's main stress hormone, made by the adrenal glands. In short bursts, it's helpful — it manages energy, inflammation, and blood pressure. But when cortisol stays high for a long time, whether from chronic stress, certain illnesses, or long-term corticosteroid medication, it starts to interfere with how bone is built and maintained.

High cortisol slows down osteoblasts, the cells that build new bone, while allowing osteoclasts, the cells that break bone down, to keep working. It also reduces calcium absorption in the gut and increases calcium loss through the kidneys, and it can lower estrogen and testosterone, two hormones bone depends on. The combined effect is less new bone formation and more bone breakdown over time.

This is why conditions like Cushing's syndrome, and long-term use of corticosteroid medications (sometimes called glucocorticoid-induced osteoporosis), are known causes of bone loss. Chronic psychological stress alone hasn't been shown to cause osteoporosis the way these medical conditions can, but managing stress is still a reasonable part of an overall healthy lifestyle. If you take steroid medication long-term, your prescriber can help weigh the risks and monitor your bone health.