Anxiety Levels Predict Bone Mineral Density in Postmenopausal Women Undergoing Oral Bisphosphonates: A Two-Year Follow-Up

Abstract

Clinical psychological factors may predict medical diseases. Anxiety level has been associated with osteoporosis, but its role on bone mineral density (BMD) change is still unknown. This study aimed to investigate the association between anxiety levels and both adherence and treatment response to oral bisphosphonates (BPs) in postmenopausal osteoporosis. BMD and anxiety levels were evaluated trough dual-energy X-ray absorptiometry and the Hamilton Anxiety Rating Scale (HAM-A), respectively. Participants received weekly medication with alendronate or risedronate and were grouped according to the HAM-A scores into tertiles (HAM-A 3 > HAM-A 2 > HAM-A 1). After 24 months, BMD changes were different among the HAM-A tertiles. The median lumbar BMD change was significantly greater in both the HAM-A 2 and HAM-A 3 in comparison with the HAM-A 1. The same trend was observed for femoral BMD change. Adherence to BPs was >75% in 68% of patients in the HAM-A 1, 79% of patients in the HAM-A 2, and 89% of patients in the HAM-A 3 (p = 0.0014). After correcting for age, body mass index, depressive symptoms, and the 10-yr. probability of osteoporotic fractures, anxiety levels independently predicted lumbar BMD change (β = 0.3417, SE 0.145, p = 0.02). In conclusion, women with higher anxiety levels reported greater BMD improvement, highlighting that anxiety was associated with adherence and response to osteoporosis medical treatment, although further research on this topic is needed.

Interrelations between clinical-psychological features and bone mineral density changes in post-menopausal women undergoing anti-osteoporotic treatment: a two-year follow-up

“…Higher anxiety levels could also contribute to the development of an adequate adherence to medical treatment in post-menopausal osteoporotic women ( 20 ). It is known that a lower adherence exposes patients to a poorer treatment response and to a worst BMD ( 49 ).…”

“…These variables allowed, through a computer-based algorithm (FRAX ® , http://www.shef.ac.uk/FRAX , accessed at the time of recruitment) ( 36 ), to evaluate the probability of major osteoporotic and hip fractures within the next 10 years. At baseline and after a 2-year follow-up, the levels of anxiety, depression and HRQoL were assessed through a gold standard psychological interview ( 20 ). The Hamilton Anxiety Rating Scale (HAM-A) was administered to detect the entity of anxious symptoms, through the scoring of 14 items (assessed from 0, not present, to 4, severe) which are based on psychological and somatic symptoms (anxiety, tension, fear, insomnia, intellectual impairment, depression, somatic symptoms, sensory, cardiovascular, respiratory, gastrointestinal, genitourinary, autonomic diseases, and observed behavior during the interview.…”

“…It was previously reported that anxiety levels are significantly associated with BMD and that anxiety levels are predictors of BMD loss ( 19 , 20 ). However, it is still unknown whether anxiety levels change over time in post-menopausal women receiving standard antiresorptive medical treatment for osteoporosis.…”

Common osteoporosis drug associated with increased rates of depression and anxiety

“…A 2010 report demonstrated an association between the bisphosphonates as a class and depressive symptoms in humans, reporting a reported odds ratio (ROR) of 2.3 (2.1–2.5) in WHO database, while in was not significant for alendronate 1.3 (0.7–2.5) in the Lareb database 14 . Interestingly, a longitudinal study of osteoporosis patients revealed that anxiety was as an independent predictor of bone mineral density 15 .…”

Editorial: Psychological Factors as Determinants of Medical Conditions, Volume II

“…Life expectancy is increasing world-wide, thus age-related diseases are becoming a major health concern. Chronic diseases and related outcomes, such as osteoporosis and associated fractures, diabetes, endocrine, and cardiovascular disease, may seriously impact people's quality of life and their perceived quality of life (Guicciardi, 2017 ; Marchetti et al, 2017 ; Catalano et al, 2020 ; Vita et al, 2020 ; Di Bari et al, 2021 ; Martino et al, 2021a , b , c ). This impact may, in turn, lead to psychopathological consequences (Di Giuseppe et al, 2020a ; Giusti et al, 2021 ).…”