title: Depression in anorexia nervosa: a risk factor for osteoporosis.
abstract: BACKGROUND
  Both anorexia nervosa (AN) and depression are associated with osteoporosis. We hypothesized that adolescent girls with AN and depression will have lower bone mineral density (BMD) than anorexic girls without depression.
  
  
  OBJECTIVE
  The objective of this study was to investigate whether depression is an independent risk factor for osteoporosis in anorexic adolescent girls.
  
  
  METHODS
  This study was cross-sectional.
  
  
  METHODS
  This study was conducted at the University Children's Hospital (Bialystok, Poland) from October 2002 through September 2003.
  
  
  METHODS
  Forty-five Caucasian anorexic girls aged 13-23 yr, matched by age, Tanner stage, weight, height, calcium intake, and duration of AN, were studied, including 14 with comorbid depression (based on Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale) and 31 anorexic girls without depression.
  
  
  METHODS
  Total body and lumbar spine (LS) BMD, fat mass, and lean mass assessed using dual-energy x-ray absorptiometry were compared between AN girls with and without depression.
  
  
  RESULTS
  BMD was reduced in both groups, relative to reference data, but girls with AN and depression had lower BMD than those with AN alone (LS Z-scores, -2.6 +/- 0.3 vs. -1.7 +/- 0.3; P = 0.02) (mean +/- sem). Quantitative assessment of depression correlated independently with total body BMD (r = -0.4; P < 0.05) and LS BMD (r = -0.6; P < 0.001).
  
  
  CONCLUSIONS
  Anorexic girls with depression are at higher risk of osteoporosis than those without depression. The mechanisms responsible for decreased BMD in depression are not known. Independent treatment of the depressive disorder in AN may partly alleviate the bone fragility.
authors.affiliation: Department of Pediatrics and Auxology, Medical University of Bialystok, University Children's Hospital Dr. Ludwik Zamenhof, 15-274 Bialystok, Poland. jerzyk@unimelb.edu.au
authors.forename: Jerzy
authors.initials: J
authors.lastname: Konstantynowicz
authors.forename: Halina
authors.initials: H
authors.lastname: Kadziela-Olech
authors.forename: Maciej
authors.initials: M
authors.lastname: Kaczmarski
authors.forename: Roger M D
authors.initials: RM
authors.lastname: Zebaze
authors.forename: Sandra
authors.initials: S
authors.lastname: Iuliano-Burns
authors.forename: Janina
authors.initials: J
authors.lastname: Piotrowska-Jastrzebska
authors.forename: Ego
authors.initials: E
authors.lastname: Seeman
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology*; D015519:Bone Density; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications* / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000378:metabolism; D010024:Osteoporosis / Q000209:etiology* / Q000378:metabolism; D012307:Risk Factors