The correlation between malondialdehyde (MDA) and cortisol levels with bone mineral density (BMD) in women diagnosed with osteoporosis and osteopenia

Stress induces physiological and behavioral changes that can impair bone health and lead to bone loss, making chronic stress a risk factor for osteoporosis. Despite growing research on the effects of oxidative stress and cortisol on bone health, the relationship among MDA, cortisol, and BMD in patients with osteoporosis and osteopenia remains unclear. Investigating the combined effects of MDA and cortisol on BMD is essential for understanding the mechanisms of bone loss and identifying novel therapeutic targets in these patients. This study is a cross-sectional analytical investigation involving 49 women (mean age 59.53 ± 10.60; osteoporosis ( N = 12), osteopenia ( N = 20), and normal BMD ( N = 17)) who were referred to the Bone Densitometry Department at the Abadan Nuclear Medicine Center in 2024. The study included women seeking bone density assessments, with no restrictions on age, medical conditions, or medications. However, women with hypoadrenal or hyperadrenal disorders were excluded. All provided informed consent, while those hesitant to participate were excluded. Classification was based on T-scores: above − 1 for healthy bone density, between − 1 and − 2.5 for osteopenia, and below − 2.5 for osteoporosis. Bone indices, including BMD, Z-score, and T-score for the femur and lumbar vertebrae (L1-L4), were assessed using dual-energy X-ray absorptiometry (DXA). MDA and cortisol levels were measured using specialized kits and an ELISA reader. Data collected from patients were entered into IBM SPSS Statistics (version 16) for analysis. All statistical analyses were performed with a significance level of α = 0.05. The osteoporosis group had the highest mean age, at 69.25 ± 6.43 years, which was significantly higher ( P < 0.001). They also had the lowest mean BMD, T-score, and Z-score, with significant differences among all groups ( P < 0.001). The mean MDA level in the osteoporosis group was higher than in the other groups, but not significantly so. Similarly, cortisol levels were elevated in the osteopenia (333.84 ± 31.42) and osteoporosis (318.01 ± 58.13) groups compared to the normal BMD group, but the differences were not significant. A significant positive correlation was found between BMD, Z-score, and T-score ( P < 0.001). A significant negative correlation was found between MDA and BMD ( r = -0.287, P = 0.046). A negative correlation was noted between cortisol and BMD, although it was not statistically significant ( r = -0.079, p = 0.589). This study showed a negative correlation between MDA levels and BMD, suggesting that higher oxidative stress may be associated with lower BMD and increased fracture risk. Although cortisol levels also showed a negative correlation with BMD, it was not statistically significant. Elevated cortisol can reduce bone formation and increase resorption, suggesting a need for further research on its impact on bone health. These findings highlight the complex relationship between stress markers and BMD in osteoporosis, underlining the importance of early detection and management for better bone health and quality of life.