Even Mild Depression Tied to Bone Loss
Depression Can Cause Low Bone Density — Even in Younger Women
Even mild depression may significantly increase a woman's risk for developing osteoporosis, new government-funded research suggests.
The degree of bone density loss caused by depression in the study was similar to that previously associated with other well-known osteoporosis risk factors, including getting little or no exercise and smoking. The average age of the women in the study was only 35 and none had reached menopause.
The newly published study, published in the November 26, 2007 issue of Archives of Internal Medicine, included 89 women with mostly mild depression between the ages of 21 and 45 and 44 similarly aged women without depression.
Except for depression, the women in the two groups had similar risk factors for osteoporosis.
Bone mineral density testing revealed that 17% of the depressed women showed evidence of bone thinning at a particularly vulnerable area of the thigh bone, compared to 2% of women who were not depressed.
Study participants with depression had much higher blood levels of inflammatory proteins secreted by the immune system than the participants without depression and much lower levels of anti-inflammatory proteins.
An inflammatory protein that has specifically been linked to bone loss — interleukin-6 — was found to be significantly elevated in the women with depression, compared to women without depression.
Ten million older Americans have osteoporosis, and an estimated 1.5 million experience fractures related to osteoporosis every year.
So should I take Prozac to treat depression associated osteoporosis?
No. A study published earlier this year found that use of selective serotonin reuptake inhibitor (SSRI) antidepressants may exacerbate bone thinning in older women.
Low Bone Mass in Premenopausal Women With Depression
Farideh Eskandari, MD, MHSc; Pedro E. Martinez, MD; Sara Torvik, MSN; Terry M. Phillips, PhD; Esther M. Sternberg, MD; Sejal Mistry, BS; Donna Ronsaville, PhD; Robert Wesley, PhD; Caitlin Toomey, BS; Nancy G. Sebring, MEd; James C. Reynolds, MD; Marc R. Blackman, MD; Karim A. Calis, PharmD; Philip W. Gold, MD; Giovanni Cizza, MD, PhD, MHSc; for the Premenopausal, Osteoporosis Women, Alendronate, Depression (POWER) Study Group.
Arch Intern Med. 2007;167(21):2329-2336.
Background: An increased prevalence of low bone mineral density (BMD) has been reported in patients with major depressive disorder (MDD), mostly women.
Methods: Study recruitment was conducted from July 1, 2001, to February 29, 2003. We report baseline BMD measurements in 89 premenopausal women with MDD and 44 healthy control women enrolled in a prospective study of bone turnover. The BMD was measured by dual-energy x-ray absorptiometry at the spine, hip, and forearm. Mean hourly levels of plasma 24-hour cytokines, 24-hour urinary free cortisol, and catecholamine excretion were measured in a subset of women. We defined MDD according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).
Results: The prevalence of low BMD, defined as a T score of less than -1, was greater in women with MDD vs controls at the femoral neck (17% vs 2%; P = .02) and total hip (15% vs 2%; P = .03) and tended to be greater at the lumbar spine (20% vs 9%; P = .14). The mean ± SD BMD, expressed as grams per square centimeters, was lower in women with MDD at the femoral neck (0.849 ± 0.121 vs 0.866 ± 0.094; P = .05) and at the lumbar spine (1.024 ± 0.117 vs 1.043 ± 0.092; P = .05) and tended to be lower at the radius (0.696 ± 0.049 vs 0.710 ± 0.055; P = .07). Women with MDD had increased mean levels of 24-hour proinflammatory cytokines and decreased levels of anti-inflammatory cytokines.
Conclusions: Low BMD is more prevalent in premenopausal women with MDD. The BMD deficits are of clinical significance and comparable in magnitude to those resulting from established risk factors for osteoporosis, such as smoking and reduced calcium intake. The possible contribution of immune or inflammatory imbalance to low BMD in premenopausal women with MDD remains to be clarified.