title: The role of stress-induced cortisol in the relationship between depression and decreased bone mineral density.
abstract: BACKGROUND
  This study was designed to test the hypothesis that cortisol mediates the relationship between bone density and depression in postmenopausal women.
  
  
  METHODS
  Nineteen women aged 52-79 who had been assessed for bone mineral density by dual-energy x-ray absorptiometer (DEXA) were evaluated for depression and anxiety. Diurnal and stress-induced measures of salivary cortisol were obtained during the following week and at a laboratory session involving a speech task.
  
  
  RESULTS
  Nine volunteers reported depression while 10 were never depressed. Ever depressed women had significantly lower total lumbar and right femur DEXA Z scores than never depressed (t(17) = 2.5, p = .019 and t(17) = 2.06, p = .05, respectively). Ever depressed women demonstrated a significant increase in salivary cortisol (area under the curve (AUC) = 27.83, SD = 37.64) compared to never depressed women (AUC = -13.34, SD = 19.55) (t(17) = -3.041, p = .007) during a psychological challenge. There were significant inverse relationships between salivary cortisol AUC values and bone density Z scores at every measured bone site. Mediation analyses suggest that 51 - 67% of the association between depression and bone density could be attributed to stress-induced changes in cortisol.
  
  
  CONCLUSIONS
  Cortisol hypersecretion in response to stress may, in part, explain the impact of depression on bone density in post-menopausal women.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. furlan@mail.med.upenn.edu
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Furlan
authors.forename: Tom
authors.initials: T
authors.lastname: Ten Have
authors.forename: Mark
authors.initials: M
authors.lastname: Cary
authors.forename: Babette
authors.initials: B
authors.lastname: Zemel
authors.forename: Felix
authors.initials: F
authors.lastname: Wehrli
authors.forename: Ira R
authors.initials: IR
authors.lastname: Katz
authors.forename: David R
authors.initials: DR
authors.lastname: Gettes
authors.forename: Dwight L
authors.initials: DL
authors.lastname: Evans
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology; D003866:Depressive Disorder / Q000097:blood* / Q000523:psychology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000502:physiology*; D008875:Middle Aged; D017698:Postmenopause; D011569:Psychiatric Status Rating Scales; D012463:Saliva / Q000378:metabolism; D012931:Social Environment; D013315:Stress, Psychological / Q000097:blood*
chemical_list: D006854:Hydrocortisone