Female residents with poor-quality social relationships may face a higher risk of bone loss, researchers have found.

In a study of more than 11,000 women, high levels of social stress were shown to be associated with lower bone mineral density, when adjusted for factors such as smoking status, hormone therapy use and physical activity.

Participants were questioned about social strain, social support and limitations on social activity at their enrollment as part of the U.S. Women’s Health Initiative study. Their bone mineral density levels were analyzed at enrollment and at a six-year follow-up.

Quality of social relationships was found to be more strongly related to bone loss than quantity, wrote the study’s lead author Shawna L. Follis, Ph.D. In addition, areas of bone loss were linked to the type of social stress experienced. More strain due to negative social relationships was associated with greater bone loss in the total hip, the lumbar spine (lower back) and the femoral neck (just below the ball of the ball-and-socket hip joint). Participants who reported more limitations on their social activities had greater bone loss at the total hip and femoral neck.

The study does not establish cause. But when taken together with earlier findings, it suggests that improving one’s social life may help prevent bone loss and related injuries, the authors suggested. “The results support community-building social stress interventions in postmenopausal women to potentially limit bone loss,” concluded Follis.