Psikososyal Stresin Kemik Sağlığına Etkileri

Mustafa Emre

doi:10.47141/geriatrik.727624

Derleme

Effects of Psychosocial Stress on Bone Health

Yıl 2020, Cilt: 3 Sayı: 2, 66 - 74, 31.08.2020

Mustafa Emre

https://doi.org/10.47141/geriatrik.727624

Öz

Summary: At the present time, it has been shown that physical stress stimulates the bone remodeling and affects the bone structure and function through complex mechanotransduction mechanisms. Recent research support the hypothesis that as well as physical stress, psychosocial stress (mental, behavioral, emotional) also affects the bone biology and eventually leads to osteoporosis, bone pain and increased risk of bone fracture. It has been considered that these effects originates from modulation of activity around the hypothalamic-pituitary-adrenal axis. In human and experimental animal studies, it has been reported that psychosocial stress brings about changes related to insulin-like growth factors, glucocorticoids, catecholamines, serotonin, GABA, brain-derived neurotrophic factor, receptor activator nuclear kappa ligand and release in cytokines (IL-1-6-11 -17, TNFα). This review summarises the current state of knowledge that psychosocial stress has a crucial role in structural adaptation of bone.

Keywords: Stress, osteoporosis, bone health

Anahtar Kelimeler

Stress, osteoporosis, bone health

Kaynakça

1. Alexander G. Robling and Charles H. Turner. Mechanical Signaling for Bone Modeling and Remodeling. Crit Rev Eukaryot Gene Expr. 2009;19(4): 319–338.
2. Klein-Nulend J, Bacabac RG, Bakker AD. Mechanical loading and how it affects bone cells: the role of the osteocyte cytoskeleton in maintaining our skeleton. Eur Cell Mater. 2012;24:278–91. doi:10.22203/eCM.v024a20
3. Tümay Sözen, Lale Özışık, Nursel Çalık Başaran. An overview and management of osteoporosis. Eur J Rheumatol. 2017; 4: 46-56.
4. Tan VPS, Macdonald HM, Kim S, et al. Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis. J Bone Miner Res. 2014; 29:2161–81. doi:10.1002/jbmr.2254
5. Maycas M, Esbrit P, Gortázar AR. Molecular mechanisms in bone mechanotransduction. Histol Histopathol. 2017;32(8):751-760. doi: 10.14670/HH-11-858.
6. Bonewald LF. The amazing osteocyte. J Bone Miner Res.2011; 26:229–38. doi:10.1002/jbmr.320
7. Baum A. Stress, intrusive imagery, and chronic distress. Health Psychol. 1990; 9:653–75. doi: 10.1037/0278-6133.9.6.653.
8. Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: a theo-retical integration and synthesis of laboratory research. Psychol Bull. 2004; 130:355–91. doi:10.1037/0033-2909.130.3.355
9. Pia-Maria Wipper, Michael Recto, Gisela Kuhn et al. Stress and Alterations in Bones: An interdisciplinary Perspective. Frontiers in Endocrinology. 2017;8. doi: 10.3389/fendo.2017.00096.
10. Levi L. Stress and Distress in Response to Psychosocial Stimuli: Laboratory and Real-Life Studies on Sympatho-Adrenomedullary and Related Reactions. Amsterdam: Elsevier (2016).
11. Miller GE, Murphy MLM, Cashman R, et al. Greater inflammatory activity and blunted glucocorticoid signaling in monocytes of chronically stressed caregivers. Brain Behav Immun. 2014; 41:191–9. doi: 10.1016/j.bbi.2014.05.016.
12. Yang L, Zhao Y, Wang Y, et al. The effects of psychological stress on depression. Curr Neuropharmacol. 2015; 13:494–504. doi: 10.2174/1570159X1304150831150507
13. Furlan PM, Ten Have T, Cary M, et al. The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density. Biol Psychiatry. 2005; 57:911–7. doi:10.1016/j. biopsych.2004.12.033
14. Julietta Ursula Schweiger, Ulrich Schweiger, Michael Hüppe, et al. Bone density and depressive disorder: a meta-analysis. Brain and Behavior. 2016; 6(8), e00489, doi: 10.1002/brb3.489
15. Azuma K, Adachi Y, Hayashi H, et al. Chronic psychological stress as a risk factor of osteoporosis. J UOEH. 2015; 37:245–53. doi:10.7888/juoeh.37.245
16. Williams LJ, Pasco JA, Jackson H, et al. Depression as a risk factor for fracture in women: a 10 year longitudinal study. J Affect Disord. 2016;192:34–40. doi:10.1016/j.jad.2015.11.048 17. Zhang ZD, Ren H, Shen GY, et al. Animal models for glucocorticoid-induced postmenopausal osteoporosis: An updated review. Biomed Pharmacother.2016; 84:438–46.
18. Yirmiya R, Bab I. Major depression is a risk factor for low bone mineral density: a meta-analysis. Biol Psychiatry.2009; 66:423–32. doi:10.1016/j. biopsych.2009.03.016
