Bone density and depressive disorder: a meta‐analysis

Abstract

BackgroundThe aim of this study was to evaluate the evidence of low bone mineral density (BMD) in depression. Low BMD is a major risk factor for osteoporotic fractures and frailty.MethodsThe searched database was Pubmed, Meta‐analysis included human studies in men and women fulfilling the following criteria: (1) assessment of BMD in the lumbar spine, the femur or the total hip; (2) comparison of BMD between depressed individuals and the healthy control group; (3) measurement of BMD using dual‐energy X‐ray absorptiometry (DEXA); and (4) data on the mean, standard deviation, or standard error of BMD.ResultsTwenty‐one studies were identified, encompassing 1842 depressed and 17,401 nondepressed individuals. Significant negative composite weighted mean effect sizes were identified for the lumbar spine (d = −0.15, 95%CL −0.22 to −0.08), femur (d = −0.34, 95%CL −0.64 to −0.05), and total hip (d = −0.14, 95%CL −0.23 to −0.05) indicating low BMD in depression. Examining men and women shows low bone density in the lumbar spine and femur in women and low bone density in the hip in men. The differences between men and women with MDD and the comparison group tended to be higher when examined by expert interviewers. Low bone density was found in all age groups.ConclusionsBone mineral density is reduced in patients with depressive disorders. The studies provide little evidence for potential relevant mediating factors.

The Effect of Depression, Generalized Anxiety, and Selective Serotonin Reuptake Inhibitors on Change in Bone Metabolism in Adolescents and Emerging Adults

“…Examination of the independent effect of anxiety disorders on bone mineralization is needed, given their high prevalence, their potential impact on sympathetic nervous system signaling, and their high comorbidity with depressive disorders. Of note, population‐based studies have largely failed to show an association between depression and bone mass . We propose that this may be attributable, at least in part, to the fact that the depression severity scales used in epidemiologic studies are not suited for distinguishing between depression and anxiety disorders.…”

“…Major depressive disorder (MDD) is characterized by depressed mood, anhedonia, neuro‐vegetative symptoms (eg, insomnia, anorexia, fatigue), and cognitive symptoms (eg, concentration difficulty) . MDD is associated with low bone mass, increasing one's lifetime risk for osteoporosis and fractures, as well as medical expenditures . The effects of MDD on bone mass has been attributed to dysregulation of the hypothalamic‐pituitary‐adrenal (HPA) axis, other hormonal abnormalities, autonomic nervous system dysfunction, and subclinical inflammation .…”

“…Notably, the association of MDD with bone mass holds across the age spectrum; however, other factors moderate it. For instance, bone mass may be more strongly impacted by MDD in women than in men and in clinical populations compared with epidemiologic samples . Additionally, psychotropic medications, particularly selective serotonin reuptake inhibitors (SSRIs), may accelerate bone loss and increase fracture risk …”

Bone health in bipolar disorder: a study protocol for a case–control study in Australia

“…Research is now emerging to suggest that poor bone health is yet another potential comorbidity 5 6. Both clinically diagnosed unipolar depression and depressive symptoms have been associated with deficits in bone mineral density (BMD) and increases in fracture risk in both men and women across the adult age range,7–10 as has schizophrenia,11 alcohol use12 and eating disorders 13. Furthermore, psychotropic agents commonly used in the treatment of bipolar disorder (antidepressants, antipsychotics and anticonvulsants), have each been shown to be independently detrimental to bone 14–16…”

Role of Inflammatory Bone Markers in the Antidepressant Actions of (R)-Ketamine in a Chronic Social Defeat Stress Model

“…Meta-analyses have demonstrated that depression is associated with low bone mineral density, especially in women ( Wu et al, 2009 ; Yirmiya and Bab, 2009 ; Schweiger et al, 2016 ). The osteoprotegerin (OPG)/receptor activator of nuclear factor kB (RANK)/RANK Ligand (RANKL)/pathway contributes to bone formation and resorption.…”