title: Depression and low bone mineral density: a meta-analysis of epidemiologic studies.
abstract: CONCLUSIONS
  The association between depression and loss of bone mineral density (BMD) has been reported inconsistently. This meta-analysis, which pooled results from 14 qualifying individual studies, found that depression was associated with a significantly decreased BMD, with a substantially greater BMD decrease in depressed women and in cases of clinical depression.
  
  
  BACKGROUND
  The reported association between depression and loss of BMD has been controversial. This meta-analysis was conducted to determine whether depression and BMD are associated and to identify the variation in some subgroups.
  
  
  METHODS
  English-language articles published before October 2008 were used as the data source. A total of six case-controlled and eight cross-sectional studies met prestated inclusion criteria (N = 10,523). Information on study design, participant characteristics, measurements of BMD and depression, and control for potential confounders was abstracted independently by two investigators using a standardized protocol.
  
  
  RESULTS
  Overall, depression was associated with a significant decrease in mean BMD of spine (-0.053 g/cm(2) [95% confidence interval {CI} -0.087 to -0.018 g/cm(2)]) and hip (-0.052 g/cm(2) [95% CI -0.083 to -0.022 g/cm(2)]). A substantially greater BMD decrease was observed in depressed women (-0.076 g/cm(2) in spine; -0.059 g/cm(2) in hip) and in cases of clinical depression (-0.074 g/cm(2) in spine; -0.080 g/cm(2) in hip).
  
  
  CONCLUSIONS
  Depression is associated with low BMD, with a substantially greater BMD decrease in depressed women and in cases of clinical depression. Depression should be considered as an important risk factor for osteoporosis.
authors.affiliation: Biostatistics, Mayo Clinic, Scottsdale, AZ 85259, USA. wu.qing@mayo.edu
authors.forename: Q
authors.initials: Q
authors.lastname: Wu
authors.forename: J H
authors.initials: JH
authors.lastname: Magnus
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.forename: A F
authors.initials: AF
authors.lastname: Bencaz
authors.forename: J G
authors.initials: JG
authors.lastname: Hentz