19. Willner P. Chronic mild stress (CMS) revisited: consistency and behavioural-neurobiological concordance in the effects of CMS. Neuropsychobiology.2005; 52:90–110. doi:10.1159/000087097.
20. Neporada KS, Leont’eva FS, Tarasenko LM. Chronic stress impairs structural organization of organic matrix in bone tissue of rat periodontium. Bull Exp Biol Med.2003;135:543–4. doi:10.1023/A:1025464932135.
21. Furuzawa M, Chen HY, Fujiwara S, et al. Chewing ameliorates chronic mild stress-induced bone loss in senescence-accelerated mouse (SAMP8), a murine model of senile osteoporosis. Exp Gerontol. 2014;55:12–8. doi:10.1016/j.exger.2014.03.003.
22. Seferos N, Kotsiou A, Petsaros S, et al. Mandibular bone density and calcium content affected by different kind of stress in mice. J Musculoskelet Neuronal Interact (2010) 10:231–6.
23. Toepfer P, Heim C, Entringer S, et al. Oxytocin path-ways in the intergenerational transmission of maternal early life stress. Neurosci Biobehav Rev. 2016; 73:293–308. doi:10.1016/j.neubiorev. 2016.12.026.
24. Bowers ME, Yehuda R. Intergenerational transmission of stress in humans. Neuropsychopharmacology. 2016;41:232–44. doi:10.1038/npp.2015.247.
25. Kelly RR, McDonald LT, Jensen NR, et al. Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front Psychiatr. 2019; 10:1-21. doi: 10.3389/fpsyt.2019.00200.
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29. Paratz ED, Katz B. Ageing Holocaust survivors in Australia. Med J Aust.2011;194:194–7. doi: 10.5694/j.1326-5377.2011.tb03771.x
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32. Chrousos GP. Stress, chronic inflammation, and emotional and physical well-being: concurrent effects and chronic sequelae. J Allergy Clin Immunol. 2000;106 (5 Suppl): S275–91. doi: 10.1067/mai.2000.110163
33. Eastell R, O’Neill TW, Hofbauer LC, et al. Postmenopausal osteoporosis. Nat Rev Dis Primer. 2016; 2:16069. doi: 10.1038/nrdp.2016.69
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35. Canalis E. Growth factor control of bone mass. J Cell Biochem. 2009;108:769–77. doi: 10.1002/jcb.22322
36. Crane JL, Zhao L, Frye JS, et al. IGF-1 Signaling is essential for differentiation of mesenchymal stem cells for peak bone mass. Bone Res. 2013;1:186–94. doi: 10.4248/BR201302007
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38. Rosen CJ, Donahue LR, Hunter SJ. Insulin-like growth factors and bone: The osteoporosis connection. Proc Soc Exp Biol Med. 1994; 206(2): 83-102. doi: 10.3181/00379727-206-43726.
39. Reijnders CM, Bravenboer N, Tromp AM, et al. Effect of mechanical loading on insulin-like growth factor-I gene expression in rat tibia. J Endocrinol. 2007;192:131–40. doi:10.1677/joe.1.06880.
40. Wasserman E, Webster D, Kuhn G, et al. Differential load-regulated global gene expression in mouse trabecular osteo-cytes. Bone. 2013;53:14–23. doi:10.1016/j.bone.2012.11.017.
41. Meakin LB, Todd H, Delisser PJ, et al. Parathyroid hormone’s enhancement of bones’ osteogenic response to loading is affected by ageing in a dose- and time-dependent manner. Bone. 2017; 98:59–67. doi:10.1016/j.bone.2017.02.009.
42. Kulkarni RN, Bakker AD, Everts V, et al. Mechanical loading prevents the stimulating effect of IL-1beta on osteocyte-modulated osteo-clastogenesis. Biochem Biophys Res Commun. 2012; 420:11–6. doi:10.1016/j. bbrc.2012.02.099.
43. Bot M, Milaneschi Y, Penninx BW, et al. Plasma insulin-like growth factor I levels are higher in depressive and anxiety disorders, but lower in antidepressant medication users. Psychoneuroendocrinology. 2016; 68:148– 55. doi: 10.1016/j.psyneuen.2016.02.028
44. Deuschle M, Blum WF, Strasburger CJ, et al. Insulin-like growth factor-I (IGF-I) plasma concentrations are increased in depressed patients. Psychoneuroendocrinology.1997; 22:493–503.
45. Santi A, Bot M, Aleman A, et al. Circulating insulin-like growth factor I modulates mood and is a biomarker of vulnerability to stress: from mouse to man. Transl Psychiatry. 2018; 8:142. doi: 10.1038/s41398-058-0196-5
46. Yasuhiro Tamura, Hiroko Okinaga, Hiroshi Takami. Glucocorticoid-induced osteoporosis; Biomedecine & Pharmacotherapy. 2004;58(9): 500-504.
47. Miller GE, Murphy MLM, Cashman R, et al. Greater inflammatory activity and blunted glucocorticoid signaling in monocytes of chronically stressed caregivers. Brain Behav Immun. 2014; 41:191–9. doi: 10.1016/j.bbi.2014.05.016
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Psikososyal Stresin Kemik Sağlığına Etkileri

