Low bone mass in premenopausal women with depression.
BACKGROUND
An increased prevalence of low bone mineral density (BMD) has been reported in patients with major depressive disorder (MDD), mostly women.


METHODS
Study recruitment was conducted from July 1, 2001, to February 29, 2003. We report baseline BMD measurements in 89 premenopausal women with MDD and 44 healthy control women enrolled in a prospective study of bone turnover. The BMD was measured by dual-energy x-ray absorptiometry at the spine, hip, and forearm. Mean hourly levels of plasma 24-hour cytokines, 24-hour urinary free cortisol, and catecholamine excretion were measured in a subset of women. We defined MDD according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).


RESULTS
The prevalence of low BMD, defined as a T score of less than -1, was greater in women with MDD vs controls at the femoral neck (17% vs 2%; P = .02) and total hip (15% vs 2%; P = .03) and tended to be greater at the lumbar spine (20% vs 9%; P = .14). The mean +/- SD BMD, expressed as grams per square centimeters, was lower in women with MDD at the femoral neck (0.849 +/- 0.121 vs 0.866 +/- 0.094; P = .05) and at the lumbar spine (1.024 +/- 0.117 vs 1.043 +/- 0.092; P = .05) and tended to be lower at the radius (0.696 +/- 0.049 vs 0.710 +/- 0.055; P = .07). Women with MDD had increased mean levels of 24-hour proinflammatory cytokines and decreased levels of anti-inflammatory cytokines.


CONCLUSIONS
Low BMD is more prevalent in premenopausal women with MDD. The BMD deficits are of clinical significance and comparable in magnitude to those resulting from established risk factors for osteoporosis, such as smoking and reduced calcium intake. The possible contribution of immune or inflammatory imbalance to low BMD in premenopausal women with MDD remains to be clarified.
Department of Medicine, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, Ohio, USA.
Farideh
F
Eskandari
Pedro E
PE
Martinez
Sara
S
Torvik
Terry M
TM
Phillips
Esther M
EM
Sternberg
Sejal
S
Mistry
Donna
D
Ronsaville
Robert
R
Wesley
Caitlin
C
Toomey
Nancy G
NG
Sebring
James C
JC
Reynolds
Marc R
MR
Blackman
Karim A
KA
Calis
Philip W
PW
Gold
Giovanni
G
Cizza
D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density; D001847:Bone Diseases / Q000209:etiology / Q000503:physiopathology; D002395:Catecholamines / Q000652:urine; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D016753:Interleukin-10 / Q000097:blood; D018793:Interleukin-13 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D007376:Interleukin-2 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D017697:Premenopause / Q000097:blood / Q000502:physiology* / Q000652:urine; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D002395:Catecholamines; D018793:Interleukin-13; D053583:Interleukin-1beta; D007376:Interleukin-2; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D006854:Hydrocortisone