Abstract
Major depressive disorder has been associated with low bone mineral density. The strength
of this association, however, varies greatly among studies; the direction of the causative
link is still controversial, and the etiology remains unclear. We aimed to confirm
this association, assess its magnitude and estimate its clinical relevancy. A total
of 535 articles were initially identified and the research synthesis was based on
33 qualified articles. Of these, 25 articles (or 76%) showed an inverse relationship
between major depression or minor depression or depressive symptoms and bone mineral
density or bone turnover. Meta-analysis could be performed on 20 of the initially
selected 33 articles. Standardized weighted differences in mean AP spine, total femur
and femoral neck bone mineral density, each from at least 10 studies, were computed
in g/cm2 and transformed into percent differences. At each site, bone mass was lower in subjects
with depression as compared to controls: AP spine bone mineral density was 4.73% lower
(95% CI −7.28% to −2.19%, p<0.0001; n=16 studies), total femur bone mineral density
was 3.53% lower (95% CI −5.66% to −1.41%, p<0.001; n=13 studies), and femoral neck
bone mineral density was 7.32% lower (95% CI −10.67% to −3.96%; p<0.0005; n=8 studies).
In conclusion, major depressive disorder was associated with lower bone mineral density
at the AP spine, femoral neck, and total femur. The deficits in bone mineral density
in subjects with depression are of clinical significance and likely to increase fracture
risk over the lifetime of these subjects.
Key words
bone - fractures - stress - antidepressants - women - evidence-based medicine - leptin
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Correspondence
G. CizzaMD, PhD, MHSc
Building 10, CRC, Rm. 6-3940
MD 20892-1613 Bethesda
USA
Phone: +1/301/496 87 11
Fax: +1/301/480 20 47
Email: cizzag@intra.niddk.nih.gov