Yıl 2020, Cilt: 3 Sayı: 2, 66 - 74, 31.08.2020

Mustafa Emre

https://doi.org/10.47141/geriatrik.727624

Öz

Özet: Günümüzde, fiziksel stresin kemiğin yeniden şekillenmesini uyardığını ve karmaşık mekanotransdüksiyon mekanizmalarıyla kemik yapısını ve işlevini etkilediği gösterilmiştir. Son yapılan araştırmalar, fiziksel stresin yanı sıra psikososyal stresinde (zihinsel, davranışsal, duygusal) kemik biyolojisini etkilediği ve sonunda osteoporoza, kemik ağrılarına ve kemik kırık riskinin artmasına neden olduğu hipotezine zemin hazırlamıştır. Bu etkiler, muhtemelen hipotalamik-hipofiz-adrenal eksenindeki aktivitenin modülasyonu ile gerçekleştirildiği düşünülmektedir. İnsan ve deneysel hayvan çalışmalarında, psikososyal stresin insülin benzeri büyüme faktörleri, glukokortikoidler, katekolaminler, serotonin, GABA, beyin kaynaklı nörotrofik faktör, reseptör aktivatör nükleer kappa ligandı ve sitokinlerin (IL-1-6-11-17, TNFα) salınımında değişikliklere neden olduğu bildirilmiştir. Bu derlemede, psikososyal stresin kemiğin yapısal adaptasyonunda önemli bir oyuncu olduğuna dair mevcut bilgi durumu özetlenmiştir.

