Depression causes brittle bones

Researchers have established an association between major depression and osteoporosis and an increase in the incidence of fractures. In a recent article published in the November 07, 2006 issue of the Proceedings of the National Academy of Sciences, they noted that stress resulted in fewer bone-forming cells, osteoblasts, and the loss of bone mass1. The processes involved in this link are still unknown, although the findings that bone mass returned to control levels when antidepressant treatment reduced depression-like behavior, suggest that increasing bone mass involved other processes besides antidepressant effects.

There is need for further research into the brain-behavior-bone link, which the findings of another recent study that middle-aged and post-menopausal women with major depression (MD) are at a higher risk of developing osteoporosis, and which a concomitant diagnosis of borderline personality disorder (BPD) worsens, further highlights2. Borderline personality disorder is often chronic and the individuals have major depression. The researchers found significantly lower bone mineral density (osteopenia) in women with this dual diagnosis than in those with either, and in older than younger women with just major depression did.

 

Women with major depression and borderline personality disorder also had higher levels of osteocalcin, which indicates higher bone turnover, although lower estrogen levels in the older women could also be a factor, even if not measured in this study. Incidentally, cigarette smoking also increases the risk for osteoporosis, which would increase even further in older women that smoke. These studies point to the need to evaluate all individuals with major depression for bone mineral density, and persons with MD/BPD even more so, indeed from an early age.

 

References

 

1. Yirmiya R et al. Depression induces bone loss through stimulation of the sympathetic nervous system. Proc Natl Acad Sci USA 2006 Nov 7; 103:16876-81.   

 

2. Kahl KG et al. Bone mineral density, bone turnover, and osteoprotegerin in depressed women with and without borderline personality disorder. Psychosom Med 2006 Sep/Oct; 68:669-74