Depression and Osteoporosis in Men: Association or Casual Link?

Abstract

The longer life expectancy of women than that of men and, therefore, the longer exposure to fracture risk has, at least partially, led to neglect of osteoporosis in men. Recently, unipolar depression, which is 2 times more frequent in women than in men, has been linked to osteoporosis. However, it is quite possible that this diagnosis may escape detection in men because of a different behavioral phenotype between the genders. A potential mechanism of bone loss in depression has been proposed, involving concurrent activation of the hypothalamopituitary-adrenal and sympatho-adrenal axes, suppression of the gonadal and somatotrophic axes, and high inteleukin-6 and low leptin levels. We suggest that similar neurohormonal changes may cause osteoporosis in men. OSTEOPOROSIS IN MENOver the last two decades, osteoporosis has received increasing attention as a major health problem worldwide. It has been estimated that in the United States alone, 10 million people suffer from osteoporosis, and 18 million more are afflicted with osteopenia, which has been associated with an increased risk for nontraumatic fractures later in life. 1Osteoporosis is still regarded mainly as a womens disease. This could be attributed to a higher bone mass in men and the absence of menopause, as well as to the fact that men undergo fewer bone mineral density (BMD) measurements than women.2 Since life expectancy has considerably increased worldwide over the last century (with mens longevity, however, still lagging somewhat behind that of women: 75v. 80 years in the U.S.), more and more older men are now are now expected to develop multiple coexisting illnesses contributing to bone loss. With advancing age, the likelihood of accidental falls also increases and this is accompanied by an elevated likelihood of sustaining fractures. In the following review we examine the tentative association of depression and osteoporosis in men.

Depression induces bone loss through stimulation of the sympathetic nervous system

“…Nevertheless, our attempts to assess the specific role of central IL-1 in the depression-induced bone loss were unsuccessful because IL1rKO mice were resistant to CMS, namely, they did not exhibit CMS-induced decreases in depressive or skeletal parameters. In addition, it has been recently suggested that depression-induced elevations in the serum levels of another cytokine, IL-6, comprise a risk factor for osteoporosis (25,32). However, this suggestion is not supported by the present findings, which suggest that an increase in blood IL-6 levels is not critically involved in CMS-induced bone loss.…”

Chronic Psychological Stress as a Risk Factor of Osteoporosis

“…However, this association in postmenopausal women may be masked by other factors contributing to low BMD, such as estrogen depletion, reduced physical activity, and drug treatments [32]. There were several studies concerning the relation between osteoporosis and depression in men [35,36]. In a population study of 80 depression patients, including 27 men, the spine BMD was 15% lower than in the control subjects [37].…”

Depression, Selective Serotonin Reuptake Inhibitors, and Osteoporosis

“…The other approach, that depression is the causal process, claims that most studies demonstrate an association of depression with low BMD rather than with increased fracture rate. That depression is the causal attribute has been further proposed based on the wellestablished depression-induced increases in glucocorticoids and norepinephrine [10], agents also known to suppress bone formation and bone mass [11,12].…”