Anahtar kelimeler: Stres, osteoporoz, kemik sağlığı

Anahtar Kelimeler

Stres, osteoporoz, kemik sağlığı

Kaynakça

1. Alexander G. Robling and Charles H. Turner. Mechanical Signaling for Bone Modeling and Remodeling. Crit Rev Eukaryot Gene Expr. 2009;19(4): 319–338.
2. Klein-Nulend J, Bacabac RG, Bakker AD. Mechanical loading and how it affects bone cells: the role of the osteocyte cytoskeleton in maintaining our skeleton. Eur Cell Mater. 2012;24:278–91. doi:10.22203/eCM.v024a20
3. Tümay Sözen, Lale Özışık, Nursel Çalık Başaran. An overview and management of osteoporosis. Eur J Rheumatol. 2017; 4: 46-56.
4. Tan VPS, Macdonald HM, Kim S, et al. Influence of physical activity on bone strength in children and adolescents: a systematic review and narrative synthesis. J Bone Miner Res. 2014; 29:2161–81. doi:10.1002/jbmr.2254
5. Maycas M, Esbrit P, Gortázar AR. Molecular mechanisms in bone mechanotransduction. Histol Histopathol. 2017;32(8):751-760. doi: 10.14670/HH-11-858.
6. Bonewald LF. The amazing osteocyte. J Bone Miner Res.2011; 26:229–38. doi:10.1002/jbmr.320
7. Baum A. Stress, intrusive imagery, and chronic distress. Health Psychol. 1990; 9:653–75. doi: 10.1037/0278-6133.9.6.653.
8. Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: a theo-retical integration and synthesis of laboratory research. Psychol Bull. 2004; 130:355–91. doi:10.1037/0033-2909.130.3.355
9. Pia-Maria Wipper, Michael Recto, Gisela Kuhn et al. Stress and Alterations in Bones: An interdisciplinary Perspective. Frontiers in Endocrinology. 2017;8. doi: 10.3389/fendo.2017.00096.
10. Levi L. Stress and Distress in Response to Psychosocial Stimuli: Laboratory and Real-Life Studies on Sympatho-Adrenomedullary and Related Reactions. Amsterdam: Elsevier (2016).
11. Miller GE, Murphy MLM, Cashman R, et al. Greater inflammatory activity and blunted glucocorticoid signaling in monocytes of chronically stressed caregivers. Brain Behav Immun. 2014; 41:191–9. doi: 10.1016/j.bbi.2014.05.016.
12. Yang L, Zhao Y, Wang Y, et al. The effects of psychological stress on depression. Curr Neuropharmacol. 2015; 13:494–504. doi: 10.2174/1570159X1304150831150507
13. Furlan PM, Ten Have T, Cary M, et al. The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density. Biol Psychiatry. 2005; 57:911–7. doi:10.1016/j. biopsych.2004.12.033
14. Julietta Ursula Schweiger, Ulrich Schweiger, Michael Hüppe, et al. Bone density and depressive disorder: a meta-analysis. Brain and Behavior. 2016; 6(8), e00489, doi: 10.1002/brb3.489
15. Azuma K, Adachi Y, Hayashi H, et al. Chronic psychological stress as a risk factor of osteoporosis. J UOEH. 2015; 37:245–53. doi:10.7888/juoeh.37.245
16. Williams LJ, Pasco JA, Jackson H, et al. Depression as a risk factor for fracture in women: a 10 year longitudinal study. J Affect Disord. 2016;192:34–40. doi:10.1016/j.jad.2015.11.048 17. Zhang ZD, Ren H, Shen GY, et al. Animal models for glucocorticoid-induced postmenopausal osteoporosis: An updated review. Biomed Pharmacother.2016; 84:438–46.
18. Yirmiya R, Bab I. Major depression is a risk factor for low bone mineral density: a meta-analysis. Biol Psychiatry.2009; 66:423–32. doi:10.1016/j. biopsych.2009.03.016
19. Willner P. Chronic mild stress (CMS) revisited: consistency and behavioural-neurobiological concordance in the effects of CMS. Neuropsychobiology.2005; 52:90–110. doi:10.1159/000087097.
20. Neporada KS, Leont’eva FS, Tarasenko LM. Chronic stress impairs structural organization of organic matrix in bone tissue of rat periodontium. Bull Exp Biol Med.2003;135:543–4. doi:10.1023/A:1025464932135.
21. Furuzawa M, Chen HY, Fujiwara S, et al. Chewing ameliorates chronic mild stress-induced bone loss in senescence-accelerated mouse (SAMP8), a murine model of senile osteoporosis. Exp Gerontol. 2014;55:12–8. doi:10.1016/j.exger.2014.03.003.
22. Seferos N, Kotsiou A, Petsaros S, et al. Mandibular bone density and calcium content affected by different kind of stress in mice. J Musculoskelet Neuronal Interact (2010) 10:231–6.
23. Toepfer P, Heim C, Entringer S, et al. Oxytocin path-ways in the intergenerational transmission of maternal early life stress. Neurosci Biobehav Rev. 2016; 73:293–308. doi:10.1016/j.neubiorev. 2016.12.026.
24. Bowers ME, Yehuda R. Intergenerational transmission of stress in humans. Neuropsychopharmacology. 2016;41:232–44. doi:10.1038/npp.2015.247.
25. Kelly RR, McDonald LT, Jensen NR, et al. Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front Psychiatr. 2019; 10:1-21. doi: 10.3389/fpsyt.2019.00200.
26. Monolagas SC. Birth and death of bone cells. basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr. Rev. 2000;21, 115–117. 27. Cohen S, Janicki-Deverts D, Doyle WJ, et al. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci USA. (2012) 109:5995–9. doi: 10.1073/pnas.1118355109
28. El-Gabalawy R, Blaney C, Tsai J, et al. Physical health conditions associated with full and subthreshold PTSD in U.S. military veterans: results from the National Health and Resilience in Veterans Study. J Affect Disord. 2018;227:849–53. doi: 10.1016/j.jad.2017.11.058
