MELBOURNE, Australia—Bone health is an emerging concern in patients with depression, who are also at increased risk for osteoporosis, suggests a review study published in Psychotherapy and Psychosomatics.¹

Depression, osteoporosis link suggests neuroendocrine role

"The exact mechanism by which low bone mineral density is evident in those with depression still remains to be determined [but a] number of biological mechanisms [including] neuroendocrine alterations and leptin and inflammatory marker dysregulation [that are] evident in the aetiology of both depression and osteoporosis have been identified as potential mediators,” lead researcher Lana Williams, PhD, of the University of Melbourne, Victoria, Australia, told MSKreport.com

Depressive behavior, meds also contribute

“Furthermore, behavioral distortions typically associated with psychiatric illness, including increased cigarette smoking and alcohol consumption, physical inactivity and poor dietary patterns, have been shown to exert negative effects on bone metabolism and thus may also confound the relationship. Additionally, some medications used to treat depression, such as selective serotonin reuptake inhibitors (SSRI) have recently been shown to affect bone mineral density.”

The researchers reviewed studies from PubMed and Web of Science (ISI) databases that were published prior to 2007. They conducted their search using a combination of key words and terms including depression, major depressive disorder, osteoporosis, bone mineral density, hypothalamic-pituitary-adrenal axis, cortisol, cytokines, leptin, antidepressants, selective serotonin reuptake inhibitors, smoking, alcohol, physical activity and diet.

The researchers did not perform a meta-analysis of the data because of the heterogeneity of the studied populations and the differences in study designs as well as the tools used to identify depression in the various study populations.

Translating research into practice

Clearly, they write, more longitudinal studies are needed. Still “the current findings have clinical relevance given the health burden of both depression and osteoporosis, and provide evidence to support monitoring bone health in high-risk individuals diagnosed with depression,” the researchers conclude. “Furthermore, an interdisciplinary approach for endocrine patients is a novel concept that would benefit patients with co-morbid depression.” Such care may include suggesting a healthy lifestyle to patients with depression, “which will in turn have flow on effects on bone health.”

Reference

1. Williams LJ, Pasco JA, Jacka FN, et al. Depression and bone metabolism. Psychother Psychosom. 2009;78:16-25.