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The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density

  • Patricia M. Furlan
    Correspondence
    Address reprint requests to Dr. Patricia M. Furlan, Department of Psychiatry, University of Pennsylvania, 3535 Market, Room 3047, Philadelphia, PA 19104
    Affiliations
    Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

    Mental Illness Research Educational and Clinical Center, Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania
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  • Tom Ten Have
    Affiliations
    Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Mark Cary
    Affiliations
    Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Babette Zemel
    Affiliations
    Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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  • Felix Wehrli
    Affiliations
    Laboratory for Structural NMR Imaging, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
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  • Ira R. Katz
    Affiliations
    Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

    Mental Illness Research Educational and Clinical Center, Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania
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  • David R. Gettes
    Affiliations
    Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Dwight L. Evans
    Affiliations
    Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

    Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

    Department of Neuroscience, University of Pennsylvania, Philadelphia, Pennsylvania
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      Background

      This study was designed to test the hypothesis that cortisol mediates the relationship between bone density and depression in postmenopausal women.

      Methods

      Nineteen women aged 52–79 who had been assessed for bone mineral density by dual-energy x-ray absorptiometer (DEXA) were evaluated for depression and anxiety. Diurnal and stress-induced measures of salivary cortisol were obtained during the following week and at a laboratory session involving a speech task.

      Results

      Nine volunteers reported depression while 10 were never depressed. Ever depressed women had significantly lower total lumbar and right femur DEXA Z scores than never depressed (t(17) = 2.5, p = .019 and t(17) = 2.06, p = .05, respectively). Ever depressed women demonstrated a significant increase in salivary cortisol (area under the curve (AUC) = 27.83, SD = 37.64) compared to never depressed women (AUC = -13.34, SD = 19.55) (t(17) = -3.041, p = .007) during a psychological challenge. There were significant inverse relationships between salivary cortisol AUC values and bone density Z scores at every measured bone site. Mediation analyses suggest that 51 – 67% of the association between depression and bone density could be attributed to stress-induced changes in cortisol.

      Conclusions

      Cortisol hypersecretion in response to stress may, in part, explain the impact of depression on bone density in post-menopausal women.

      Key words

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