29. Paratz ED, Katz B. Ageing Holocaust survivors in Australia. Med J Aust.2011;194:194–7. doi: 10.5694/j.1326-5377.2011.tb03771.x
30. Foertsch S, Haffner-Luntzer M, Kroner J, et al. Chronic psychosocial stress disturbs long-bone growth in adolescent mice Dis Model Mech. 2017; 10:1399–409. doi: 10.1242/dmm.030916
31. Bottaccioli AG, Bottaccioli F, Minelli A. Stress and the psyche-brain-immune network in psychiatric diseases based on psychoneuroendocrineimmunology: a concise review. Ann N Y Acad Sci. 2018; 1437:31–42. doi: 10.1111/nyas.13728
32. Chrousos GP. Stress, chronic inflammation, and emotional and physical well-being: concurrent effects and chronic sequelae. J Allergy Clin Immunol. 2000;106 (5 Suppl): S275–91. doi: 10.1067/mai.2000.110163
33. Eastell R, O’Neill TW, Hofbauer LC, et al. Postmenopausal osteoporosis. Nat Rev Dis Primer. 2016; 2:16069. doi: 10.1038/nrdp.2016.69
34. Pietschmann P, Mechtcheriakova D, Meshcheryakova A, et al. Immunology of osteoporosis: a mini-review. Gerontology. 2016; 62:128–37. doi: 10.1159/000431091
35. Canalis E. Growth factor control of bone mass. J Cell Biochem. 2009;108:769–77. doi: 10.1002/jcb.22322
36. Crane JL, Zhao L, Frye JS, et al. IGF-1 Signaling is essential for differentiation of mesenchymal stem cells for peak bone mass. Bone Res. 2013;1:186–94. doi: 10.4248/BR201302007
37. Zegarra-Valdivia JA. Insulin-like growth factor type 1 and its relation with neuropsychiatric disorders. Medwave. 2017; 17:e(7031) doi: 10.5867/medwave.2017.07.7031
38. Rosen CJ, Donahue LR, Hunter SJ. Insulin-like growth factors and bone: The osteoporosis connection. Proc Soc Exp Biol Med. 1994; 206(2): 83-102. doi: 10.3181/00379727-206-43726.
39. Reijnders CM, Bravenboer N, Tromp AM, et al. Effect of mechanical loading on insulin-like growth factor-I gene expression in rat tibia. J Endocrinol. 2007;192:131–40. doi:10.1677/joe.1.06880.
40. Wasserman E, Webster D, Kuhn G, et al. Differential load-regulated global gene expression in mouse trabecular osteo-cytes. Bone. 2013;53:14–23. doi:10.1016/j.bone.2012.11.017.
41. Meakin LB, Todd H, Delisser PJ, et al. Parathyroid hormone’s enhancement of bones’ osteogenic response to loading is affected by ageing in a dose- and time-dependent manner. Bone. 2017; 98:59–67. doi:10.1016/j.bone.2017.02.009.
42. Kulkarni RN, Bakker AD, Everts V, et al. Mechanical loading prevents the stimulating effect of IL-1beta on osteocyte-modulated osteo-clastogenesis. Biochem Biophys Res Commun. 2012; 420:11–6. doi:10.1016/j. bbrc.2012.02.099.
43. Bot M, Milaneschi Y, Penninx BW, et al. Plasma insulin-like growth factor I levels are higher in depressive and anxiety disorders, but lower in antidepressant medication users. Psychoneuroendocrinology. 2016; 68:148– 55. doi: 10.1016/j.psyneuen.2016.02.028
44. Deuschle M, Blum WF, Strasburger CJ, et al. Insulin-like growth factor-I (IGF-I) plasma concentrations are increased in depressed patients. Psychoneuroendocrinology.1997; 22:493–503.
45. Santi A, Bot M, Aleman A, et al. Circulating insulin-like growth factor I modulates mood and is a biomarker of vulnerability to stress: from mouse to man. Transl Psychiatry. 2018; 8:142. doi: 10.1038/s41398-058-0196-5
46. Yasuhiro Tamura, Hiroko Okinaga, Hiroshi Takami. Glucocorticoid-induced osteoporosis; Biomedecine & Pharmacotherapy. 2004;58(9): 500-504.
47. Miller GE, Murphy MLM, Cashman R, et al. Greater inflammatory activity and blunted glucocorticoid signaling in monocytes of chronically stressed caregivers. Brain Behav Immun. 2014; 41:191–9. doi: 10.1016/j.bbi.2014.05.016
48. Vega D, Maalouf NM, Sakhaee K. The role of receptor activator of nuclear factor-kappa B (RANK)/RANK ligand/osteoprotegerin: clinical implications. J Clin Endocrinol Metab.2007; 92:4514–21 doi: 10.1210/jc.2007-0646
49. Briot K, Roux C. Glucocorticoid-induced osteoporosis. RMD Open. 2015; 1:e00(0014) doi: 10.1136/rmdopen-2014-000014
50. Lopez-Alarcona C, Denicola A. Evaluating the antioxidant capacity of natural products: a review on chemical and cellular- based assays. Anal. Chim. Acta. 2013; 763: 1e10.
51. Suzuki H, Hayakawa M, Kobayashi K, et al. H2O2-derived free radicals treated fibrinectin substratum reduces the bone nodule formation of rat calvarial osteoblast. Mech. Ageing Dev. 1997; 98: 113–125.
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54. Nazrun AS, Khairunnur A, Norliza M, et al. Effects of palm tocotrienols on oxidative stress and bone strength in ovariectomised rats. Med Health. 2008; 3:247–55.
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Toplam 67 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Konular	Klinik Tıp Bilimleri
Bölüm	Derleme
Yazarlar	Mustafa Emre
Yayımlanma Tarihi	31 Ağustos 2020
Gönderilme Tarihi	7 Mayıs 2020
Kabul Tarihi	24 Ağustos 2020
Yayımlandığı Sayı	Yıl 2020 Cilt: 3 Sayı: 2

