title: Bone mineral density, bone turnover, and osteoprotegerin in depressed women with and without borderline personality disorder.
abstract: OBJECTIVE
  Low bone mineral density has repeatedly been reported in patients with major depressive disorder (MDD), and MDD has been discussed as a risk factor for the development of osteoporosis. MDD in young adults often occurs in the context of borderline personality disorder (BPD), and both MDD and BPD have been associated with a dysregulation of the hypothalamic-pituitary-adrenal system and subsequent hypercortisolemia. To date, it is unclear whether comorbid BPD in depressed patients modulates the extent of bone mass reduction. Therefore, we examined bone density, markers of bone turnover, and proinflammatory cytokines in depressed patients with and without BPD. Patients with BPD alone and healthy women served as comparison groups.
  
  
  METHODS
  Twenty-four patients with MDD and 23 patients with comorbid MDD and BPD were included. Sixteen patients with BPD and 20 healthy women of similar body mass index served as the comparison group. BMD was assessed by means of dual-energy x-ray absorptiometry. Markers of bone turnover, endocrine and immune parameters were determined. For data analysis, the group of depressed patients without comorbid BPD was divided according to age into two groups (younger depressed patients with a mean age of 30 years and older patients with a mean age of 42.9 years).
  
  
  RESULTS
  BMD at the lumbar spine was significantly reduced in a) depressed women with comorbid BPD (mean age, 28.6 years) and in b) older depressed patients without BPD (mean age, 42.9 years). Osteocalcin, a marker of osteoblastic activity, and crosslaps, a marker of bone loss, were significantly different between the study groups. Tumor necrosis factor-alpha was increased in depressed patients when compared with healthy women. Furthermore, TNF-alpha was positively correlated with serum crosslaps, a marker for osteoclastic activity.
  
  
  CONCLUSIONS
  Depression is associated with reduced bone mass, in particular in patients with comorbid BPD. Possible factors contributing to BMD reduction include endocrine and immune alterations associated with either MDD or BPD. We conclude from our data that a history of MDD with and without comorbid BPD should be considered as a risk factor in clinical assessment instruments for the identification of persons prone to osteoporosis.
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University of Schleswig-Holstein, Lübeck, Germany. kaig.kahl@psychiatrie.uk-sh.de
authors.forename: Kai G
authors.initials: KG
authors.lastname: Kahl
authors.forename: Wiebke
authors.initials: W
authors.lastname: Greggersen
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rudolf
authors.forename: Beate M
authors.initials: BM
authors.lastname: Stoeckelhuber
authors.forename: Claudia U
authors.initials: CU
authors.lastname: Bergmann-Koester
authors.forename: Leif
authors.initials: L
authors.lastname: Dibbelt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schweiger
mesh_terms: D000328:Adult; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology; D016723:Bone Remodeling; D001883:Borderline Personality Disorder / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism; D004198:Disease Susceptibility; D005260:Female; D006023:Glycoproteins / Q000097:blood*; D006801:Humans; D008159:Lumbar Vertebrae / Q000737:chemistry; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010010:Osteoclasts / Q000378:metabolism; D010024:Osteoporosis / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology; D053244:Osteoprotegerin; D018160:Receptors, Cytoplasmic and Nuclear / Q000097:blood*; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D006023:Glycoproteins; D015675:Osteocalcin; D053244:Osteoprotegerin; D018160:Receptors, Cytoplasmic and Nuclear; D018124:Receptors, Tumor Necrosis Factor; D017367:Selective Serotonin Reuptake Inhibitors; D014409:Tumor Necrosis Factor-alpha; C506030:TNFRSF11B protein, human