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.
Key Words
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Article info
Publication history
Published online: May 18, 2009
Accepted:
March 13,
2009
Received in revised form:
February 25,
2009
Received:
December 29,
2008
Identification
Copyright
© 2009 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