Kaynak Göster

APA	Emre, M. (2020). Psikososyal Stresin Kemik Sağlığına Etkileri. Geriatrik Bilimler Dergisi, 3(2), 66-74. https://doi.org/10.47141/geriatrik.727624
AMA	Emre M. Psikososyal Stresin Kemik Sağlığına Etkileri. GBD. Ağustos 2020;3(2):66-74. doi:10.47141/geriatrik.727624
Chicago	Emre, Mustafa. “Psikososyal Stresin Kemik Sağlığına Etkileri”. Geriatrik Bilimler Dergisi 3, sy. 2 (Ağustos 2020): 66-74. https://doi.org/10.47141/geriatrik.727624.
EndNote	Emre M (01 Ağustos 2020) Psikososyal Stresin Kemik Sağlığına Etkileri. Geriatrik Bilimler Dergisi 3 2 66–74.
IEEE	M. Emre, “Psikososyal Stresin Kemik Sağlığına Etkileri”, GBD, c. 3, sy. 2, ss. 66–74, 2020, doi: 10.47141/geriatrik.727624.
ISNAD	Emre, Mustafa. “Psikososyal Stresin Kemik Sağlığına Etkileri”. Geriatrik Bilimler Dergisi 3/2 (Ağustos 2020), 66-74. https://doi.org/10.47141/geriatrik.727624.
JAMA	Emre M. Psikososyal Stresin Kemik Sağlığına Etkileri. GBD. 2020;3:66–74.
MLA	Emre, Mustafa. “Psikososyal Stresin Kemik Sağlığına Etkileri”. Geriatrik Bilimler Dergisi, c. 3, sy. 2, 2020, ss. 66-74, doi:10.47141/geriatrik.727624.
Vancouver	Emre M. Psikososyal Stresin Kemik Sağlığına Etkileri. GBD. 2020;3(2):66-74.

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