HEALTH NEWS

Study Title:

Depression and Bone Loss

Study Abstract

Background
The role of depression as a risk factor for low bone mineral density (BMD) and osteoporosis is not fully acknowledged, mainly because the relevant literature is inconsistent and because information on the mechanisms mediating brain-to-bone signals is rather scanty.

Methods
Searching databases and reviewing citations in relevant articles, we identified 23 studies that quantitatively address the relationship between depression and skeletal status, comparing 2327 depressed with 21,141 nondepressed individuals. We subjected these studies to meta-analysis, assessing the association between depression and BMD as well as between depression and bone turnover markers.

Results
Overall, depressed individuals displayed lower BMD than nondepressed subjects, with a composite weighted mean effect size (d) of −.23 (95% confidence interval: −.33 to −.13; p < .001). The association between depression and BMD was similar in the spine, hip, and forearm. It was stronger in women (d = −.24) than men (d = −.12) and in premenopausal (d = −.31) than postmenopausal (d = −.12) women. Only women individually diagnosed for major depression by a psychiatrist with DSM criteria displayed significantly low BMD (d = −.36), women diagnosed by self-rating questionnaires did not (d = −.06). Depressed subjects had increased urinary levels of bone resorption markers (d = .52).

Conclusions
The present findings portray depression as a significant risk factor for low BMD. Premenopausal women who are psychiatrically diagnosed with major depression are particularly at high-risk for depression-associated low BMD. Hence, periodic BMD measurements and antiosteoporotic prophylactic and curative measures are strongly advocated for these patients.

From press release:

Research carried out among thousands of people has shown a clear connection between depression and a loss of bone mass, leading to osteoporosis and fractures.

This was revealed by Hebrew University of Jerusalem researchers, Prof. Raz Yirmiya, head of the Brain and Behavior Laboratory, and Prof. Itai Bab, head of the Bone Laboratory. They further revealed that the relationship between depression and bone loss is particularly strong among young women.

Osteoporosis is the most widespread degenerative disease in the developed world, afflicting 1 in 3 women and 1 in 5 men over 50. Sufferers experience decrease in bone density, which often leads to bone fractures. In many cases, these fractures cause severe disability and even death.

Despite the accumulating evidence for a connection between depression and decreased bone density, official authorities, such as the US National Institutes of Health and the World Health Organization, have not yet acknowledged depression as a risk factor for osteoporosis, due to the lack of studies in large samples. To remedy this situation, the Hebrew University researchers assembled the data from all studies on the subject conducted to date, and analyzed them using a special statistical approach called meta-analysis.

The results were recently reported in the journal Biological Psychiatry. In the article the Hebrew University scientists assessed data from 23 research projects conducted in eight countries, comparing bone density among 2,327 people suffering from depression against 21,141 non-depressed individuals.

The results, say the researchers, show clearly that depressed individuals have a substantially lower bone density than non-depressed people and that depression is associated with a markedly elevated activity of cells that breakdown bone (osteoclasts).

Yirmiya and Bab found that the association between depression and bone loss was stronger in women than men, especially young women before the end of their monthly period. This connection was especially strong in women with clinical depression diagnosed by a psychiatrist, but not in community studies, in which women subjectively identified themselves as being depressed using self-rating questionnaires.

Based on the present findings, Profs. Yirmiya and Bab propose that "all individuals psychiatrically diagnosed with major depression are at risk for developing osteoporosis, with depressed young women showing the highest risk. These patients should be periodically evaluated for progression of bone loss and signs of osteoporosis, allowing the use of anti-osteoporotic prophylactic and therapeutic treatments".

Study Information

Raz Yirmiya, Itai Bab
Major Depression Is a Risk Factor for Low Bone Mineral Density: A Meta-Analysis
Biological Psychiatry
2009 September
Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.