Mild Depression Tied to Bone Loss
Signs of Low Bone Density Seen in Younger Women
Nov. 26, 2007 -- Even mild
depression may significantly increase a woman's risk for developing
osteoporosis, new government-funded research suggests.
The level of bone density loss attributed to depression in the study was
similar to that previously associated with other well- known osteoporosis risk
smoking cigarettes and getting little or no exercise.
The average age of the women in the study was 35 and none had reached
"The question of whether depression is associated with osteoporosis had
not really been addressed in younger women," researcher Giovanni Cizza, MD,
PhD, of the National Institute of Mental Health (NIMH) tells WebMD.
(If you’re a woman with depression, have you considered a bone density
test? Tell us about it on WebMD's
Depression: Support Group message board.)
Depression and Bone Loss
Earlier research suggested a link between depression and bone density loss
in older women, and a study published earlier this year found that use of
selective serotonin reuptake inhibitor (SSRI) antidepressants may exacerbate
bone thinning in older women.
The newly published study, published today in the Archives of Internal
Medicine, included 89 women with mostly mild depression between the ages of
21 and 45 and 44 similarly-aged women without depression.
Except for depression, the women in the two groups had similar risk factors
Bone mineral density testing revealed that 17% of the depressed women showed
evidence of bone thinning at a particularly vulnerable area of the thigh bone,
compared to 2% of women who were not depressed.
Lower bone density at the lumbar spine was also seen in 20% of the depressed
women, compared to 9% of women without depression.
Cizza says depression was associated with a 2% reduction in bone mass at the
hip -- roughly seven times the expected loss for a healthy premenopausal woman
and comparable to the accelerated loss seen each year in the first few years
Other risk factors for bone loss, like low calcium intake, cigarette
smoking, and lack of exercise did not explain the difference in outcomes. And a
subanalysis of patients taking antidepressants suggested that the medications
were not a factor in the bone loss.
"This study shows that even mild depression can have very real
consequences for bones," Cizza tells WebMD. "Depression needs to be
recognized as a risk factor for bone loss in premenopausal women and general
practitioners should consider testing women with depression for osteoporosis
and treating them if necessary."
Hormones and Bones
It has been suggested that specific hormonal changes associated with
depression lead to bone loss, and the study strengthens the case for the
Study participants with depression had much higher blood levels of
inflammatory proteins secreted by the immune system than the participants
without depression and much lower levels of anti-inflammatory proteins.
Inflammation has previously been linked to other illnesses, including
heart disease and
type 2 diabetes.
An inflammatory protein that has specifically been linked to bone loss --
interleukin-6 -- was found to be significantly elevated in the women with
depression, compared to women without depression.
Ten million older Americans have osteoporosis, and an estimated 1.5 million
experience fractures related to osteoporosis every year.
Because early osteoporosis is primarily a silent disease, knowing that even
mild depression can lead to bone loss years before fractures occur is of major
clinical importance, NIMH deputy director Richard Nakamura, PhD, said in a
"Too often, the first symptom a clinician sees is when a patient shows
up with a broken bone," he notes. "Now we know that depression can
serve as a red flag -- that depressed women are more likely than other women to
approach menopause already at higher risk of fractures."