Depression and osteoporosis: a research synthesis with meta-analysis.
Major depressive disorder has been associated with low bone mineral density. The strength of this association, however, varies greatly among studies; the direction of the causative link is still controversial, and the etiology remains unclear. We aimed to confirm this association, assess its magnitude and estimate its clinical relevancy. A total of 535 articles were initially identified and the research synthesis was based on 33 qualified articles. Of these, 25 articles (or 76%) showed an inverse relationship between major depression or minor depression or depressive symptoms and bone mineral density or bone turnover. Meta-analysis could be performed on 20 of the initially selected 33 articles. Standardized weighted differences in mean AP spine, total femur and femoral neck bone mineral density, each from at least 10 studies, were computed in g/cm (2) and transformed into percent differences. At each site, bone mass was lower in subjects with depression as compared to controls: AP spine bone mineral density was 4.73% lower (95% CI -7.28% to -2.19%, p<0.0001; n=16 studies), total femur bone mineral density was 3.53% lower (95% CI -5.66% to -1.41%, p<0.001; n=13 studies), and femoral neck bone mineral density was 7.32% lower (95% CI -10.67% to -3.96%; p<0.0005; n=8 studies). In conclusion, major depressive disorder was associated with lower bone mineral density at the AP spine, femoral neck, and total femur. The deficits in bone mineral density in subjects with depression are of clinical significance and likely to increase fracture risk over the lifetime of these subjects.
Cizza
G
G
Clinical Endocrine Section, Clinical Endocrinology Branch, NIDDK, NIH, DHHS, Bethesda, MD, USA. cizzag@intra.niddk.nih.gov <cizzag@intra.niddk.nih.gov>
Primma
S
S
Coyle
M
M
Gourgiotis
L
L
Csako
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003866:Depressive Disorder / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology*; D055815:Young Adult
Eur J Radiol. 2009 Sep;71(3):406-14
19647962
Psychosom Med. 2004 Jul-Aug;66(4):533-7
15272099
J Obstet Gynaecol Can. 2002 Jun;24(6):476-84
12196854
J Geriatr Psychiatry Neurol. 2004 Jun;17(2):88-92
15157349
Bone. 2006 Aug;39(2):385-91
16530030
Osteoporos Int. 2009 Aug;20(8):1309-20
19343469
Menopause. 2005 Jan-Feb;12(1):88-91
15668605
BMJ. 2003 Sep 6;327(7414):557-60
12958120
Soc Psychiatry Psychiatr Epidemiol. 2008 Nov;43(11):898-904
18642124
J Clin Endocrinol Metab. 2009 Jan;94(1):45-9
18984661
Biol Psychiatry. 2009 Sep 1;66(5):423-32
19446797
Am J Psychiatry. 1994 Nov;151(11):1691-3
7943462
Horm Metab Res. 2007 May;39(5):314-21
17533572
Trends Endocrinol Metab. 2009 Jul;20(5):230-6
19546009
Expert Rev Neurother. 2007 Nov;7(11 Suppl):S59-80
18039069
BMJ. 1997 Dec 6;315(7121):1533-7
9432252
Int J Geriatr Psychiatry. 2007 Nov;22(11):1087-94
17407107
J Clin Endocrinol Metab. 2009 Mar;94(3):827-32
19088165
Maturitas. 1999 Oct 24;33(2):133-7
10597877
Arch Pediatr Adolesc Med. 2008 Dec;162(12):1181-8
19047547
Biol Psychiatry. 2005 Aug 1;58(3):175-89
16084838
Am J Psychiatry. 2000 Jan;157(1):118-20
10618024
J Am Geriatr Soc. 2007 Jun;55(6):824-31
17537081
Osteoporos Int. 2005 Jun;16(6):610-5
15448988
J Gerontol A Biol Sci Med Sci. 2006 May;61(5):488-94
16720746
Prog Neuropsychopharmacol Biol Psychiatry. 1998 Feb;22(2):267-77
9608600
Arch Intern Med. 2007 Jun 25;167(12):1240-5
17592096
J Rheumatol. 2007 Jan;34(1):140-4
17216681
Am J Public Health. 2008 Aug;98(8):1480-5
18556604
J Am Geriatr Soc. 1999 Jul;47(7):799-803
10404922
Psychiatry Res. 2003 Mar 25;117(3):271-5
12686369
Eura Medicophys. 2004 Sep;40(3):199-209
16172588
Joint Bone Spine. 2005 Dec;72(6):540-3
16046174
Osteoporos Int. 2006;17(4):565-74
16392027
Arch Intern Med. 1999 Mar 8;159(5):484-90
10074957
J Am Geriatr Soc. 2001 Jun;49(6):732-6
11454111
N Engl J Med. 1996 Oct 17;335(16):1176-81
8815939
J Clin Endocrinol Metab. 2005 Sep;90(9):5382-5
15941868
Menopause. 2006 May-Jun;13(3):340-67; quiz 368-9
16735931
J Epidemiol Community Health. 1999 Jun;53(6):343-7
10396480
Public Health Rep. 2005 Jan-Feb;120(1):71-5
15736334
Osteoporos Int. 2005 Aug;16(8):887-97
15618997
Proc Natl Acad Sci U S A. 2006 Nov 7;103(45):16876-81
17075068
Yonsei Med J. 2002 Feb;43(1):101-8
11854939
Arch Intern Med. 2007 Nov 26;167(21):2329-36
18039992
Arch Gerontol Geriatr. 2005 May-Jun;40(3):307-15
15814164
Psychosom Med. 2006 Sep-Oct;68(5):669-74
17012519
Osteoporos Int. 2007 Mar;18(3):315-22
17053870
Calcif Tissue Int. 2001 May;68(5):259-70
11683532
Turk Psikiyatri Derg. 2005 Summer;16(2):77-82
15981144
Trends Endocrinol Metab. 2001 Jul;12(5):198-203
11397644
Trends Endocrinol Metab. 2009 Oct;20(8):367-73
19747841
Health Qual Life Outcomes. 2005 Dec 01;3:78
16321148
Int J Clin Pract. 2007 Mar;61(3):416-20
17313608
J Affect Disord. 2004 Feb;78(2):131-40
14706723
Control Clin Trials. 1981 May;2(1):31-49
7261638
Bone. 2008 Mar;42(3):582-90
18226593
Horm Metab Res. 2009 Apr;41(4):261-70
19156597
Cochrane Database Syst Rev. 2002;(3):CD000333
12137611
Osteoporos Int. 2005 Apr;16(4):424-9
15300363